JMIR Publications

ABSTRACT

Background:

Smoking remains a highly significant preventable global public health problem. In this context, digital interventions offer great advantages in terms of a lack of biological side effects, possibility of automatic delivery and consequent human resource savings relative to traditional interventions. Such interventions have been studied in randomized controlled trials (RCT) but this area has not been systematically reviewed with inclusion of text-based and multi-platform-based interventions. In addition, this area has not been evaluated from the perspective of the psychological theoretical basis of intervention.

Objective:

This systemic review plus meta-analysis aimed to assess the efficiency of digital interventions in RCT studies and to evaluate the association between intervention effectiveness and the theoretical basis.

Methods:

An electronic search of RCTs was conducted by using PubMed, Embase and the Cochrane Library by June 30, 2021. Eligible studies had to compare automated digital intervention (ADI) to use of a self-help guideline or no intervention. Participants were current smokers (aged 16 years or older). As the main outcome, abstinence after final follow-up was extracted from studies. Meta-regressions were conducted to assess the relationship between intervention theory and effectiveness.

Results:

Sixteen trials (14,857 participants) were included in the analysis. The overall abstinence rate (95% CI) at the final follow-up was 16.4% (15.5, 17.2). The overall risk ratio of the intervention group compared to the controls at the final follow-up was 1.51 (1.24 to 1.84). I2 was 79%. Cochrane ROB2 suggested that most of the studies had a low risk of bias (56.3%). Psychological theory-related constructs or predictors, which refer to other theory-based concepts (rather than only behavioral theory) such as craving or anxiety, are associated with effectiveness.

Conclusions:

This study found that ADI had a clear effect compared to self-help guidelines or to no intervention, and effectiveness was associated with theory-related constructs or predictors. ADIs should be promoted by policy makers and clinical practitioners to address the huge gap between the need for smoking cessation and availability of traditional treatment resources. Possible increases in ADI efficiency may be achieved by optimally integrating psychotherapeutic theories and techniques. Clinical Trial: PROSPERO registration CRD42021256593