Get with the program: Adherence to a smartphone app for smoking cessation

Abstract

Introduction Although engagement is generally predictive of positive outcomes in technology-based behavioral change interventions, engagement measures remain largely atheoretical and lack treatment-specificity. This study examines the extent to which adherence measures based on the underlying behavioral change theory of an Acceptance and Commitment Therapy (ACT) app for smoking cessation predict smoking outcomes, and user characteristics associated with adherence. Methods Study sample was adult daily smokers in a single arm pilot study (n=84). Using the app’s log file data, we examined measures of adherence to four key components of the ACT behavior change model as predictors of smoking cessation and reduction. We also examined baseline user characteristics associated with adherence measures that predict smoking cessation. Results Fully adherent users (24%) were over four times more likely to quit smoking (OR = 4.45; 95% CI = 1.13, 17.45; p = 0.032). Both an increase in tracking the number of urges passed (OR = 1.02; 95% CI = 1.00, 1.03; p = 0.043) and ACT modules completed (OR = 1.27; 95% CI = 1.01, 1.60; p = 0.042) predicted cessation. Lower baseline acceptance of cravings was associated with over four times higher odds of full adherence (OR = 4.59; 95% CI = 1.35, 15.54; p = 0.014). Conclusions Full adherence and use of specific ACT theory-based components of the app predicted quitting. Consistent with ACT theory, users with low acceptance were most likely to adhere to the app. Further research is needed on ways to promote app engagement.

Effectiveness of Mobile Apps for Smoking Cessation: Α Review

“…Two studies included were a post-hoc analysis of the single arm pilot randomised control trials 31,32 . Three studies did not have a control group 29,33,34 .…”

“…Six studies adopted automated data extraction from the application. Four studies 30,31,33,34,36 included automated motivational messages while another included a specific daily educational module on smoking cessation . Most studies have adopted a quit plan, pictorial and audio-visual, cost saving, coping skills, and social support features in the application for smoking cessation.…”

“…The majority of the studies were conducted in the United States [29][30][31][32][33] . One unique intervention of mobile apps on the tablet was conducted among randomly selected hospital patients.…”

A Novel Approach to Evaluating Mobile Smartphone Screen Time for iPhones: Feasibility and Preliminary Findings (Preprint)

“…Studies have concluded that smartphone applications can be beneficial in monitoring and evaluating patients [23][24][25], as well as increasing adherence to medical interventions [26,27]. The BUS approach offers the ability to take these studies further in understanding real-time use and overall time spent on apps as a factor that could contribute to health outcomes.…”

Exploring the effectiveness of a mindfulness training app for managing stress in a university student population : a pilot study

“…Therefore, pilot studies have been utilized to evaluate a variety of mHealth technologies, including a pilot study to assess the usability and acceptability of a smartphone app ("MindSurf") designed to promote contentment, wellbeing, and goal achievement (Carey, Haviland, Tai, Vanags, & Mansell, 2016), adherence to a smartphone app for smoking cessation (Zeng, Heffner, Copeland, Mull, & Bricker, 2016), and using a smartphone app to promote psychiatric and physical well-being (Macias et al, 2015), among others. The overall rationale is that unlike the more established treatment protocols, delivered in more traditional settings, many mHealth-related technologies are often relatively new to the market and are by their very nature delivered in less traditional formats.…”