JMIR Publications

ABSTRACT

Background:

Numerous mHealth applications have been developed to support smokers attempting to quit. Although successful, only modest improvements in the quit rate have been measured. It has been proposed that efforts to improve user engagement and retention may improve the quit rate further. Due to the high cost of smoking related disease, it is considered worthwhile to pursue even small improvements.

Objective:

To test a novel smartphone application which leverages premium currency strategies developed by the mobile games industry in an attempt to improve engagement and retention with a smoking cessation intervention.

Methods:

We designed and developed a smoking cessation app “Quittr” in line with previously developed smoking cessation mHealth applications. In addition to this established framework, we added a stand-alone fully featured city-building clicker-style game called “Tappy Town”, and a premium virtual currency called “QuitCoins”. The user earned QuitCoins for using the app in a way that contributed positively towards their quit attempt, and could redeem these coins in Tappy Town for bonuses. To establish whether these features improved engagement and retention, we ran a 5-month randomized controlled trial where the intervention group had the full app with the extra games features, while the control group had the standard app only. Recruitment was performed via online advertising. Participants had no direct contact with researchers or other support staff.

Results:

No significant differences in terms of engagement, retention, or smoking outcomes were detected between the control and intervention groups. However, survey data indicated that the majority of participants valued Tappy Town (58.8%) and the QuitCoin rewards system (76.5%). Usage data also suggested that Tappy Town was widely played, and was generally appealing to users (mean total time spent in app: 797s control vs. 3502s intervention, p<0.001). Analysis of the body of results suggests that users in the intervention group may have been negatively impacted by aspects of the chosen design, and some theories were explored to explain this unexpected outcome.

Conclusions:

Although the novel features failed to improve the key outcomes measured in this study, there were enough positive indications to warrant further exploration of the concept. Additional research will be required to identify and correct any design flaws which may have adversely impacted our participants, before a follow-up study can be completed. Clinical Trial: The protocol was registered with the Australian and New Zealand Clinical Trials Register [ACTRN12617000491369] and ethics approval was granted by the Tasmanian Health and Medical Human Research Ethics Committee [H0016506].