Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Apr 13, 2023
Date Accepted: Sep 18, 2023
The effect of interactivity, tailoring and the utilization intensity on the effectiveness of an internet-based smoking cessation intervention over a 12-month period: A Randomized Controlled Trial
ABSTRACT
Background:
eHealth approaches show promising results for smoking cessation (SC). They can improve quit rates, but rigorous research is sparse regarding their effectivity, the effects of interactivity and tailoring of these programs, as well as the effect of the users´ utilization intensity.
Objective:
We examined the effectiveness of the Techniker Krankenkasse Smoking Cessation Coaching (TK-SCC), an internet-based, tailored and interactive SC intervention. Our hypotheses were: H1: in the intervention group (IG = access to TK-SCC), a clinically relevant number of participants is abstinent 12 months after end of program (T3). H2: the number of abstinent participants is significantly greater in the IG compared to the control group (CG) at T3. H3: in the IG, a more intense utilization of the TK-SCC is positively associated with abstinence.
Methods:
Smokers were randomized into the IG (n = 563) or CG (n = 552) comprising a non-interactive, non-tailored, information-only web-based intervention. Data were collected before the intervention, directly following it (T1), 6 months (T2), and 12 months after end of program (T3). We tested the H1 by comparing the percentages of subjects who became smoke-free with data from similar trials. For H2, we conducted binary logistic regressions with potential confounders included into the models. For H3, we assigned the IG´s participants to one of four user types and employed binary logistic regressions with user types as independent variable and smoking abstinence as dependent variable.
Results:
In the IG, 12% of the participants were smoke-free at the measurement points T1 and T3. These values were higher than average effects reported in a current meta-analysis. In the CG, 6% of the participants were smoke-free at T1, which increased up to 8% by T3. The difference between IG and CG was statistically significant only at T1, OR = 2.0, p = .002; whereas the effect was non-significant following alpha error corrections at T3 (OR = 1.6., p = .024). In the IG, constant users of the program became smoke-free significantly more often than rare users of the program (T1: OR = 15.0, p < .001; T3: OR = 6.5, p < .001).
Conclusions:
The TK-SCC is effective for smoking cessation. Yet, its superiority compared to a minimal SC intervention could not be confirmed on long term. Both an insufficient implementation of the techniques employed in the TK-SCC (interactivity, tailoring, or the utilized behavior change techniques), as well as co-treatment bias could be explanations for this outcome. A higher utilization intensity of the TK-SCC was positively related with abstinence. Therefore, additional efforts to motivate users to adhere to the usage as intended could be one way to improve the intervention´s effectiveness. Clinical Trial: German Clinical Trials Register ID: DRKS00020249 (https://drks.de/search/de), Universal Trial Number (UTN): U1111-1245-0273
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