JMIR Publications

ABSTRACT

Background:

Most smokers are ambivalent about quitting—they want to quit someday, but not now. Interventions are needed that can engage ambivalent smokers, build their motivation for quitting, and support future quit attempts. mHealth apps offer a cost-effective platform for such interventions, but research is needed to inform their optimal design and to assess their acceptability, feasibility, and potential effectiveness.

Objective:

To assess the feasibility, acceptability, and potential impact of a novel mHealth app for smokers who want to quit smoking someday, but who are ambivalent about quitting in the near term.

Methods:

We enrolled adults across the U.S. who smoked ≥10 cigarettes a day and were ambivalent about quitting (n=60). Participants were randomly assigned to one of two versions of the GEMS© app: standard care (SC) vs. enhanced care (EC). Both had a similar design and identical evidence-based, best-practice smoking cessation advice and resources including the ability to earn free nicotine patches. EC also included a series of exercises, called Experiments, designed to help ambivalent smokers clarify their goals, strengthen their motivation, and learn important behavioral skills for changing smoking behavior without making a commitment to quit. Outcomes were analyzed using automated app data and self-report surveys at one and 3-months post-enrollment.

Results:

Participants who installed the app (n = 57/60; 95%) were largely female, white, socioeconomically disadvantaged and highly nicotine dependent. As expected, key outcomes trended in favor of the EC group. Compared to SC users, EC participants had greater engagement (mean sessions = 19.9 EC vs. 7.3 SC). 39.3% (11/28) of EC users versus 37.9% (11/29) of SC users reported an intentional quit attempt. 14.7% (4/28) of EC users versus 6.9% (2/29) of SC users reported 7-day point prevalence smoking abstinence at 3-month follow-up. Among participants who earned a free trial of nicotine replacement therapy based on their app use, 36.4% (8/22) of EC participants and 11.1% (2/18) of SC participants requested the treatment. 17.9% (5/28) of EC and 3.4% (1/29) of SC participants utilized an in-app feature to access a free tobacco quitline. Other metrics were also promising. EC participants completed an average of 6.9 (SD 3.1) of 9 Experiments. Median helpfulness ratings for completed Experiments ranged from 3 to 4 on a 5-point scale. Finally, satisfaction with both app versions was very good (mean 4.1 on a 5-point Likert scale) and 95.3% of all respondents (41/43) would recommend their app version to others.

Conclusions:

Ambivalent smokers were receptive to app-based intervention, but the EC version, which combined best-practice cessation advice with self-paced, experiential exercises was associated with greater utilization and evidence of behavior change. Further development and evaluation of the EC program is warranted. Clinical Trial: The study is registered with ClinicalTrials.gov (NCT04560868).