mHealth Messaging to Motivate Quitline Use and Quitting: Protocol for a Community-Based Randomized Controlled Trial in Rural Vietnam

Abstract

Background Tobacco kills more than 8 million people each year, mostly in low- and middle-income countries. In Vietnam, 1 in every 2 male adults smokes tobacco. Vietnam has set up telephone Quitline counseling that is available to all smokers, but it is underused. We previously developed an automated and effective motivational text messaging system to support smoking cessation among US smokers. Objective The aim of this study is to adapt the aforementioned system for rural Vietnamese smokers to promote cessation of tobacco use, both directly and by increasing the use of telephone Quitline counseling services and nicotine replacement therapy. Moreover, we seek to enhance research and health service capacity in Vietnam. Methods We are testing the effectiveness of our culturally adapted motivational text messaging system by using a community-based randomized controlled trial design (N=600). Participants were randomly allocated to the intervention (regular motivational and assessment text messages) or control condition (assessment text messages only) for a period of 6 months. Trial recruitment took place in four communes in the Hung Yen province in the Red River Delta region of Vietnam. Recruitment events were advertised to the local community, facilitated by community health workers, and occurred in the commune health center. We are assessing the impact of the texting system on 6-month self-reported and biochemically verified smoking cessation, as well as smoking self-efficacy, uptake of the Quitline, and use of nicotine replacement therapy. In addition to conducting the trial, the research team also provided ongoing training and consultation with the Quitline during the study period. Results Site preparation, staff training, intervention adaptation, participant recruitment, and baseline data collection were completed. The study was funded in August 2017; it was reviewed and approved by the University of Massachusetts Medical School Institutional Review Board in 2017. Recruitment began in November 2018. A total of 750 participants were recruited from four communes, and 700 (93.3%) participants completed follow-up by March 2021. An analysis of the trial results is in progress; results are expected to be published in late 2022. Conclusions This study examines the effectiveness of mobile health interventions for smoking in rural areas in low- and middle-income countries, which can be implemented nationwide if proven effective. In addition, it also facilitates significant collaboration and capacity building among a variety of international partners, including researchers, policy makers, Quitline counselors, and community health workers. Trial Registration ClinicalTrials.gov NCT03567993; https://clinicaltrials.gov/ct2/show/NCT03567993. International Registered Report Identifier (IRRID) DERR1-10.2196/30947

Peer Texting to Promote Quitline Use and Smoking Cessation Among Rural Participants in Vietnam: Randomized Clinical Trial

“…We conducted a two-arm randomized controlled trial among participants in Hung Yen, a rural province northern Vietnam, between November 2018 and April 2021 ( Figure 1 ). Participants were randomized and followed for 6 months [ 11 ].…”

“…The third type was a two-way message assessing whether the participants had smoked recently, followed by tailored feedback encouraging the participants toward their smoking cessation goals, sent bi-weekly in alternate weeks to the Quitline messages. We have detailed our procedure for adapting the peer messages and the Quitline training protocol [ 11 ].…”

“…These Quitlines are staffed by certified tobacco treatment specialists (e.g., registered nurses and public health professionals) who have been trained in principles of motivational interviewing, tobacco risks, and evidence-based tobacco cessation strategies summarized in the 2008 U.S. Treating Tobacco Use and Dependence guidelines including the 5As (Ask, Advise, Assess, Assist, and Arrange) and the 5Rs (Relevance, Risks, Rewards, Roadblocks, and Repetition) [ 11 ]. Unfortunately, these Quitlines are underused, with one estimate suggesting they conduct as few as 25 daily calls.…”

“…Peer messages, a form of vicarious learning, can influence self-efficacy [ 18 ]. The messages were motivational and promoted the use of the Bach Mai Quitline (one of the two Quitlines in Vietnam) and nicotine replacement therapy (NRT), which could be requested through the Quitline [ 11 ].…”

“…Thus, we tested the M2Q2 texting intervention, an adaptation of an effective U.S.-based texting intervention for people in Vietnam who smoke [13][14][15][16][17]. The intervention used peer text messages that are pre-written advice messages written by other people in Vietnam who smoke [11]. Messages "in a smoker's own words" enhance homophily, a feeling of similarity between the message writer and the message reader [15].…”