Accepted for/Published in: JMIR Formative Research
Date Submitted: May 6, 2021
Date Accepted: Jul 6, 2021
Avatar-led Digital Program for Sexual and Gender Minority Young Adult Smoking Cessation: Intervention Development and Results of a Single-Arm Pilot Trial
ABSTRACT
Background:
Sexual and gender minority (SGM) young adults have a high prevalence of smoking and unique barriers to accessing tobacco treatment.
Objective:
To address these challenges as well as their preferences for SGM-targeted interventions and digital programs, we developed the Acceptance and Commitment Therapy (ACT)-based digital program called Empowered, Queer, Quitting, and Living (EQQUAL) via user-centered design methods and evaluated its acceptability, preliminary efficacy, and impact on theory-based change processes in a single-arm trial.
Methods:
Trial participants (n=22) were young adults, age 18-30, who identified as SGM and smoked at least one cigarette per day. All participants received access to the ACT-based EQQUAL program, a 6-session, avatar-led, mobile-optimized web-based program, with accompanying text messages for 6 weeks. Participants completed web-based surveys at baseline and at 2-month follow-up. Self-reported smoking abstinence was biochemically verified.
Results:
On the acceptability outcome of program usage, among those with at least one log-in (n=18), average number of log-ins was 5.5 (SD=3.6), average number of sessions completed was 3.1 (SD=2.6), and 39% (7/18) completed all 6 sessions. Overall, 93% of participants were satisfied with the EQQUAL program, 100% found it easy to use, and 100% said it helped them be clearer about how to quit. There was a 22.7% rate of biochemically-confirmed abstinence (where missing data was coded as smoking/using tobacco). Both quantitative and qualitative results suggested a positive overall response to the avatar guide, with areas for future improvement largely centered on the avatar’s appearance and movements.
Conclusions:
Treatment acceptability of EQQUAL was very promising. Biochemically-confirmed abstinence rates were 3 times higher than the only other digital program targeted for SGM young adults and 6 to 13 times higher than non-targeted digital smoking interventions among SGM young adults. Planned improvements for the next iteration of the program include making the avatar’s movements more natural, offering multiple avatar guides to choose from that differ on characteristics like race/ethnicity and gender identity, and providing a support forum for users to connect anonymously with peers. Clinical Trial: NCT#04194918
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