Mobile Chat Messaging for Preventing Smoking Relapse Amid the COVID-19 Pandemic: A Pilot Randomized Controlled Trial

Systematic review and meta-analysis of text messaging interventions to support tobacco cessation

OBJECTIVE

To review randomised controlled trials (RCTs) investigating the effectiveness of text message-based interventions for smoking cessation, including the effects of dose (number of text messages) and concomitant use of behavioural or pharmacological interventions.

DATA SOURCES

We searched seven databases (PubMed, CINAHL, PsycINFO, Scopus, EMBASE, Cochrane Library and Web of Science), Google Scholar and the reference lists of relevant publications for RCTs. Eligible studies included participants aged ≥15 years who smoked tobacco at enrolment.

STUDY SELECTION

One reviewer screened titles and abstracts and two reviewers independently screened full texts of articles.

DATA EXTRACTION

One of three reviewers independently extracted data on study and intervention characteristics and smoking abstinence rates using Qualtrics software.

DATA SYNTHESIS

30 of the 40 included studies reported higher rates of smoking cessation among those receiving text messaging interventions compared with comparators, but only 10 were statistically significant. A meta-analysis of seven RCTs found that participants receiving text messages were significantly more likely to quit smoking compared with participants in no/minimal intervention or 'usual care' conditions (risk ratio 1.87, 95% CI 1.52 to 2.29, p <0.001). Three trials found no benefit from a higher dose of text messages on smoking cessation. Two trials that tested the added benefit of text messaging to pharmacotherapy reported outcomes in favour of adding text messaging.

CONCLUSIONS

Findings suggest that text messaging-based interventions are effective at promoting smoking cessation. Further research is required to establish if any additional benefit is gained from an increased number of text messages or concurrent pharmacotherapy or behavioural counselling.

Effectiveness of digital tools for smoking cessation in Asian countries: a systematic review

AIM

The use of tobacco is responsible for many preventable diseases and deaths worldwide. Digital interventions have greatly improved patient health and clinical care and have proven to be effective for quitting smoking in the general population due to their flexibility and potential for personalization. However, there is limited evidence on the effectiveness of digital interventions for smoking cessation in Asian countries.

METHODS

Three major databases - Web of Science (WOS), Scopus, and PubMed - for relevant studies published between 1 January 2010 and 12 February 2023 were searched for studies evaluating the effectiveness of digital intervention for smoking cessation in Asian countries.

RESULTS

A total of 25 studies of varying designs were eligible for this study collectively involving a total of n = 22,005 participants from 9 countries. Among different digital tools for smoking cessation, the highest abstinence rate (70%) was reported with cognitive behavioural theory (CBT)-based smoking cessation intervention via Facebook followed by smartphone app (60%), WhatsApp (59.9%), and Pharmacist counselling with Quit US smartphone app (58.4%). However, WhatsApp was preferred over Facebook intervention due to lower rates of relapse. WeChat was responsible for 15.6% and 41.8% 7-day point prevalence abstinence. For telephone/text messaging abstinence rate ranged from 8-44.3% and quit rates from 6.3% to 16.8%. Whereas, no significant impact of media/multimedia messages and web-based learning on smoking cessation was observed in this study.

CONCLUSION

Based on the study findings the use of digital tools can be considered an alternative and cost-effective smoking cessation intervention as compared to traditional smoking cessation interventions.

WhatsApp-based intervention in urban Colombia to support the prevention of arboviral diseases: a feasibility study

Arboviral diseases remain a significant health concern worldwide, with over half the world's population at risk for dengue alone. Without a vaccine or targeted treatment, the most effective strategy of prevention is vector management with community involvement. mHealth interventions, like WhatsApp, offer promising results for engaging communities and promoting healthier behaviors. This study explores the feasibility of integrating WhatsApp in vector control activities to improve arbovirus prevention in Colombia. A mixed-methods approach was employed to assess the WhatsApp-based intervention. WhatsApp messages were sent to 45 community women for 5 weeks to increase their knowledge and practices about dengue, Zika, and chikungunya. Pre-and-post surveys and focus group discussions were conducted in community settings to measure the feasibility and acceptability of this intervention. Chat reviews were done to assess the usability of users. A total of 1566 messages were exchanged in 45 WhatsApp chats. High acceptance and good usability (82% of users used the app for replying) were reported in this study. WhatsApp messages were perceived as short, clear, and enjoyable. Users liked the frequency, and design of messages. Pre- and post-surveys demonstrated improvements in the knowledge and practices of arboviral diseases. The intention to apply this knowledge in practice was reflected in a significant improvement, particularly in cleaning the laundry tank once a week (pre 62.1% to post 89.6%, p < 0.008). This study suggests that using WhatsApp as an additional tool could be a feasible, acceptable, and affordable strategy for improving the adoption of better practices in the prevention of arboviral diseases.

Mobile chat messaging for preventing relapse among people who recently quit smoking: Study protocol for a randomized controlled trial

Objective

Most smokers who achieve short-term abstinence relapse even when aided by evidence-based cessation treatment. Mobile health presents a promising but largely untested avenue for providing adjunct behavioral support for relapse prevention. This paper presents the rationale and design of a randomized controlled trial aimed at evaluating the effectiveness of personalized mobile chat messaging support for relapse prevention among people who recently quit smoking.

Methods

This is a two-arm, assessor-blinded, randomized controlled trial conducted in two clinic-based smoking cessation services in Hong Kong. An estimated 586 daily tobacco users who have abstained for 3 to 30 days will be randomized (1:1) to intervention group or control group. Both groups receive standard-of-care smoking cessation treatment from the services. The intervention group additionally receives 3-month relapse prevention support via mobile chat messaging, including cessation advice delivered by a live counselor and access to a supportive chatbot via WhatsApp. The control group receives text messaging on generic cessation advice for 3 months as attention control. The primary outcome is tobacco abstinence verified by an exhaled carbon monoxide of <5 parts per million or a negative salivary cotinine test at 6 months after randomization. Secondary outcomes include self-reported 6-month prolonged tobacco abstinence, 7-day point-prevalent abstinence, and relapse rate. The primary analyses will be by intention-to-treat, assuming participants with missing data are non-abstinent. This trial is registered with ClinicalTrials.gov (NCT05370352) and follows CONSORT-EHEALTH.

Conclusion

This trial will provide new evidence on the effectiveness of mobile chat messaging as a scalable and accessible intervention for relapse prevention.

Effect of smoking-related COVID-19 risk messaging on smoking cessation in community smokers: A pragmatic randomized controlled trial

INTRODUCTION

Observational and experimental studies have suggested that messaging on smoking-related COVID-19 risk may promote smoking abstinence, but evidence from randomized clinical trials (RCTs) is lacking.

METHODS

This was a pragmatic RCT in Hong Kong, China, to compare the effectiveness of communicating smoking-related COVID-19 risk with generic cessation support on abstinence. Both groups received brief cessation advice at baseline. The intervention group received messaging on smoking-related COVID-19 risk and cessation support via instant messaging for three months (16 messages in total), which highlighted the increased risk of severe COVID-19 and deaths, and potentially higher risk of viral exposure (e.g. due to mask removal) for smokers. The control group received generic text messaging support for three months (16 messages). The primary outcomes were biochemically validated 7-day point prevalence abstinence (PPA) at 3 and 6 months. Intention to treat analyses was used.

RESULTS

Between 13 June and 30 October 2020, 1166 participants were randomly assigned to an intervention (n=583) or control (n=583) group. By intention-to-treat, validated 7-day PPA did not significantly differ between the intervention and control groups at three months (9.6% and 11.8%, relative risk, RR=0.81; 95% CI: 0.58-1.13, p=0.22) or six months (9.3% and 11.7%, RR=0.79; 95% CI: 0.57-1.11, p=0.18). A higher perceived severity of COVID-19 in smokers at baseline was associated with a greater validated 7-day PPA at six months, and a marginally significant intervention effect on changes in perceived severity from baseline through 6 months was found (p for group × time interaction = 0.08).

CONCLUSIONS

Communicating smoking-related COVID-19 risk via instant messaging was not more effective in increasing smoking abstinence than generic cessation support.

TRIAL REGISTRATION

The study is registered on ClinicalTrials.gov Identifier: NCT04399967.

"I didn't Notice that You Were Watching Me": Exploring a User Acceptance Study to Conduct Cultural Domain Analysis Online During the COVID-19 Pandemic

This article explores the implementation process of a User Acceptance Study to evaluate the feasibility of conducting cultural domain analysis (CDA) online during the COVID-19 pandemic. We conducted 19 cultural domain analysis sessions involving three techniques: free listing, pile sorts, and rank ordering. A diverse set of participants were recruited to help assess requirements and needs that researching online involves. We found that conducting CDA online is a feasible research method that offers benefits such as generating large amounts of data, making participants feel comfortable joining sessions from a safe space, providing anonymity, reducing research costs such as time and travel, and eliciting large numbers of responses. We also identified several factors for consideration when implementing CDA online and provide recommendations for improvement, including the aesthetics of the digital software employed, user accessibility and digital literacy, participants' environments, Internet connection, and online-specific ethical issues.

Associations of changes in smoking-related practices with quit attempt and smoking consumption during the COVID-19 pandemic: A mixed-methods study

INTRODUCTION

How changes in smoking routine due to COVID-19 restrictions (e.g. refraining from smoking outdoors and stockpiling tobacco products) influence smoking behaviors remains understudied. We examined the associations of changes in smoking-related practices with quit attempts and smoking consumption in current smokers using a mixed-methods design.

METHODS

In a community-based telephone survey conducted between the second and third wave of the COVID-19 pandemic in Hong Kong, 659 smokers (87.1% male; 45.2% aged 40-59 years) were asked about quit attempts and changes in cigarette consumption and five smoking-related practices since the COVID-19 outbreak. Logistic regression was used to calculate adjusted odds ratio (AOR), adjusting for sex, age, education level, chronic disease status, heaviness of smoking (HSI), psychological distress (PHQ-4) and perceived danger of COVID-19. A subsample of 34 smokers provided qualitative data through semi-structured interviews for thematic analyses.

RESULTS

Favorable changes in smoking-related practices, including having avoided smoking on the street (prevalence: 58.9%) and reduced going out to buy cigarettes (33.5%), were associated with a quit attempt (AOR: 2.09 to 2.26; p<0.01) and smoking reduction (AOR: 1.76 to 4.97; p<0.05). Avoiding smoking with other smokers (50.5%) was associated with smoking reduction (AOR=1.76; p<0.05) but not quit attempt (AOR=1.26; p>0.05). Unfavorable changes, including having increased smoking at home (25.0%) and stockpiled tobacco products (19.6%), were associated with increased smoking (AOR: 2.84 to 6.20; p<0.05). Low HSI (0-2) was associated with favorable changes (p<0.01), while high HSI score (3-6) was associated with unfavorable changes (p<0.01). Qualitative interviews revealed a double-edged effect of staying at home on smoking consumption and that pandemic precautionary measures (e.g. mask-wearing) reduced outdoor smoking.

CONCLUSIONS

Amid the pandemic, favorable changes in smoking-related practices in smokers were mostly associated with quit attempts and smoking reduction, while unfavorable changes were associated with increased smoking. Smokers with higher nicotine dependence were more negatively impacted.