The purpose of this study was to design and test the usability of a computer-mediated smoking cessation program for inner-city women. Design and content were developed consistent with principles of user-centered design. Formative and summative evaluation strategies were utilized in its testing. The summative evaluation was designed to test usability in a naturalistic environment. A sample of 100 women who receive care at an inner-city community health center participated in the study. Average time for completing the computer program was 13.9 minutes. Participants reported a high level of satisfaction with usability of the program. Standardized instruments to measure cognitive processes of change related to smoking were completed at baseline and at 1 week. Participants reported a decrease in favorable attitudes toward smoking (P=0.014) and an increase in cognitive change processes at follow-up (P=0.037). These results indicate that interactive computer technology is acceptable to, and potentially useful for, promoting smoking cessation in low-income women.

BackgroundTobacco dependence is a chronic, relapsing condition that typically requires multiple quit attempts and extended treatment. When offered the opportunity, relapsed smokers are interested in recycling back into treatment for a new, assisted quit attempt. This manuscript presents the results of a randomized controlled trial testing the efficacy of interactive voice response (IVR) in recycling low income smokers who had previously used quitline (QL) support back to QL support for a new quit attempt.MethodsA sample of 2985 previous QL callers were randomized to either receive IVR screening for current smoking (control group) or IVR screening plus an IVR intervention. The IVR intervention consists of automated questions to identify and address barriers to re-cycling in QL support, followed by an offer to be transferred to the QL and reinitiate treatment. Re-enrollment in QL services for both groups was documented.ResultsThe IVR system successfully reached 715 (23.9%) former QL participants. Of those, 27% (194/715) reported to the IVR system that they had quit smoking and were therefore excluded from the study and analysis. The trial’s final sample was composed of 521 current smokers. The re-enrollment rate was 3.3% for the control group and 28.2% for the intervention group (p < .001). Logistic regression results indicated an 11.2 times higher odds for re-enrollment of the intervention group than the control group (p < .001). Results did not vary by gender, race, ethnicity, or level of education, however recycled smokers were older (Mean =45.2; SD = 11.7) than smokers who declined a new treatment cycle (Mean = 41.8; SD = 13.2); (p = 0.013). The main barriers reported for not engaging in a new treatment cycle were low self-efficacy and lack of interest in quitting. After delivering IVR messages targeting these reported barriers, 32% of the smokers reporting low self-efficacy and 4.8% of those reporting lack of interest in quitting re-engaged in a new QL treatment cycle.ConclusionProactive IVR outreach is a promising tool to engage low income, relapsed smokers back into a new cycle of treatment. Integration of IVR intervention for recycling smokers with previous QL treatment has the potential to decrease tobacco-related disparities.Trial registrationClinicalTrials.gov Identifier: NCT01260597

Nurses have been at the forefront of initiatives to improve patient outcomes through systems change. Nursing research addressing systems approaches to treatment of tobacco dependence has demonstrated increased implementation of evidence-based practice guidelines. Existing health system research conducted by nurse scientists has focused on four strategies: tobacco use identification systems, education and training of nursing staff to deliver tobacco intervention, dedicated staff for tobacco dependence treatment in both acute and primary care settings, and institutional policies to support tobacco intervention. Nursing involvement in multidisciplinary health services research focusing on tobacco treatment has lagged behind advances in clinical nursing research of individual-focused smoking cessation interventions. Health information technology shows promise as part of an integrated approach to systems changes to support tobacco intervention, particularly in light of the current national emphasis on adoption and meaningful use of electronic health records. Future directions for translational research present unprecedented opportunity for nurse scientists to respond to the call for policy and systems changes to support tobacco treatment.

The discipline of Human-Computer Interaction design has potential for significant benefit to the field of health informatics. This paper describes the design approach used to develop a web-based interface to help cancer patients manage their chemotherapy side effects. Previous versions of this intervention utilizing telephone technology had been efficacious, but limited. The paper discusses the design decisions made in order to leverage the potential benefits of the Internet in supporting patients while avoiding the potential pitfalls that the patients may encounter with a web-based approach.

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