Accepted for/Published in: JMIR Formative Research
Date Submitted: Nov 21, 2022
Date Accepted: Feb 5, 2023
Avatar-led Digital Smoking Cessation Program for Socioeconomically Disadvantaged Veterans: A Pilot Randomized Controlled Trial
ABSTRACT
Background:
Socioeconomically disadvantaged Veterans receiving care through the Veterans Health Administration have a high prevalence of smoking, and there is a great need for accessible, effective smoking cessation interventions for Veterans at all levels of readiness to quit.
Objective:
To address these needs, we developed Vet Flexiquit, a web-based Acceptance and Commitment Therapy (ACT) program for Veterans, and evaluated its acceptability (primary aim), efficacy, and impact on theory-based change processes relative to the National Cancer Institute’s SmokefreeVET program in a pilot randomized controlled trial.
Methods:
Participants (n=49) were randomized 1:1 to receive either Vet Flexiquit (n=25) or SmokefreeVET (n=24). Both groups received text messages as part of the intervention for 6 weeks. Primary outcome data were collected at 3 months post-randomization. Self-reported smoking abstinence was biochemically verified via saliva cotinine. Multivariable logistic, negative binomial, and linear regression models were used to evaluate the association between treatment arm and outcomes of interest.
Results:
Acceptability as measured by overall treatment satisfaction was high and similar across arms: 100% (17/17) for Vet Flexiquit and 95% (18/19) for SmokefreeVET,. Acceptability as measured by utilization was more modest (Mlog-ins=3.7 for Vet Flexiquit, M=3.2 for SmokefreeVET). There were no statistically significant differences between arms on any acceptability measure. Likewise, there were no statistically significant differences between arms on the secondary outcomes of smoking cessation or change in ACT theory-based processes. On open-ended survey responses, some Veterans expressed interest in having support from a professional or peer to enhance their experience as well as an expanded text messaging program.
Conclusions:
Both programs had high ratings of acceptability, limited utilization, and similar impact on cessation and cessation processes. Taken together with the qualitative data suggesting that additional support may enhance participants’ experience of both programs, these preliminary findings suggest that either program may be beneficial to Veterans who are looking for a digital cessation treatment option and that integrating provider or peer support and enhancing the text messaging program may boost engagement and outcomes. Clinical Trial: Clinicaltrials.gov NCT04502524; https://clinicaltrials.gov/ct2/show/NCT04502524
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