JMIR Publications

ABSTRACT

Background:

Attentional bias modification can help address smokers’ implicit attention to smoking cues, which trigger cravings and lapses impeding smoking cessation. We developed an attentional bias modification mobile game, Fruit Squish, to support smokers in quitting as part of a multi-component smoking cessation mobile application, Quit Journey. Smokers advance in the game by tapping on neutral (i.e., fruit) rather than smoking-related (e.g., cigarette pack) imagery that they are presented with, essentially training them to avoid focusing on smoking cues.

Objective:

This study aimed to gauge acceptance of an attentional bias modification smoking cues mobile game among young adults who smoked and were socioeconomically disadvantaged.

Methods:

We recruited 38 cigarette smokers aged 18-29 years who were neither four-year college graduates nor enrollees in four-year colleges to participate in 12 semi-structured virtual focus groups. Sessions were audio recorded and transcribed verbatim. We used ATLAS.ti software to code the transcripts for salient themes based on the Second Unified Theory of Acceptance and Use of Technology constructs (i.e., effort expectancy, facilitating conditions, hedonic motivation, performance expectancy, social influence) and sentiment (i.e., negative, neutral, positive).

Results:

Performance expectancy of the mobile game was the dominant technology acceptance construct discussed (30.90%). Perceived usefulness of the game was mixed in sentiment owing to perceptions that the game aimed to distract smokers during cravings and concerns that cue imagery in the game could trigger cravings. Hedonic motivation was the second most discussed technology acceptance construct (15.45%), with participants describing the game as neither fun nor engaging. Participants referenced their past experiences with mobile games and mobile device characteristics as facilitating conditions to using the game (9.09%). Although effort expectancy was minimally discussed (5.45%), the game was characterized as easy to use. To improve the game, participants suggested adding new levels with increasing difficulty (e.g., increase stimuli speed, limit session time) and new game elements (e.g., leaderboard). Other suggestions included improving game graphics and renaming the game to capture its relation to smoking cessation.

Conclusions:

Low socioeconomic young adult smokers had mixed reactions to a mobile smoking cues attentional bias modification game. Results suggest the need to communicate the rationale underlying attentional bias modification games to users and their potential positive effects on smoking cessation. To promote the uptake and sustained use of attentional bias modification mobile games, they need to be on par with commercially available entertainment mobile applications. Research is needed to explore the efficacy of gamified attentional bias modification on cognitive biases in real-life settings. Clinical Trial: Not applicable.