Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Sep 28, 2023
Date Accepted: May 2, 2024
Effectiveness and user experience of a smoking cessation chatbot: A mixed-methods study comparing motivational interviewing and confrontational counselling
ABSTRACT
Background:
Cigarette smoking poses a major public health risk. Chatbots may serve as an accessible and useful tool to promote cessation due to their high accessibility and potential in facilitating long-term, personalized interactions. To increase the effectiveness and acceptability, there remains a need to identify and evaluate counselling strategies for these chatbots, an aspect that has yet to be comprehensively addressed in prior research.
Objective:
This study aimed to identify effective counselling strategies for such chatbots to support smoking cessation. Additionally, we seek to gain insights into smokers’ expectations and experiences with the chatbot.
Methods:
This mixed-methods study incorporated an online experiment and semi-structured interviews. Smokers (N=229) interacted with either a motivational interviewing (MI) style chatbot (n=112) or a confrontational counselling (CC) style chatbot (n=117). Both cessation-related (i.e., intention to quit and self-efficacy) and user experience-related outcomes (i.e., engagement, therapeutic alliance, perceived empathy, and interaction satisfaction) were assessed. Semi-structured interviews were conducted with 16 participants, 8 each from both conditions, and data were analyzed using thematic analysis.
Results:
Results from a MANOVA indicated a significant overall advantage of the MI (vs. CC) chatbot. Follow-up discriminant analysis revealed that user experience-related outcomes, but not cessation-related outcomes, contributed mostly to the advantage. Exploratory analyses indicated that smokers in both conditions reported increased intention to quit and self-efficacy after the chatbot interaction. Interview findings illustrated several constructs (e.g., affective attitude and engagement) explaining people’s prior expectations, timely and retrospective experience with the chatbot.
Conclusions:
The results confirmed that chatbots are a promising tool in motivating smoking cessation, and the use of MI can improve user experience. We did not find extra support for MI to motivate cessation and discuss possible reasons. Smokers expressed both relational and instrumental needs in the quitting process. Implications for future research and practice are discussed.
Citation
Request queued. Please wait while the file is being generated. It may take some time.
Copyright
© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.