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:

We enrolled 2331 organic users (adults willing to prepare to quit smoking via a mobile app through the Apple store). Participants choose to pursue one of two program versions: the basic version (B) or the premium version (P). Both versions were identical in design, but the premium version had four more steps than the basic version and offered more evidence-based best practices and resources for increasing motivation and learning different strategies for smoking cessation, including nicotine replacement therapies. Outcomes were analyzed based on automated data registered in the app (engagement rate, motif to quit, motivation type and 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 the end of the program, but 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 for quitting (X2 (4, n = 2331) = 19, p = <.001), V = 0.08), type of motivation (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

Conclusions:

: These results suggest that even in ecological contexts where engagement rates are meager, the Kwit 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.