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Kruse GR, Joyce A, Yu L, Park ER, Neil J, Chang Y, Rigotti NA. A pilot adaptive trial of text messages, mailed nicotine replacement therapy, and telephone coaching among primary care patients who smoke. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 145:208930. [PMID: 36880910 PMCID: PMC10016234 DOI: 10.1016/j.josat.2022.208930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 07/01/2022] [Accepted: 10/31/2022] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Sequential multiple assignment randomized trials (SMART) inform the design of adaptive treatment interventions. We tested the feasibility of a SMART to deliver a stepped-care intervention among primary care patients who smoked daily. METHODS In a 12-week pilot SMART (NCT04020718), we tested the feasibility of recruiting and retaining (>80 %) participants to an adaptive intervention starting with cessation text messages (SMS). The study randomly assigned participants (R1) to assessment of quit status, the tailoring variable, after either 4 or 8 weeks of SMS. The study offered continued SMS alone to those reporting abstinence. Those reporting smoking were randomized (R2) to SMS + mailed NRT or SMS + NRT + brief telephone coaching. RESULTS During Jan-March and July-Aug 2020, we enrolled 35 patients (>18 years) from a primary care network in Massachusetts. Two (6 %) of 31 participants reported seven-day point prevalence abstinence at their tailoring variable assessment. The 29 participants who continued to smoke at 4 or 8 weeks were randomized (R2) to SMS + NRT (n = 16) or SMS + NRT + coaching (n = 13). Thirty of 35 participants (86 %) completed 12-weeks; 13 % (2/15) of those in 4-week group and 27 % (4/15) of those in 8-week group had CO < 6 ppm at 12-weeks (p = 0.65). Among 29 participants in R2, one was lost to follow-up, 19 % (3/16) of the SMS + NRT group had CO < 6 ppm vs. 17 % (2/12) of SMS + NRT + coaching (p = 1.00). Treatment satisfaction was high (93 %, 28 of 30 who completed 12-weeks). CONCLUSIONS A SMART exploring a stepped-care adaptive intervention combining SMS, NRT, and coaching for primary care patients was feasible. Retention and satisfaction were high and quit rates were promising.
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Affiliation(s)
- G R Kruse
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, United States of America; Tobacco Research and Treatment Center, Massachusetts General Hospital, United States of America; Harvard Medical School, United States of America.
| | - A Joyce
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, United States of America; Tobacco Research and Treatment Center, Massachusetts General Hospital, United States of America
| | - L Yu
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, United States of America
| | - E R Park
- Tobacco Research and Treatment Center, Massachusetts General Hospital, United States of America; Harvard Medical School, United States of America; Department of Psychiatry, Massachusetts General Hospital, United States of America; Health Policy Research Center, Massachusetts General Hospital, United States of America
| | - J Neil
- Tobacco Research and Treatment Center, Massachusetts General Hospital, United States of America; Harvard Medical School, United States of America; Health Policy Research Center, Massachusetts General Hospital, United States of America; Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, United States of America
| | - Y Chang
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, United States of America; Tobacco Research and Treatment Center, Massachusetts General Hospital, United States of America; Harvard Medical School, United States of America
| | - N A Rigotti
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, United States of America; Tobacco Research and Treatment Center, Massachusetts General Hospital, United States of America; Harvard Medical School, United States of America; Health Policy Research Center, Massachusetts General Hospital, United States of America
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Morgan KA, Wong AWK, Walker K, Desai RH, Knepper TM, Newland PK. A Mobile Phone Text Messaging Intervention to Manage Fatigue for People With Multiple Sclerosis, Spinal Cord Injury, and Stroke: Development and Usability Testing. JMIR Form Res 2022; 6:e40166. [PMID: 36542466 DOI: 10.2196/40166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 10/21/2022] [Accepted: 11/05/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Fatigue significantly affects daily functioning in persons with disabilities. Fatigue management can be challenging, and the information provided during routine physician visits to manage fatigue can be overwhelming. One way to address fatigue is to increase knowledge, skills, and confidence for self-management (ie, patient activation). Self-management programs have shown promising effects in targeting fatigue in persons with disabilities. However, satisfaction with self-management programs is low for persons with disabilities, and tailoring interventions to personalized needs has been recommended. SMS text messaging is increasingly being used to implement health behavior change interventions in a person's natural environment. Little has been done to link mobile health approaches with patient activation and self-management to address fatigue in persons with disabilities. OBJECTIVE This study aimed to develop and test a mobile phone-based fatigue self-management SMS text messaging intervention targeting patient activation in 3 groups of persons with disabilities: persons with multiple sclerosis, persons who had a stroke, and persons with a spinal cord injury. METHODS We used evidence-based resources and input from a consumer advisory board (CAB; composed of 2 participants from each of the 3 disability groups) and a neurologist to develop the intervention. The study was conducted using a 4-step process: development of the initial SMS text messaging library and categorization of the content into 9 content areas, review and modification of the SMS text messages by the neurologist and CAB, integration of the content library into a digital platform, and utility testing by CAB members. RESULTS A total of 6 CAB participants rated SMS text messages covering 9 domain areas of fatigue self-management with good clarity (mean ratings=3.5-5.0 out of 5) and relevance (mean ratings=3.2-5.0 out of 5). Overall, SMS text messaging content was reported by CAB participants as helpful, clear, and well suited for a mobile health intervention. The CAB reached consensus on the time of day that SMS text messages should be sent (morning) and their frequency (once per day). This feedback led the research team to narrow down the program to deliver 48 SMS text messages, 1 per day, Monday through Thursday only, a total of 4 SMS text messages per week, over a 12-week period. The final set of SMS text messages was programmed into a digital platform with a predefined delivery schedule. The usability of the intervention was high, with 55 (83%) out of 66 responses endorsing the highest rating. CONCLUSIONS This study demonstrates a step-by-step process for developing a fatigue self-management SMS text messaging intervention for persons with disabilities. For this population, whose access to health services is often limited, this intervention provides an alternative delivery model to increase access to fatigue information and deliver content that aligns with the person's needs.
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Affiliation(s)
- Kerri A Morgan
- Program in Occupational Therapy, St. Louis School of Medicine, Washington University, St. Louis, MO, United States
| | - Alex W K Wong
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, United States.,Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States.,Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Kim Walker
- Program in Occupational Therapy, St. Louis School of Medicine, Washington University, St. Louis, MO, United States
| | - Rachel Heeb Desai
- Program in Occupational Therapy, St. Louis School of Medicine, Washington University, St. Louis, MO, United States
| | - Tina M Knepper
- Program in Occupational Therapy, St. Louis School of Medicine, Washington University, St. Louis, MO, United States
| | - Pamela K Newland
- Goldfarb School of Nursing, Barnes Jewish College, St. Louis, MO, United States
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Risling T, Carlberg C, Kassam I, Moss T, Janssen P, Iduye S, Strudwick G. Supporting population mental health and wellness during the COVID-19 pandemic in Canada: protocol for a sequential mixed-method study. BMJ Open 2021; 11:e052259. [PMID: 34794993 PMCID: PMC8602926 DOI: 10.1136/bmjopen-2021-052259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION The global COVID-19 pandemic has reported to have a negative impact on the mental health and well-being of individuals around the world. Mental health system infrastructure, primarily developed to support individuals through in-person care, struggled to meet rising demand for services even prior to COVID-19. With public health guidelines requiring the use of physical distancing during the pandemic, digital mental health supports may be one way to address the needs of the population. Despite this, barriers exist in promoting and supporting access to existing and emerging digital resources. Text messaging may address some of these barriers, extending the potential reach of these digital interventions across divides that may separate some vulnerable or disadvantaged groups from essential mental health supports. Building on an existing knowledge synthesis project identifying key digital resources for improved mental health, this research will establish low-tech connections to assess need and better match access to services for those who need it most. The aim of this study is to codesign a customised two-way texting service to explore need and better align access to mental health supports for Canadians located in Saskatchewan during the COVID-19 pandemic. METHODS AND ANALYSIS This study will be completed in Saskatchewan, Canada. For this project, the RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework will be used to support three phases of a sequential mixed-method study. An advisory committee of Saskatchewan residents will guide this work with the study team. A 10-week service will be launched to connect individuals with appropriately suited digital mental health interventions through the use of text messaging. In phase 1, implementation and prototyping will be conducted with collaborative codesign for key elements related to features of an enrolment survey and initial messaging content. Phase 2 will focus on advancing the effectiveness of the service using quantitative user data. In phase 3, an embedding approach will be used to integrate both qualitative and quantitative data collected to understand the overall acceptability, satisfaction and perceived benefit of the text messaging service. Thematic analysis and descriptive statistics will be used as analytic methods. ETHICS AND DISSEMINATION This study has received approval from the Research Ethics Board at the University of Saskatchewan. A knowledge dissemination plan has been developed that includes traditional academic approaches such as conference presentations, and academic publications, as well as mainstream approaches such as social media, radio and dissemination through the advisory committee.
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Affiliation(s)
- Tracie Risling
- College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Courtney Carlberg
- College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Iman Kassam
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Tyler Moss
- College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Patricia Janssen
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Steve Iduye
- College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Gillian Strudwick
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Joyce AA, Styklunas GM, Rigotti NA, Neil JM, Park ER, Kruse GR. Quit Experiences among Primary Care Patients Enrolled in a Smoking Cessation Pilot RCT Early in the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:1011. [PMID: 33498834 PMCID: PMC7908271 DOI: 10.3390/ijerph18031011] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 01/20/2021] [Accepted: 01/21/2021] [Indexed: 12/18/2022]
Abstract
The impact of the COVID-19 pandemic on US adults' smoking and quitting behaviors is unclear. We explored the impact of COVID-19 on smoking behaviors, risk perceptions, and reactions to text messages during a statewide stay-at-home advisory among primary care patients who were trying to quit. From May-June 2020, we interviewed smokers enrolled in a 12-week, pilot cessation trial providing text messaging and mailed nicotine replacement medication (NCT04020718). Twenty-two individuals (82% white, mean age 55 years), representing 88% of trial participants during the stay-at-home advisory, completed exit interviews; four (18%) of them reported abstinence. Interviews were thematically analyzed by two coders. COVID-19-induced environmental changes had mixed effects, facilitating quitting for some and impeding quitting for others. While stress increased for many, those who quit found ways to cope with stress. Generally, participants felt at risk for COVID-19 complications but not at increased risk of becoming infected. Reactions to COVID-19 and quitting behaviors differed across age groups, older participants reported difficulties coping with isolation (e.g., feeling disappointed when a text message came from the study and not a live person). Findings suggest that cessation interventions addressing stress and boredom are needed during COVID-19, while smokers experiencing isolation may benefit from live-person supports.
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Affiliation(s)
- Andrea A. Joyce
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA 02114, USA; (G.M.S.); (N.A.R.)
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA 02114, USA; (J.M.N.); (E.R.P.)
| | - Grace M. Styklunas
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA 02114, USA; (G.M.S.); (N.A.R.)
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA 02114, USA; (J.M.N.); (E.R.P.)
- Department of Public Health and Professional Degrees, Tufts University School of Medicine, Boston, MA 02111, USA
| | - Nancy A. Rigotti
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA 02114, USA; (G.M.S.); (N.A.R.)
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA 02114, USA; (J.M.N.); (E.R.P.)
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
- Health Policy Research Center, Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Jordan M. Neil
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA 02114, USA; (J.M.N.); (E.R.P.)
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
- Health Policy Research Center, Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Elyse R. Park
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA 02114, USA; (J.M.N.); (E.R.P.)
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
- Health Policy Research Center, Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Gina R. Kruse
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA 02114, USA; (G.M.S.); (N.A.R.)
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA 02114, USA; (J.M.N.); (E.R.P.)
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
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Kruse GR, Park ER, Chang Y, Haberer JE, Abroms LC, Shahid NN, Howard S, Haas JS, Rigotti NA. Proactively Offered Text Messages and Mailed Nicotine Replacement Therapy for Smokers in Primary Care Practices: A Pilot Randomized Trial. Nicotine Tob Res 2020; 22:1509-1514. [PMID: 32198520 PMCID: PMC7443591 DOI: 10.1093/ntr/ntaa050] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 03/17/2020] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Proactive, population health cessation programs can guide efforts to reach smokers outside of the clinic to encourage quit attempts and treatment use. AIMS AND METHODS This study aimed to measure trial feasibility and preliminary effects of a proactive intervention offering text messages (TM) and/or mailed nicotine replacement therapy (NRT) to smokers in primary care clinics. From 2017 to 2019 we performed a pilot randomized trial comparing brief telephone advice (control: BA), TM, 2 weeks of mailed NRT, or both interventions (TM + NRT). Patients were identified using electronic health records and contacted proactively by telephone to assess interest in the study. We compared quit attempts, treatment use, and cessation in the intervention arms with BA. RESULTS Of 986 patients contacted, 153 (16%) enrolled (mean age 53 years, 57% female, 76% white, 11% black, 8% Hispanic, 52% insured by Medicaid) and 144 (94%) completed the 12-week assessment. On average, patients in the TM arms received 159 messages (99.4% sent, 0.6% failed), sent 19 messages, and stayed in the program for 61 days. In all groups, a majority of patients reported quit attempts (BA 67% vs. TM 86% [p = .07], NRT 81% [p = .18], TM + NRT 79% [p = .21]) and NRT use (BA 51% vs. NRT 83% [p = .007], TM 65% [p = .25], TM + NRT 76% [p = .03]). Effect estimates for reported 7-day abstinence were BA 10% versus TM 26% (p = .09), NRT 28% (p = .06), and TM + NRT 23% (p = .14). CONCLUSIONS Proactively offering TM or mailed nicotine medications was feasible among primary care smokers and a promising approach to promote quit attempts and short-term abstinence. IMPLICATIONS Proactive intervention programs to promote quit attempts outside of office visits among smokers enrolled in primary care practices are needed. TM have potential to engage smokers not planning to quit or to support smokers to make a planned quit attempt. This pilot study demonstrates the feasibility of testing a proactive treatment model including TM and/or mailed NRT to promote quit attempts, treatment use, and cessation among nontreatment-seeking smokers in primary care. CLINICALTRIALS.GOV IDENTIFIER NCT03174158.
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Affiliation(s)
- Gina R Kruse
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA
- Tobacco Research and Treatment Center, Department of Medicine, Massachusetts General Hospital, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Elyse R Park
- Tobacco Research and Treatment Center, Department of Medicine, Massachusetts General Hospital, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Yuchiao Chang
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Jessica E Haberer
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
- Center for Global Health, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Lorien C Abroms
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC
| | - Naysha N Shahid
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Sydney Howard
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Jennifer S Haas
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Nancy A Rigotti
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA
- Tobacco Research and Treatment Center, Department of Medicine, Massachusetts General Hospital, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
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Kruse GR, Park E, Haberer JE, Abroms L, Shahid NN, Howard SE, Chang Y, Haas JS, Rigotti NA. Proactive text messaging (GetReady2Quit) and nicotine replacement therapy to promote smoking cessation among smokers in primary care: A pilot randomized trial protocol. Contemp Clin Trials 2019; 80:48-54. [PMID: 30923022 DOI: 10.1016/j.cct.2019.03.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 03/12/2019] [Accepted: 03/14/2019] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Most smokers see a physician each year, but few use any assistance when they try to quit. Text messaging programs improve smoking cessation in community and school settings; however, their efficacy in a primary care setting is unclear. The current trial assesses the feasibility and preliminary clinical outcomes of text messaging and mailed nicotine replacement therapy (NRT) among smokers in primary care. METHODS In this single-center pilot randomized trial, eligible smokers in primary care are offered brief advice by phone and randomly assigned to one of four interventions: (1) Brief advice only, (2) text messages targeted to primary care patients and tailored to quit readiness, (3) a 2-week supply of nicotine patches and/or lozenges (NRT), and (4) both text messaging and NRT. Randomization is stratified by practice and intention to quit. The text messages (up to 5/day) encourage those not ready to quit to practice a quit attempt, assist those with a quit date through a quit attempt, and promote NRT use. The 2-week supply of NRT is mailed to patients' homes. RESULTS Feasibility outcomes include recruitment rates, study retention, and treatment adherence. Clinical outcomes are assessed at 1, 2, 6, and 12-weeks post-enrollment. The primary outcome is ≥1self-reported quit attempt(s). Secondary clinical outcomes include self-reported past 7- and 30-day abstinence, days not smoked, NRT adherence, and exhaled carbon monoxide. CONCLUSIONS This pilot assesses text messaging plus NRT, as a proactively offered intervention for smoking cessation support in smokers receiving primary care and will inform full-scale randomized trial planning. TRIAL REGISTRATION ClinicalTrials.govNCT03174158.
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Affiliation(s)
- G R Kruse
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA; Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA.
| | - E Park
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA; Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - J E Haberer
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA; Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - L Abroms
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - N N Shahid
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - S E Howard
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Y Chang
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - J S Haas
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
| | - N A Rigotti
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA; Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
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