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White JS, Salem MK, Toussaert S, Westmaas JL, Raiff BR, Crane D, Warrender E, Lyles C, Abroms L, Thrul J. Developing a Game (Inner Dragon) Within a Leading Smartphone App for Smoking Cessation: Design and Feasibility Evaluation Study. JMIR Serious Games 2023; 11:e46602. [PMID: 37566442 PMCID: PMC10457699 DOI: 10.2196/46602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 04/08/2023] [Accepted: 07/08/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Several stand-alone smartphone apps have used serious games to provide an engaging approach to quitting smoking. So far, the uptake of these games has been modest, and the evidence base for their efficacy in promoting smoking cessation is still evolving. The feasibility of integrating a game into a popular smoking cessation app is unclear. OBJECTIVE The aim of this paper was to describe the design and iterative development of the Inner Dragon game within Smoke Free, a smartphone app with proven efficacy, and the results of a single-arm feasibility trial as part of a broad program that seeks to assess the effectiveness of the gamified app for smoking cessation. METHODS In phase 1, the study team undertook a multistep process to design and develop the game, including web-based focus group discussions with end users (n=15). In phase 2, a single-arm study of Smoke Free users who were trying to quit (n=30) was conducted to assess the feasibility and acceptability of the integrated game and to establish the feasibility of the planned procedures for a randomized pilot trial. RESULTS Phase 1 led to the final design of Inner Dragon, informed by principles from psychology and behavioral economics and incorporating several game mechanics designed to increase user engagement and retention. Inner Dragon users maintain an evolving pet dragon that serves as a virtual avatar for the users' progress in quitting. The phase-2 study established the feasibility of the study methods. The mean number of app sessions completed per user was 13.8 (SD 13.1; median 8; range 1-46), with a mean duration per session of 5.8 (median 1.1; range 0-81.1) minutes. Overall, three-fourths (18/24, 75%) of the participants entered the Inner Dragon game at least once and had a mean of 2.4 (SD 2.4) sessions of game use. The use of Inner Dragon was positively associated with the total number of app sessions (correlation 0.57). The mean satisfaction score of participants who provided ratings (11/24, 46%) was 4.2 (SD 0.6) on a 5-point scale; however, satisfaction ratings for Inner Dragon were only completed by 13% (3/24) of the participants. CONCLUSIONS Findings supported further development and evaluation of Inner Dragon as a beneficial feature of Smoke Free. The next step of this study is to conduct a randomized pilot trial to determine whether the gamified version of the app increases user engagement over a standard version of the app.
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Affiliation(s)
- Justin S White
- Philip R Lee Institute for Health Policy Studies, University of California, San Francisco, CA, United States
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, United States
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, United States
| | - Marie K Salem
- Philip R Lee Institute for Health Policy Studies, University of California, San Francisco, CA, United States
| | | | - J Lee Westmaas
- Population Science, American Cancer Society, Atlanta, GA, United States
| | - Bethany R Raiff
- Department of Psychology, Rowan University, Glassboro, NJ, United States
| | | | | | - Courtney Lyles
- Department of Medicine, University of California, San Francisco, CA, United States
| | - Lorien Abroms
- Department of Prevention and Community Health, George Washington University, Washington, DC, United States
| | - Johannes Thrul
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, United States
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
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Bloom EL, Japuntich SJ, Pierro A, Dallery J, Leahey TM, Rosen J. Pilot trial of QuitBet: A digital social game that pays you to stop smoking. Exp Clin Psychopharmacol 2022; 30:642-652. [PMID: 34110881 PMCID: PMC10259805 DOI: 10.1037/pha0000487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Contingency management is an effective treatment for cigarette smoking cessation but feasibility and acceptability concerns have been barriers to implementation. We conducted a pilot test of QuitBet, a commercial, digital (smartphone) social game for smoking cessation during which participants earned financial incentives for abstinence. QuitBet included a social feed for posting messages and entirely participant-funded incentives in the form of a deposit contract (the "bet"). QuitBet had a bet of $30 and lasted for 28 days. After a week to prepare for quitting, the quit day was Day 8. Between Day 9-28 (a 20-day period), participants earned back $1 of their $30 bet for each day of carbon monoxide (CO)-verified abstinence (≤ 6 ppm). Remaining bet money was pooled into a "grand prize" pot. Participants who were abstinent on at least 19 of the 20 days (1 "lapse" day allowed) were declared "winners" and split the grand prize pot equally. A game host posted a daily message containing evidence-based education about smoking cessation or a discussion topic. Recruitment goals were met. Among the players (N = 50 U.S. adults, 78% female), 17 (34%) were winners. Thirty-seven participants (74%) responded to a post-QuitBet survey, of whom 95% said they would be interested in playing another QuitBet and would recommend QuitBet to others. Overall, feedback was positive with some suggestions for improvement. In conclusion, a digital social game for smoking cessation with a deposit contract was feasible and acceptable. Next steps include conducting a randomized trial to establish efficacy and a sustainable business model. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Erika Litvin Bloom
- Behavioral and Policy Sciences, RAND Corporation, Boston, Massachusetts, United States
| | - Sandra J. Japuntich
- Department of Clinical Pharmacology and Toxicology, Hennepin Healthcare, Minneapolis, Minnesota, Hennepin
- Department of Medicine, University of Minnesota Medical School
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Rostami M, Moheban F, Davoudi M, Heshmati K, Taheri AA. Current Status and Future Trends of Acceptance and Commitment Therapy (ACT) for Smoking Cessation: A Narrative Review with Specific Attention to Technology-Based Interventions. ADDICTION & HEALTH 2022; 14:229-238. [PMID: 36544979 PMCID: PMC9743826 DOI: 10.34172/ahj.2022.1225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 07/09/2022] [Indexed: 12/24/2022]
Abstract
Background During recent decades, it has become evident that cigarette smoking has led to an increase in cancer, risk of death, and economic problems or sanitation issues worldwide. Acceptance and commitment therapy (ACT), as a third-wave behavioral therapy, has devoted significant attention to smoking cessation. However, this treatment has been utilized in different formats and protocols. Moreover, addressing its challenges and progress needs examination and integration. Accordingly, the primary aim of this study was to present a narrative review for summarizing and integrating the current data on the effectiveness of ACT on smoking cessation. This study also aimed to investigate the challenges and the future of this field. Methods The publications from January 1, 2010 to October 9, 2021 were identified by searching MEDLINE, Embase, Scopus, PsycINFO, and Web of Science electronic databases. The search was performed with the following keywords: "Acceptance AND Commitment Therapy" OR "Acceptance" AND "smoking" OR "tobacco" OR "cigarette" OR "smoker" OR "Nicotine". The inclusion criterion was studies with interventions aimed at reducing smoking cessation in smokers. Findings A total of 17 articles were analyzed in this study. The results showed that this treatment has significant effectiveness in smoking cessation and psychiatric comorbidities. Moreover, the role of experiential avoidance in smoking cessation was discussed in detail. Conclusion ACT is a suitable psychotherapy module for smoking cessation. However, it needs some upgrades regarding technology. To this end, smartphone applications and AVATAR therapy technologies were discussed with their advantages and solvable disadvantages.
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Affiliation(s)
- Mostafa Rostami
- Department of Clinical Psychology, Faculty of Psychology and Educational Sciences, Allameh Tabataba’i University, Tehran, Iran
| | - Fatemeh Moheban
- Department of Clinical Psychology, School of Behavioral Sciences, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mohammadreza Davoudi
- Department of Clinical Psychology, School of Behavioral Sciences, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran,Corresponding Author: Mohammadreza Davoudi,
| | - Khatereh Heshmati
- Department of Clinical Psychology, Faculty of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Amir Abbas Taheri
- Department of Counselling, School of Behavioral Sciences, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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Lu LT, Huang CM, Huang SF, Wu SI, Guo JL. Perspectives of the Elderly with Mild Cognitive Impairment Living Alone on Participating in a Dementia Prevention Program: A Q Methodology Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17217712. [PMID: 33105662 PMCID: PMC7659959 DOI: 10.3390/ijerph17217712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 10/18/2020] [Accepted: 10/20/2020] [Indexed: 11/16/2022]
Abstract
This study aimed to identify and describe the various patterns of perspectives among older adults with mild cognitive impairment (MCI) living alone on participating in a dementia prevention program. Q methodology was applied to investigate the perspectives of 30 community-dwelling elderly people with MCI living alone from March to August 2018. As Q methodology applies a forced distribution through the Q-sorting technique, it could capture participants’ perspective patterns. Thirty-two Q-statements were constructed to explore the participants’ attitudes regarding their participation in a dementia prevention program. The participants performed Q-sorting to rank the 32 statements into a Q-sort grid. Principal component analysis was conducted using the PQ Method 2.35 software to identify patterns in participants’ perspectives. Four patterns of shared perspectives, accounting for 54.65% of the total variance, were identified: (a) awareness of health benefits and readiness to take preventive actions; (b) emphasis on cost consideration, and not ready to participate; (c) concern about family’s attitude and needing family support; (d) emphasis on medical care and needing providers’ recommendation. The exploration of clusters of the elderly with MCI could assist health professionals in acknowledging elderly people’s attitudes and responses towards participating in a dementia prevention program.
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Affiliation(s)
- Li-Ting Lu
- Department of Nursing, University of Kang Ning, Taipei 114, Taiwan;
- Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei 106, Taiwan
| | - Chiu-Mieh Huang
- Institute of Clinical Nursing, School of Nursing, National Yang-Ming University, Taipei 112, Taiwan;
| | - Su-Fei Huang
- Department of Senior Citizen Service, Mackay Junior College of Medicine, Nursing, and Management, Taipei 112, Taiwan;
| | - Shu-I Wu
- Xinyi District Health Center, Taipei City 110, Taiwan;
| | - Jong-Long Guo
- Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei 106, Taiwan
- Correspondence: ; Tel.: +886-2-7749-3705
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