JMIR Publications

ABSTRACT

Background:

Older adults are a high priority population for tobacco cessation. Yet, this age group commonly experiences barriers (e.g., mobility impairments, lack of transportation) to in-person evidence-based cessation treatment. App-delivered cessation programs are publicly available and an accessible modality in which to widely deliver evidence-based treatment to this population. Despite promise, there has been limited research on the acceptability and efficacy of these cessation treatments within older adult populations.

Objective:

To (1) examine treatment acceptability and (2) identify treatment facilitators and barriers to a publicly available app-delivered cessation program among adults 60+ years who smoke cigarettes.

Methods:

U.S. adults 60+ years who reported past-month cigarette use and owned a smartphone were recruited via social media. At baseline, participants reported sociodemographic characteristics, cigarette smoking patterns, quitting interest/self-efficacy, and digital literacy. Personnel instructed participants how to download a National Cancer Institute freely available cessation app, with no usage guidelines imposed. At a one-month follow-up, participants completed semi-structured interviews regarding treatment acceptability. Using a deductive-inductive thematic analysis approach, themes were identified and meaningfully organized by the Technology Acceptance Model. Subsequently, qualitative and quantitative data were integrated using the Pillar Integration Technique to create “pillars” converging mixed data.

Results:

Participants (N=30; age range 60-83 years) were mostly (73%) women and diverse by race, education, and income. On average, this sample was highly motivated to quit (M=8.7/10), had moderate quitting self-efficacy (M=5.4), and reported high digital proficiency (M=4.7; possible range 1-5). Participants smoked an average of 13 cigarettes per day, with the majority having moderate or high nicotine dependence. At follow-up, 67% said they would use the app in the future and almost half (46%) reported daily usage. Thematic analysis identified 10 themes overall and 5 pillars converged 2 quantitative categories with 8 qualitative themes. Individuals with low to moderate dependence described the app as useful (e.g., distraction from cravings, educational); whereas those with high dependence did not. Individuals with moderate quitting interest also described the app as useful and valued its self-guided delivery format. Those highly interested in quitting wanted more instructions for optimizing treatment. Participants with moderate to high interest in quitting described the app as easy to use and motivating; whereas those with low motivation did not.

Conclusions:

A publicly available app-delivered program was an acceptable cessation treatment among adults 60+ years. Acceptability was highest among individuals with moderate interest in quitting and low to moderate nicotine dependence. App-delivered treatments might be optimal for adults 60+ years who are contemplating cessation but not yet ready to engage with more intensive treatment, providing an accessible opportunity to explore quitting at one’s own pace. Studies should identify app components that may enhance acceptability among individuals with low motivation to quit and high nicotine dependence.