JMIR Publications

ABSTRACT

Background:

In the United States (U.S.), Hispanic adults who smoke face disparities in receiving advice to quit and accessing evidence-based, culturally and linguistically relevant smoking cessation treatment. These disparities reflect inequitable access to support rather than a lower capacity to quit successfully.

Objective:

This study aimed to evaluate the cultural relevance and acceptability of a culturally and linguistically adapted version of iCanQuit, an evidence-based smartphone app that uses Acceptance and Commitment Therapy (ACT) to support smoking cessation, for Hispanic adults.

Methods:

A community-engaged, user-experience (UX) testing multistep adaptation approach was used. Step 1 involved selecting theory-based frameworks to guide the process; identifying relevant smoking cessation themes among Hispanic individuals through a scientific literature review; and collaborating with a Community Advisory Board (CAB) composed of Hispanic individuals of diverse age groups, gender, occupations, and Hispanic national-origin groups. Step 2 entailed developing an app prototype. Step 3 evaluated the cultural relevance and acceptability of the app through UX testing across six consecutive days of app usage followed by one-on-one interviews conducted remotely. English- and Spanish-speaking Hispanic adults who wanted to quit smoking were recruited nationwide via social media. Recommendations for improvement were identified using inductive qualitative content analysis.

Results:

Prototype development included redesigning imagery; emphasizing culturally salient values such as family unity, warm and trusting relationships, and resilience; expanding avatar testimonials reflecting relevant stress-related barriers to cessation; and creating interactive, avatar-led smoke-free challenges to help users build confidence toward longer periods without smoking. Through a consensus-based process, CAB members selected the name DecideACT, emphasizing bilingual appeal and alignment with ACT principles. They also co-created the app's guide avatar, Sofia, shaping her into a culturally relevant, trustworthy, and relatable source of support. UX testing included eighteen Hispanic adults aged 24 to 59 years (55.6% women) who reported smoking 1-20 cigarettes daily, on avarage. Reported Hispanic identities included Chile, Colombia, Cuba, Mexico, Peru, Puerto Rico, Spain, and Venezuela. Six participants completed UX testing in Spanish. All 18 participants reported positive experiences. Across days, 28% of ratings were excellent, 35% very good, 35% good, and 2% fair. Participants generally perceived the app as culturally relevant, with 70% of ratings as extremely (35%) or moderately (35%) relevant, and 29% as somewhat relevant. Participants found Sofia relatable and likable (15/18) and responded positively to avatars and their stories (15/18). Key recommendations included expanding avatar narratives, increasing reminders visibility, making push notifications more engaging, and improving navigation support. This feedback was integrated into subsequent revisions of the final DecideACT app.

Conclusions:

DecideACT is an ACT-based, bilingual, smoking cessation app culturally adapted for Hispanic adults. Findings support its relevance and acceptability and provide a foundation for subsequent evaluation of feasibility and cessation outcomes. Clinical Trial: ClinicalTrials.gov Identifier, NCT06811038; https://clinicaltrials.gov/study/NCT06811038