JMIR Publications

ABSTRACT

Background:

M-health applications can facilitate access to effective treatment and therapeutic information services. However, it remains to be seen what the real use of mobile applications for smoking cessation in ecological contexts and their potential impact would be.

Objective:

In an ecological context, this study aims to estimate the engagement rate of a mobile app smoking cessation preparation program and its potential impact on users’ willingness, ability, and readiness to quit smoking.

Methods:

2331 organic users choose to pursue one of two program versions proposed by the mobile app: the basic version (B) or the premium version (P). Both versions were identical in design with four more evidence-based content and strategies for the premium version. Outcomes were analyzed based on automated data registered in the app (engagement rate, motif to quit, motivation type, motivation levels, and satisfaction level). Mann-Whitney and Chi² tests were used to compare the results of both groups.

Results:

As expected, in the ecological context, a high dropout rate was observed at different moments. A significant difference was observed between the two versions (X2 (1, n = 2331) = 5.43, p = 0.02)), with a proportionally higher engagement rate in the premium version (P= 4,7% vs. B= 2%). Likewise, differences were also observed between the two groups in terms of reasons to quit (X2 (4, n = 2331) = 19, p = <.001), V = 0.08), motivation type (X2 (7, n = 2331) = 14,7, p = 0.04)) and motivation level. Users with the app's premium version reported more frequently as the primary reason to stop smoking Well-being (P=23,3% vs. B = 17,9%) or Baby project (P=7,4% vs. B = 4,4%). Also, they reported being more likely to be driven in a smoking cessation process by intrinsic motivation (P=28% vs. B= 20,4%), as well as significantly feeling more willing (z= [156055], p = [< .001], d= 0.15), able (z= [172905], p = [0.041], d= 0.09), and ready (z= [166390], p = [0.005], d= 0.12) to stop smoking than users who had the basic version before competition of the preparation program. Among participants who finished each version of the program (P n=9; B n= 48), significant improvements in motivation levels were observed in both groups, although in different areas for each group (willingness levels for the premium group and ability for the basic group).

Conclusions:

These results suggest that even in ecological contexts where engagement rates are meager, the Kwit’s preparation program can address ambivalence by increasing willingness to change, self-confidence, and readiness to quit among its users, especially those who felt less able to do so. Further development and evaluations are needed to better understand determinants for regular M-health mobile apps. Clinical Trial: ClinicalTrials.gov NCT05318651