JMIR Publications

ABSTRACT

Background:

The growing number of internet users presents an opportunity to deliver health interventions to large populations. Despite their potential, many web-based interventions, including those for smoking cessation, face high rates of attrition. Further consideration of how intervention features impact attrition is needed.

Objective:

The objective of this systematic review is to identify whether tailored web-based smoking cessation interventions for smokers is associated with reduced attrition when compared to active or passive untailored web-based interventions. The outcomes of interest were loss to follow-up attrition at 1-, 3-, 6- and 12-months follow-up.

Methods:

Literature searches were conducted in May 2018 on MEDLINE, PsycINFO, CINAHL, PubMed and the Cochrane Tobacco Addiction Group Specialized Register with the following search terms: smoking cessation, tailored, web or internet-based. Included studies were published in English before or in 2018 using a randomized control trial (RCT) design. Studies were restricted to those with web-based delivery, a tailored intervention group, an untailored control group and a reported outcome of smoking cessation. Studies were assessed for methodological quality using the Cochrane Risk of Bias tool. Two reviewers independently extracted study characteristics and the number of participants lost to follow-up for each treatment group.

Results:

14 studies were included in the systematic review, 12 of which were included in the meta-analysis. Tailoring had no statistically significant effect on loss to follow-up attrition at 1-month (RR= 1.02, 95% CI 0.95–1.09, P=.58), 3-months (RR=0.99, 95% CI 0.95-1.04, P=.80), 6-months (RR=1.00, 95% CI 0.95-1.05, P=.92) or 12-months (RR=0.97, 95% CI 0.92-1.02, P=.26) follow-up. Subgroup analyses suggested that there is a statistically significant effect of tailoring between the active and passive subgroups at 1-month (P=.03), 3-months (P<.001), 6-months (P=.02) follow-up, but not at 12-months follow-up (P=.25).

Conclusions:

Results suggest that tailoring of web-based smoking cessation interventions may not be associated with reduced loss to follow-up attrition at 1-,3-,6- or 12-months; however, the role of tailoring may be more prominent for studies including a passive control group. These findings may be due to variability in the presence of additional features, the definition of smokers used, and duration of smoking abstinence measured. Future systematic reviews should seek to compare studies with similar operational definitions of smokers and smoking abstinence to facilitate more meaningful comparisons.