INTRODUCTION Tobacco smoking may increase susceptibility to and severity of coronavirus disease 2019 (COVID-19). This information may influence smoking cessation related beliefs in smokers. METHODS Online questionnaires were answered from 26 March to 3 April 2020 in the Netherlands by 340 smokers willing to quit smoking. Beliefs regarding (quitting) smoking and (consequences of) the coronavirus are described and associations with motivation to quit due to the coronavirus are reported. RESULTS While 67.7% of the smokers indicated that the coronavirus did not influence the number of cigarettes smoked per day, 18.5% smoked less cigarettes and 13.8% smoked more cigarettes per day due to the coronavirus. One-third of the smokers were more motivated to quit smoking due to the coronavirus. Motivation to quit due to the coronavirus was positively associated with beliefs about the coronavirus as a serious threat, being at high risk of catching the coronavirus and developing severe illness, smokers being at higher risk than non-smokers, quitting smoking to reduce complaints, the social environment endorsing quitting, and perceived stress. CONCLUSIONS Subgroups of smokers may be receptive to smoking cessation advice due to COVID-19. Because of the measures taken to reduce the spread of the virus (e.g. stay at home as much as possible), personalized digital health interventions may be particularly suitable to reach smokers at home.

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Background: To expedite the use of evidence-based smoking cessation interventions (EBSCIs) in primary care and to thereby increase the number of successful quit attempts, a referral aid was developed. This aid aims to optimize the referral to and use of EBSCIs in primary care and to increase adherence to Dutch guidelines for smoking cessation. Methods: Practice nurses (PNs) will be randomly allocated to an experimental condition or control condition, and will then recruit smoking patients who show a willingness to quit smoking within six months. PNs allocated to the experimental condition will provide smoking cessation guidance in accordance with the referral aid. Patients from both conditions will receive questionnaires at baseline and after six months. Cessation effectiveness will be tested via multilevel logistic regression analyses. Multiple imputations as well as intention to treat analysis will be performed. Intervention appreciation and level of informed decision-making will be compared using analysis of (co)variance. Predictors for appreciation and informed decision-making will be assessed using multiple linear regression analysis and/or structural equation modeling. Finally, a cost-effectiveness study will be conducted. Discussion: This paper describes the study design for the development and evaluation of an information and decision tool to support PNs in their guidance of smoking patients and their referral to EBSCIs. The study aims to provide insight into the (cost) effectiveness of an intervention aimed at expediting the use of EBSCIs in primary care.

Computer-tailored (CT) digital health interventions have shown to be effective in obtaining behaviour change. Yet, user perceptions of these interventions are often unsatisfactory. Traditional CT interventions rely mostly on text-based feedback messages. A way of presenting feedback messages in a more engaging manner may be the use of narrated animations instead of text. The goal of this study was to assess the effect of manipulating the mode of delivery (animation vs. text) in a smoking cessation intervention on user perceptions among smokers and non-smokers. Smokers and non-smokers (N = 181) were randomized into either the animation or text condition. Participants in the animation condition assessed the intervention as more effective (ηp2 = .035), more trustworthy (ηp2 = .048), more enjoyable (ηp2 = .022), more aesthetic (ηp2 = .233), and more engaging (ηp2 = .043) compared to participants in the text condition. Participants that received animations compared to text messages also reported to actively trust the intervention more (ηp2 = .039) and graded the intervention better (ηp2 = .056). These findings suggest that animation-based interventions are superior to text-based interventions with respect to user perceptions.

Background The aim of this study is to develop and assess usability of a web-based patient-tailored tool to support adherence to urate-lowering therapy (ULT) among gout patients in a clinical setting. Methods The content of the tool was based on the Integrated Change (I-Change) model. This model combines various socio-cognitive theories and assumes behavioral change is a result of becoming aware of the necessity of change by integrating pre-motivational, motivational, and post-motivational factors. An expert group (five gout experts, three health services researchers, and one health behavior expert) was assembled that decided in three meetings on the tool’s specific content (assessments and personalized feedback) using information from preparatory qualitative studies and literature reviews. Usability was tested by a think aloud approach and validated usability questionnaires. Results The I-Change Gout tool contains three consecutive sessions comprising 80 questions, 66 tailored textual feedback messages, and 40 tailored animated videos. Navigation through the sessions was determined by the patients’ intention to adapt suboptimal ULT adherence. After the sessions, patients receive an overview of the personalized advices and plans to support ULT adherence. Usability testing among 20 gout patients that (ever) used ULT and seven healthcare professionals revealed an overall score for the tool of 8.4 ± 0.9 and 7.7 ± 1.0 (scale 1–10). Furthermore, participants reported a high intention to use and/or recommend the tool to others. Participants identified some issues for further improvement (e.g. redundant questions, technical issues, and text readability). If relevant, these were subsequently implemented in the I-Change Gout tool, to allow further testing among the following participants. Conclusion This study provides initial support for the usability by patients and healthcare professionals of the I-Change Gout tool to support ULT adherence behavior.