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- Title
Engagement With a Mobile Chat-Based Intervention for Smoking Cessation: A Secondary Analysis of a Randomized Clinical Trial.
- Authors
Li, Yajie; Luk, Tzu Tsun; Cheung, Yee Tak Derek; Zhao, Shengzhi; Zeng, Yingpei; Tong, Henry Sau Chai; Lai, Vienna Wai Yin; Wang, Man Ping
- Abstract
Key Points: Question: How does engagement with a mobile chat-based intervention affect smoking abstinence among cigarette smokers? Findings: In this secondary analysis of a cluster randomized clinical trial involving 624 cigarette smokers receiving chat-based smoking cessation support via mobile instant messaging for 3 months, 4 distinct engagement trajectories were identified. Higher level of engagement was associated with greater biochemically validated smoking abstinence at 3- and 6-month follow-ups. Meaning: The findings of this study suggest the importance of assessing engagement patterns for a comprehensive understanding of intervention and improving user engagement. Importance: Determining how individuals engage with digital health interventions over time is crucial to understand and optimize intervention outcomes. Objective: To identify the engagement trajectories with a mobile chat-based smoking cessation intervention and examine its association with biochemically validated abstinence. Design, Setting, and Participants: A secondary analysis of a pragmatic, cluster randomized clinical trial conducted in Hong Kong with 6-month follow-up. From June 18 to September 30, 2017, 624 adult daily smokers were recruited from 34 community sites randomized to the intervention group. Data were analyzed from March 6 to October 30, 2023. Intervention: Chat-based cessation support delivered by a live counselor via a mobile instant messaging app for 3 months from baseline. Main Outcomes and Measures: Group-based trajectory modeling was used to identify engagement trajectories using the participants' weekly responses to the messages from the counselor over the 3-month intervention period. The outcome measures were biochemically validated tobacco abstinence at 3-month (end of treatment) and 6-month follow-ups. Covariates included sex, age, educational level, nicotine dependence, past quit attempt, and intention to quit at baseline. Results: Of 624 participants included in the analysis, 479 were male (76.8%), and the mean (SD) age was 42.1 (16.2) years. Four distinct engagement trajectories were identified: low engagement group (447 [71.6%]), where participants maintained very low engagement throughout; rapid-declining group (86 [13.8%]), where participants began with moderate engagement and rapidly decreased to a low level; gradual-declining group (58 [9.3%]), where participants had high initial engagement and gradually decreased to a moderate level; and high engagement group (58 [5.3%]), where participants maintained high engagement throughout. Compared with the low engagement group, the 6-month validated abstinence rates were significantly higher in the rapid-declining group (adjusted relative risk [ARR], 3.30; 95% CI, 1.39-7.81), gradual-declining group (ARR, 5.17; 95% CI, 2.21-12.11), and high engagement group (ARR, 4.98; 95% CI, 1.82-13.60). The corresponding ARRs (95% CI) of 3-month validated abstinence were 4.03 (95% CI, 1.53-10.59), 5.25 (95% CI, 1.98-13.88), and 9.23 (95% CI, 3.29-25.86). Conclusions and Relevance: The findings of this study suggest that higher levels of engagement with the chat-based smoking cessation intervention were associated with greater biochemically validated tobacco abstinence. Improving engagement with digital interventions may increase intervention benefits. Trial Registration: ClinicalTrials.gov Identifier: NCT03182790 This secondary analysis of a randomized clinical trial examines the use of support delivered by a live counselor via a mobile instant messaging for smoking cessation among individuals in Hong Kong.
- Subjects
HONG Kong (China); SALIVA analysis; SMOKING prevention; SMOKING cessation; MOBILE apps; INSTANT messaging; POISSON distribution; SECONDARY analysis; RESEARCH funding; CONSUMER attitudes; DIGITAL health; QUESTIONNAIRES; LOGISTIC regression analysis; NICOTINE; DRUG addiction; SELF-control; CHI-squared test; DESCRIPTIVE statistics; MOTIVATION (Psychology); ONE-way analysis of variance; DATA analysis software; CONFIDENCE intervals; SOCIAL support; DRUG abstinence; BIOMARKERS
- Publication
JAMA Network Open, 2024, Vol 7, Issue 6, pe2417796
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2024.17796