Questions about quitting (Q2): Design and methods of a Multiphase Optimization Strategy (MOST) randomized screening experiment for an online, motivational smoking cessation intervention

Abstract

Effective interventions are needed to improve smokers’ motivation for quitting, treatment utilization, and abstinence rates. The Internet provides an ideal modality for delivering such interventions, given the low cost, broad reach, and capacity to individually tailor content, but important methodological questions remain about how to best design and deliver an online, motivational intervention to smokers. The current paper reports on the intervention, study design and research methods of a randomized trial (called Questions about Quitting) designed to address some of these questions. Using a Multi-phase Optimization Strategy (MOST) screening experiment, the trial has two key aims: to examine the impact of four experimental intervention factors (each evaluated on two levels) on smokers’ subsequent treatment utilization and abstinence, and to examine select moderators of each sub-factor’s effectiveness. The experimental factors of interest are: navigation autonomy (content viewing order is dictated based on stage of change or not), use of self-efficacy based testimonials (yes vs. no), proactive outreach (reminder emails vs. no emails), and decisional framework (prescriptive vs. motivational tone). To our knowledge, this is the first application of the MOST methodology to explore these factors or to explore the optimal design for a motivational intervention targeting smokers not actively trying to quit smoking. The rationale for the experimental factor choice, intervention design, and trial methods are discussed. Outcome data are currently being collected and are not presented, but recruitment data confirm the feasibility of enrolling smokers at varying stages of readiness to quit.

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

“…Data were collected between May 2010 and November 2012. Study methods have been described in detail (McClure et al, 2012(McClure et al, , 2013, but relevant details are summarized here.…”

“…Each factor is summarized in the following subsections and discussed in more detail elsewhere (McClure et al, 2012(McClure et al, , 2013.…”

“…Power calculations assumed a 12-month PPA rate of 15% (see rationale in McClure et al, 2012). The study was designed to have 85% power detect a 5% difference between each contrasting factor level for each primary outcome using a two-sided test to compare two sample proportions and when significance was set to 0.05.…”

“…Each of these factors, discussed in detail elsewhere (McClure et al, 2012(McClure et al, , 2013, was chosen either based on empirical or theoretical evidence for its effects on smoking cessation or because its treatment effects were unclear. For example, research suggests interventions grounded in the principles of motivational interviewing can be effective across a range of health risk behaviors, including smoking cessation (Burke, Arkowitz, & Menchola, 2003;Heckman, Egleston, & Hofmann, 2010;Hettema & Hendricks, 2010;Hettema, Steele, & Miller, 2005;Lundahl & Burke, 2009;Vasilaki, Hosier, & Cox, 2006).…”

Moving beyond the treatment package approach to developing behavioral interventions: addressing questions that arose during an application of the Multiphase Optimization Strategy (MOST)

“…Because, as noted above, MOST is a framework rather than an off-the shelf procedure, its implementation can differ considerably across applications. Examples of applications of MOST can be found in Strecher et al [5], Collins et al [3], Caldwell et al [6], and McClure et al [7].…”