Patterns of Use of an Automated Interactive Personalized Coaching Program for Smoking Cessation

Abstract

Background The QuitCoach, an “expert system” program of tailored advice for smoking cessation developed in Australia, has been publicly available since July 2003, albeit with limited promotion. The program is designed to be used on multiple occasions, guiding the user through the process of smoking cessation in the manner of a “life coach”. Email reminders are sent at scheduled intervals to prompt optimal and repeated use.Objectives The aims of this study were to characterize QuitCoach users and to determine what characteristics of smokers affect their participation over time. Of particular interest was whether users tend to return following a relapse and, thus, use the program as a tool for relapse prevention or recovery. We also explored patterns of change associated with returns to the site, whether prompted by reminder emails or not prompted at all.Methods Between July 2003 and June 2007, 28,247 individuals completed an initial assessment on the QuitCoach, of whom 83.7% (n = 23,656) registered. Data were collected during a 10-minute online questionnaire that all users completed in order to obtain tailored cessation advice. This included questions concerning basic demographic information, quitting history, current smoking status and cigarette consumption, stage of change, and use of pharmacotherapy.Results The median age of users was 34 years, and 62% were female. Most (96%) were current smokers. Overall, 91% were planning to quit in the next 30 days, and half (49.9%) had set a quit date. Those who had recently relapsed to smoking following a quit attempt made up 37%. Among registered users, 27% returned for a second visit, a median 9 days after their first. Overall, a third visit was completed by 11% and 2% returned within 2 days. Women, older smokers, those who had recently quit, and those using pharmacotherapy were more likely to return. From the second visit on, most people who completed an assessment had quit. Likelihood of responding to a prompt to return was largely unrelated to user characteristics or cessation outcome.ConclusionsInternet-based programs have considerable potential to reach large numbers of smokers at low cost. The QuitCoach is attracting considerable use, with most using it to make a quit attempt and, for those who continue to use the QuitCoach, to help them stay quit. Nonetheless, most users only visited the site once, suggesting improved strategies are needed for encouraging repeated use.

Effectiveness and cost-effectiveness of computer and other electronic aids for smoking cessation: a systematic review and network meta-analysis.

“…The 26 papers 99,103, included in the review used the following designs: four non-randomised trials, 103,162,166,175 18 cross-sectional, 99,[158][159][160][163][164][165][167][168][169][170]173,174,176,[178][179][180][181] two cohort, 161,177 and two qualitative studies. 171,172 Two studies 99,177 described electronic aids with single or multiple generic components, 18 studies 103,[158][159][160][161][162][163][164][165][166][167][168][169][170][171]176,180,181 described el...…”

“…171,172 Two studies 99,177 described electronic aids with single or multiple generic components, 18 studies 103,[158][159][160][161][162][163][164][165][166][167][168][169][170][171]176,180,181 described electronic aids with a single tailored component (with or without a generic component) and six studies [171][172][173][174][175]178 described interventions that had multiple tailored components (with or without generic components). Thus, the balance of studies in the supplementary review is similar to the effectiveness review in that the majority involved interventions with a single tailored component.…”

“…This supplementary review included four studies that described the characteristics of existing users of already available internet sites (with or without a tailored component) for smoking cessation. [158][159][160][161] It also included three pilot studies that examined the profile of those who volunteered to test electronic aids. [162][163][164] Profile of existing online intervention users Saul et al 159 aimed to follow up all smokers (n = 607) who had accessed a state-wide internet cessation programme in Minnesota (Quitplan.com) during a 10-week period in 2004.…”

Trajectories of 12-Month Usage Patterns for Two Smoking Cessation Websites: Exploring How Users Engage Over Time (Preprint)

“…showing that being older is a predictor of higher e-health utilization [14][15][16][17], even though it was only found for WebQuit, not Smokefree.gov, in this analysis. On the other hand, participants who screen positive for a mental health condition in either website (PTSD in Smokefree and anxiety or depression in WebQuit) were more likely to be one-week users, which suggests the need develop strategies to promote longer-term engagement for people with mental disorders.…”

“…Knowing these baseline characteristics might allow researchers and intervention designers to tailor e-health interventions to users' unique challenges, needs, and limitations. While studies have found that being a woman, being older, and having a higher education are generally consistent predictors of greater e-health intervention utilization [14][15][16][17], very little is known about the user characteristics that are associated with different patterns of use over time. To our knowledge, only one study has examined this question [12], and found that being female and having higher baseline motivation were associated with more consistent login trajectories.…”