JMIR Publications

ABSTRACT

Background:

The integration of Behavioral Activation Treatment for Depression (BAT-D) into smoking cessation interventions is a promising approach to address depression as a barrier to quitting. However, this approach has only been tested as a face-to-face intervention, which has low reach.

Objective:

The aims of the study were to develop a BAT-D mHealth app with high potential reach and determine its feasibility, acceptability, and preliminary effects on theory-based behavioral processes of behavioral activation and reduced depressive symptoms as well as smoking cessation.

Methods:

Following a user-centered design process consisting of competitive analysis, focus groups, and prototype testing, we conducted a single-arm pilot trial of Actify!—the BAT-D app for depressed smokers. Participants used SmokefreeTXT along with Actify to provide cessation content that had not yet been built into the app for this initial phase of pilot testing. Participants in the trial (n=17) were current, daily smokers with mild to moderate depressive symptoms. We examined process and cessation outcomes at 6 weeks post-enrollment for study completers (n=16; 94% retention).

Results:

Regarding acceptability, average number of logins per participant was 20 (SD=16), and 63% reported being satisfied overall with the app. Post-treatment interviews identified some usability challenges—e.g., high perceived burden of planning and scheduling values-based activities. There was a significant decrease in depressive symptoms from baseline to follow-up (mean change in PHQ-9 scores= -4.5, 95% CI: -7.7, -1.3; p=.01). Additionally, CO-confirmed, 7-day point prevalence abstinence (PPA) at 6-week follow-up was 31% (5/16), and the 30-day PPA was 19% (3/16).

Conclusions:

Results demonstrate strong engagement with Actify! and promising impact on theory-based change processes and cessation outcomes. Preliminary quit rates for this high-risk population of smokers compare favorably to both previous trials of smoking cessation apps for the general population (i.e., short-term, self-reported 30-day quit rates in the 8-18% range) as well as a previous trial of face-to-face BAT-D for depressed smokers (i.e., CO-confirmed, 7-day PPA rate of 17% at end of treatment).