Perceptions Toward a Smoking Cessation App Targeting LGBTQ+ Youth and Young Adults: A Qualitative Framework Analysis of Focus Groups

Abstract

BackgroundThe prevalence of smoking among lesbian, gay, bisexual, trans, queer, and other sexual minority (LGBTQ+) youth and young adults (YYA) is significantly higher compared with that among non-LGBTQ+ persons. However, in the past, interventions were primarily group cessation classes that targeted LGBTQ+ persons of all ages. mHealth interventions offer an alternate and modern intervention platform for this subpopulation and may be of particular interest for young LGBTQ+ persons.ObjectiveThis study explored LGBTQ+ YYA (the potential users’) perceptions of a culturally tailored mobile app for smoking cessation. Specifically, we sought to understand what LGBTQ+ YYA like and dislike about this potential cessation tool, along with how such interventions could be improved.MethodsWe conducted 24 focus groups with 204 LGBTQ+ YYA (aged 16-29 years) in Toronto and Ottawa, Canada. Participants reflected on how an app might support LGBTQ+ persons with smoking cessation. Participants indicated their feelings, likes and dislikes, concerns, and additional ideas for culturally tailored smoking cessation apps. Framework analysis was used to code transcripts and identify the overarching themes.ResultsStudy findings suggested that LGBTQ+ YYA were eager about using culturally tailored mobile apps for smoking cessation. Accessibility, monitoring and tracking, connecting with community members, tailoring, connecting with social networks, and personalization were key reasons that were valued for a mobile app cessation program. However, concerns were raised about individual privacy and that not all individuals had access to a mobile phone, users might lose interest quickly, an app would need to be marketed effectively, and app users might cheat and lie about progress to themselves. Participants highlighted that the addition of distractions, rewards, notifications, and Web-based and print versions of the app would be extremely useful to mitigate some of their concerns.ConclusionsThis study provided insight into the perspectives of LGBTQ+ YYA on a smoking cessation intervention delivered through a mobile app. The findings suggested a number of components of a mobile app that were valued and those that were concerning, as well as suggestions on how to make a mobile app cessation program successful. App development for this subpopulation should take into consideration the opinions of the intended users and involve them in the development and evaluation of mobile-based smoking cessation programs.

Technology-Based Substance Use Interventions: Opportunities for Gender-Transformative Health Promotion

“…MHealth apps provide some of the leading examples of technological innovation, including in their ability to engage individuals in substance use prevention and health promotion [49]. However, the literature has described the functionality, technical issues, and security and privacy of the apps as key barriers and concerns to programmatic success [49,50]. In regards to gender-informed approaches in intervention design, programs have ranged from gender blind to gender transformative, with some reporting gendered differences to uptake and success.…”

“…The need for attention to interventions that move beyond the gender binary as well as consider sexual orientation and culture in the intervention design and implementation is also important as the prevalence of smoking among LGBTQ+ identified youth and young adults is significantly higher than among youth and young adults who identify as heterosexual [50]. The larger scoping review, from which the literature for this review was derived was inclusive of women, girls, men, boys, trans and gender diverse people of all ages and demographics, excluding pregnant women.…”

“…However, there were no technology-based substance use interventions that were inclusive of or targeted to trans and gender diverse people, beyond one study that examined LGBTQ+ youth and young adults' perceptions of a culturally tailored mHealth app for smoking cessation. In this study by Baskerville et al, LGBTQ+ identified youth and young adults have expressed that substance use mobile health apps that are culturally-tailored and recognize their specific needs are highly valued when seeking out substance use prevention programming [50]. This has also been reflected in studies that have incorporated elements of Indigenous culture into interventions with Indigenous youth, which have seen that the boys and girls prefer this type of format, are more inclined to receive the messaging, and girls in particular are more inclined to want to learn more [41,42,47].…”

“…There is concern surrounding the collection of data by mobile technology. Studies have shown that both men and women have expressed concerns pertaining to how their private information will be used or communicated outside of face-to-face interactions [50,53,58]. These concerns are reflected in how individuals engage with technology-based programs.…”

“…For example, female veterans have expressed reluctance to share their information, viewing the phone-delivered programming as 'too impersonal' [58] while younger men, appear to be more inclined to share their information [63]. Participants have expressed that having print and web-based versions of programs would help mitigate these concerns [50]. However, it has also been reported that both adolescent girls and boys are more comfortable with filling out web based surveys of alcohol and tobacco use, when compared to filling out printed surveys, reporting higher and possibly more accurate rates of use [63].…”