Engagement Promotes Abstinence in a Web-based Cessation Intervention: Cohort Study

Abstract

BackgroundWeb-based smoking cessation interventions can have a public health impact because they are both effective in promoting cessation and can reach large numbers of smokers in a cost-efficient manner. Their potential impact, however, has not been realized. It is still unclear how such interventions promote cessation, who benefits most, and how to improve their population impact.ObjectiveTo examine the effectiveness of a highly promoted Web-based smoking cessation intervention to promote quit behavior over time, identify the most effective features, and understand who is most likely to use those features by using unweighted and weighted analyses to estimate the impact in the broader pool of registered site users.MethodsA sample of 1033 new adult registrants was recruited from a Web-based smoking cessation intervention by using an automated study management system. Abstinence was assessed by self-report through a mixed-mode follow-up (online survey with telephone follow-up for nonrespondents) at 1, 3, and 6 months. Software tracked respondents’ online activity. Generalized estimating equations (GEE) were used to examine predictors of website utilization and how utilization promoted abstinence using unweighted and weighted data.ResultsThe 7-day point prevalence abstinence rates at 6 months ranged from 20.68% to 11.13% in the responder and intent-to-treat samples, respectively. Predictors of abstinence in unweighted analyses included number of visits to the website as well as accessing specific interactive or engaging features. In weighted analyses, only number of visits was predictive of abstinence. Motivation to quit was a key predictor of website utilization, whereas negative partner support decreased the likelihood of increasing visits or accessing engaging features.ConclusionsEngagement is critical to promoting smoking cessation. The next generation of Web-based smoking cessation interventions needs to maximize the initial engagement of all new visitors and work to retain those smokers who proceed to register on the site.

Exploring the “Active Ingredients” of an Online Smoking Intervention: A Randomized Factorial Trial

“…As mentioned previously, many participants failed to view the intervention, highlighting the importance of tracking and reporting program exposure in studies testing the effectiveness of online interventions. Additionally, follow-up retention rates were lower than ideal (68.6% at 2 months, 63.3% at 6 months, and 72.4% at 12 months) but higher than reported in other recent online smoking intervention studies (Pike, Rabius, McAlister, & Geiger, 2007;Richardson et al, 2013;Smit, Hoving, Cox, & de Vries, 2012;Stoddard, Augustson, & Moser, 2008;Swartz et al, 2006). This did not impact our treatment utilization outcomes, but it could have resulted in lower abstinence rates than actually occurred among participants because missing participants were counted as smokers.…”

Internet and Telephone Treatment for Smoking Cessation: Mediators and Moderators of Short-Term Abstinence

“…Indeed, the importance of logins is consistent with other trials that have identified Web site utilization as an independent predictor of abstinence. 18,[44][45][46] Increasing Web site utilization and improving adherence to the core components of web-based interventions are a priority not only for smoking cessation programs but also for eHealth interventions broadly. [47][48][49] Hypotheses regarding moderator variables were only partially supported.…”

Decisional outcomes following use of an interactive web-based decision aid for prostate cancer screening

“…Though a recent paper has found no direct benefit of using a values clarification tool for heart disease-related decision making [43], several recent studies in cancer-related decision making have found that both breast cancer and PCa patients have better outcomes, such as less decisional conflict, when using media with interactive elements versus informational materials with no interactivity [28,[31][32][33]. Additionally, a recent paper assessing participants' use of a web-based smoking cessation tool found that increased use of interactive website features and more frequent use of the website contributed to sustained smoking cessation [34]. Increased interactivity may play a key role in using the Internet to improve decision-making outcomes [20], such as expanding the use of a values clarification tool or expanding opportunities for patients to provide feedback throughout the website [44], such as brief quizzes about PCa facts.…”

“…Tracking software captured website use, allowing for an investigation of whether use of informational sections, testimonial videos, and the values clarification tool were associated with decisional outcomes. Based on prior studies in several domains [14,28,[31][32][33][34] and on a model of Internet interventions [14], we hypothesized that greater interaction with the website would be associated with improved knowledge and satisfaction, decreased decisional conflict, and decreased screening rates.…”