JMIR Publications

ABSTRACT

Background:

Web-assisted tobacco interventions can provide counseling online. We evaluated whether tobacco treatment specialists (TTS) can deliver motivational counseling to smokers through asynchronous messaging.

Objective:

To conduct a secondary analysis of secure asynchronous communications between trained TTS and a cohort of smokers during a six-month period.

Methods:

Smokers were able to select their preferred TTS and message them using a secure online form. To evaluate whether the TTS used evidence-based practices, we coded messages using the Motivational Interviewing Self-evaluation Checklist and Smoking Cessation Counseling (SCC) Scale. We assessed the content of messages initiated by the smokers by creating Topical Content codes. At six months, we assessed association between smoking cessation and amount of TTS use and created a multivariable model adjusting for demographic characteristics and smoking characteristics at baseline.

Results:

Out of the 725 smokers offered asynchronous counseling support, 34% (n= 245) messaged the TTS at least once. A total of 1,082 messages (TTS: 565; smokers 517) were exchanged between the smokers and TTS. The majority of motivational interviewing codes were those that supported client strengths (54%) and promoted engagement (54%). SCC code analysis showed that the TTS provided assistance to smokers if they were willing to quit (48%), and helped smokers prepare to quit (40%) and to anticipate barriers (38%). The majority of smoker’s messages discussed motivations to quit (41%), and current and past treatments (talking about their prior use of Nicotine Replacement Therapy and medications) (36%). The majority of TTS messages used behavioral strategies (45%), offered advice on treatments, (37%) and highlighted motivations to quit (33%). There was no association between amount of TTS use and cessation. In the multivariable model with six months cessation as the outcome, compared with smokers who did not message the TTS, smokers messaging the TTS one or two times had a smoking cessation odds ratio of 0.7 (95% CI 0.4, 1.3), and those that messaged the TTS more than 2 times had a smoking cessation odds ratio of 1.0 (95% CI 0.4, 2.2).

Conclusions:

The TTS were able to use evidence-based counseling strategies (i.e., motivational interviewing and SCC) in their messages to smokers. Future trials are needed to test the effectiveness of these communications. Clinical Trial: Web-delivered Provider Intervention for Tobacco Control (QUIT-PRIMO) - a randomized controlled trial: NCT00797628.