JMIR Publications

ABSTRACT

Background:

Blended face-to-face and web-based treatment is a promising way to deliver smoking cessation treatment. Since adherence has been shown to be an indicator for treatment acceptability and a determinant for effectiveness, we explored and compared adherence and predictors of adherence to a blended and a face-to-face smoking cessation treatment, both similar in content and intensity.

Objective:

The objectives of this study were (1) to compare adherence to a blended smoking cessation treatment (BSCT) with adherence to a face-to-face treatment (F2F); (2) to compare adherence within the blended treatment to its F2F-mode and Web-mode; and (3) to determine baseline predictors of adherence to both treatments as well as (4) the predictors to both modes of the blended treatment.

Methods:

We calculated the total duration of treatment exposure for patients (N=292) of a Dutch outpatient smoking cessation clinic, who were randomly assigned either to the blended smoking cessation treatment (BSCT, N=162) or to a face-to-face treatment with identical ingredients (F2F, N=130). For both treatments (BSCT vs. F2F) and for the two modes of delivery within the blended treatment (BSCTs F2F mode vs. BSCTs Web mode), adherence levels (i.e. treatment time) were compared and the predictors of adherence were identified within 33 demographic, smoking-related, and health-related patient characteristics.

Results:

We found no significant difference in adherence between the blended and the face-to-face treatment. BSCT patients spent an average of 246 minutes in treatment (IQR 150-355; 106.7% of intended treatment time); F2F patients spent 238 minutes (IQR 150-330; 103.3%). Within BSCT, adherence to the face-to-face mode was twice as high as to the web-mode. BSCT-patients spent an average of 198 minutes in F2F-mode (SD 120; 152% of the intended treatment time) and 75 minutes in Web-mode (SD 53, 75%). Higher age was the only characteristic consistently found to uniquely predict higher adherence in both BSCT and F2F. For F2F, more social support for smoking cessation was also predictive of higher adherence. The variability in adherence explained by these predictors was rather low (BSCT: R2=.049; F2F: R2=.076). Within BSCT, to be living without children predicted higher adherence to BSCTs F2F-mode (R2=.034), independent of age. Higher adherence to BSCTs Web-mode was predicted by a combination of an extrinsic motivation to quit, a less negative attitude toward quitting and less health complaints (R2=1.64).

Conclusions:

This study has been one of the first attempts to thoroughly compare adherence and predictors of adherence of a blended smoking cessation treatment to an equivalent face-to-face treatment. Interestingly, although the overall adherence to both treatments appeared to be high, adherence within the blended treatment was much higher to the face-to-face mode than the web mode. This supports the idea that in blended treatment one mode of delivery can compensate for the weaknesses of the other. Higher age was found to be a common predictor of adherence to the treatments. The low variance in adherence predicted by the characteristics examined in this study, suggests that other variables, such as provider-related health system factors and time-varying patient characteristics should be explored in future research. Clinical Trial: trialregister.nl NTR5113 http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=5113