Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: Aug 11, 2021
Open Peer Review Period: Aug 11, 2021 - Aug 20, 2021
Date Accepted: Oct 12, 2021
(closed for review but you can still tweet)
Mechanisms of Smartphone Applications for Cigarette Smoking Cessation: Results of a Serial Mediation Model from the iCanQuit Randomized Trial
ABSTRACT
Background:
Engagement with digital interventions is a well-known predictor of treatment outcome but this knowledge has had limited actionable value. Instead, learning why engagement with digital interventions impact treatment outcome can lead to targeted improvements in their efficacy.
Objective:
To test a serial mediation model of an Acceptance & Commitment Therapy (ACT) smartphone intervention for smoking cessation.
Methods:
In this randomized controlled trial (N=2,415), participants from 50 US States were assigned to the ACT-based smartphone intervention (iCanQuit) or comparison smartphone intervention (QuitGuide). Their engagement with the applications (primary measure: number of logins) was measured during the first three months, ACT processes were measured at baseline and three months (acceptance of internal cues to smoke, valued living), and smoking cessation was measured at 12-months with 87% follow-up retention.
Results:
There was a significant serial mediation effect of iCanQuit on smoking cessation through multiple indicators of intervention engagement (i.e., total number of logins, total number of minutes used, and total number of unique days of use) and in turn through baseline to three months changes in mean acceptance of internal cues to smoke. Analyses of the acceptance subscales showed that the mediation was through acceptance of physical sensations and emotions, but not acceptance of thoughts. There was no evidence that the effect of the iCanQuit intervention was mediated by changes in valued living.
Conclusions:
In this first study of mediators underlying the efficacy of smartphone applications for smoking cessation, results suggest the effect of the iCanQuit ACT-based smartphone application on smoking cessation was mediated through multiple indicators of engagement and in turn through increases in acceptance of physical sensations and emotions. Clinical Trial: Trial Registration: Clinical Trials.gov, registration identification number NCT02724462, https://clinicaltrials.gov/ct2/show/NCT02724462
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