JMIR Publications

ABSTRACT

Background:

Smoking remains the leading cause of death and disability in the United States. At least half of smokers make a serious quit attempt each year, but Black/African American adults who smoke are less likely than White adults who smoke to quit smoking successfully. Black adults who smoke and have high anxiety sensitivity (an individual difference factor implicated in smoking relapse and culturally relevant to Black adults) are even less successful. The Mobile Anxiety Sensitivity Program for Smoking (MASP) is a smoking cessation smartphone application culturally tailored to Black adults who smoke to help increase smoking cessation rates by targeting anxiety sensitivity.

Objective:

This study examined the acceptability and feasibility of the MASP smartphone app following a 6-week pilot test through post-intervention qualitative interviews.

Methods:

The MASP smoking cessation app was adapted from an evidence-based app by adding culturally tailored narration and images specific to the Black community, educational content on tobacco use in the Black community and the role of menthol, culturally tailored messages, and addressing tobacco use and racial discrimination. The MASP app was piloted with 24 adults with high anxiety sensitivity who identified as Black, smoked daily, and were not currently using medications or psychotherapy for smoking cessation. At the end of the 6-week pilot test, 21 participants (66.7% female; 95.2% non-Hispanic; Mage = 47.3 years) completed an audio-recorded semi-structured interview assessing the acceptability and utility of the app, individual experiences, barriers to use, the relevance and cultural fit for Black adults who wanted to quit smoking, and identified areas for improvement. Transcribed interviews were coded by a qualitative researcher using NVivo, reviewed by a second researcher, then analyzed for themes using an inductive, utilization-focused process. Recommendations were made for app modifications prior to full study implementation.

Results:

Identified themes related to participant experiences using the app included establishing trust and credibility through the recruitment experience, providing personally tailored content linked to evidence-based stress reduction techniques, and self-reflection through daily surveys. The increased relevance of the content to Black people who want to quit smoking through culturally tailored material increased app engagement and acceptability. Suggested improvements included opportunities to engage with other participants through the app and additional self-monitoring functions.

Conclusions:

The addition of culturally tailored material to an evidence-based mHealth intervention could increase utilization of smoking cessation interventions among Black adults who want to quit smoking. The MASP app pilot test with Black adults who smoke provided relevant information to improve acceptability and their engagement with the app. Qualitative interviews can give mHealth app developers important insights into how apps can be improved before full study implementation and emphasize the importance of getting feedback from the target population throughout the development process of mHealth interventions. Clinical Trial: ClinicalTrials.gov NCT04838236; https://clinicaltrials.gov/ct2/show/NCT04838236 International Registered Report Identifier (IRRID): DERR1-10.2196/38905