How Smart are Smartphone Apps for Smoking Cessation? A Content Analysis.
ABSTRACT: Smartphone technology is ideally suited to provide tailored smoking cessation support, yet it is unclear to what extent currently existing smartphone "apps" use tailoring, and if tailoring is related to app popularity and user-rated quality.We conducted a content analysis of Android smoking cessation apps (n = 225), downloaded between October 1, 2013 to May 31, 2014. We recorded app popularity (>10,000 downloads) and user-rated quality (number of stars) from Google Play, and coded the existence of tailoring features in the apps within the context of using the 5As ("ask," "advise," "assess," "assist," and "arrange follow-up"), as recommended by national clinical practice guidelines.Apps largely provided simplistic tools (eg, calculators, trackers), and used tailoring sparingly: on average, apps addressed 2.1 ± 0.9 of the 5As and used tailoring for 0.7 ± 0.9 of the 5As. Tailoring was positively related to app popularity and user-rated quality: apps that used two-way interactions (odds ratio [OR] = 5.56 [2.45-12.62]), proactive alerts (OR = 3.80 [1.54-9.38]), responsiveness to quit status (OR = 5.28 [2.18-12.79]), addressed more of the 5As (OR = 1.53 [1.10-2.14]), used tailoring for more As (OR = 1.67 [1.21-2.30]), and/or used more ways of tailoring 5As content (OR = 1.35 [1.13-1.62]) were more likely to be frequently downloaded. Higher star ratings were associated with a higher number of 5As addressed (b = 0.16 [0.03-0.30]), a higher number of 5As with any level of tailoring (b = 0.14 [0.01-0.27]), and a higher number of ways of tailoring 5As content (b = 0.08 [0.002-0.15]).Publically available smartphone smoking cessation apps are not particularly "smart": they commonly fall short of providing tailored feedback, despite users' preference for these features.
Project description:With 360 million smokers, China consumes more cigarettes than any other country in the world. Given that 620 million Chinese own smartphones, smartphone apps for smoking cessation are increasingly used in China to help smokers quit.This study analyzed and evaluated the contents of all smoking cessation apps (iOS and Android) available in China, applying the China Clinical Smoking Cessation Guideline (CCSCG; identical to the US Clinical Practice Guideline for Treating Tobacco Use and Dependence) as a framework for analysis.We conducted a content analysis of Chinese Android and iOS smoking cessation apps (N=64) designed to assist users in quitting smoking. Each app was independently coded by two raters for its approach to smoking cessation and adherence to the CCSCG. We also recorded the features of smoking cessation apps (eg, release date, size, frequency of downloads, user ratings, type, quality scores by raters, and designers). Linear regression was used to test predictors of popularity and user-rated quality.Chinese smoking cessation apps have low levels of adherence to guidelines, with an average score of 11.1 for Android and 14.6 for iOS apps on a scale of 0 to 46. There was no significant association between popularity, user rating, and the characteristics of apps. However, there was a positive relationship between popularity, user rating, and adherence score.Chinese apps for smoking cessation have low levels of adherence to standard clinical practice guidelines. New apps need be developed and existing apps be revised following evidence-based principles in China.
Project description:BACKGROUND:Adolescence and young adulthood are critical times of initiation and progression to daily use of tobacco. However, it is difficult to recruit young adults to traditional smoking cessation and retention rates are typically low. Smartphone cessation applications (apps) can provide real-time responses to smoking urges and related cues, which are known to be important factors in lapse and relapse. Given the popularity of smartphones among young adults and the considerably higher download rates of commercially developed apps compared to research-based apps, there is a need to design pragmatic studies that evaluate commercial tobacco cessation apps. The aims of this pilot study are to assess the impact on tobacco cessation of using a smartphone app compared with usual care and to generate feasibility data to inform a future fully powered clinical trial. METHODS:We will conduct an open randomized controlled trial with parallel groups. Participants will be selected from hospitalized patients and must be aged 18-30?years, interested in cessation, smoked >?5 cigarettes/day over the past 30?days, and own an Apple or Android smartphone. Participants who are eligible will be randomized to either a smartphone experimental group or patient-initiated follow up (usual care). As this study seeks to assess feasibility, the primary data will include (1) recruitment rates, (2) retention rates, and (3) adherence, measured through user engagement with the app. DISCUSSION:This pilot trial will be the first to evaluate a commercially available smartphone app for tobacco cessation in a hospitalized setting. Data generated by this study can be used for larger fully powered trials such as comparative effectiveness studies against apps developed by academics or health scientists based on behavioral theories, or cost-effectiveness analyses of mobile interventions. TRIAL REGISTRATION:ClinicalTrials.gov, NCT03538678 . Registered on 28 May 2018.
Project description:BACKGROUND:Smartphone apps for smoking cessation could offer easily accessible, highly tailored, intensive interventions at a fraction of the cost of traditional counseling. Although there are hundreds of publicly available smoking cessation apps, few have been empirically evaluated using a randomized controlled trial (RCT) design. The Smart-Treatment (Smart-T2) app is a just-in-time adaptive intervention that uses ecological momentary assessments (EMAs) to assess the risk for imminent smoking lapse and tailors treatment messages based on the risk of lapse and reported symptoms. OBJECTIVE:This 3-armed pilot RCT aimed to determine the feasibility and preliminary efficacy of an automated smartphone-based smoking cessation intervention (Smart-T2) relative to standard in-person smoking cessation clinic care and the National Cancer Institute's free smoking cessation app, QuitGuide. METHODS:Adult smokers who attended a clinic-based tobacco cessation program were randomized into groups and followed for 13 weeks (1 week prequitting through 12 weeks postquitting). All study participants received nicotine patches and gum and were asked to complete EMAs five times a day on study-provided smartphones for 5 weeks. Participants in the Smart-T2 group received tailored treatment messages after the completion of each EMA. Both Smart-T2 and QuitGuide apps offer on-demand smoking cessation treatment. RESULTS:Of 81 participants, 41 (50%) were women and 55 (68%) were white. On average, participants were aged 49.6 years and smoked 22.4 cigarettes per day at baseline. A total of 17% (14/81) of participants were biochemically confirmed 7-day point prevalence abstinent at 12 weeks postquitting (Smart-T2: 6/27, 22%, QuitGuide: 4/27, 15%, and usual care: 4/27, 15%), with no significant differences across groups (P>.05). Participants in the Smart-T2 group rated the app positively, with most participants agreeing that they can rely on the app to help them quit smoking, and endorsed the belief that the app would help them stay quit, and these responses were not significantly different from the ratings given by participants in the usual care group. CONCLUSIONS:Dynamic smartphone apps that tailor intervention content in real time may increase user engagement and exposure to treatment-related materials. The results of this pilot RCT suggest that smartphone-based smoking cessation treatments may be capable of providing similar outcomes to traditional, in-person counseling. TRIAL REGISTRATION:ClinicalTrials.gov NCT02930200; https://clinicaltrials.gov/show/NCT02930200.
Project description:<h4>Background</h4>Although many smoking cessation smartphone apps exist, few have been independently evaluated, particularly in older populations. In 2017, of the 112 commercially available smoking cessation apps in Australia, only 6 were deemed to be of high quality, in that they partially adhered to Australian guidelines. Mobile health (mHealth) apps have the potential to modify smoking behavior at a relatively low cost; however, their acceptability in older smokers remains unknown. Rigorous scientific evaluation of apps is thus urgently needed to assist smokers and clinicians alike.<h4>Objective</h4>We conducted a pilot randomized controlled trial to evaluate the feasibility of a large-scale trial to assess the use and acceptability of a high-quality smoking cessation app in older smokers.<h4>Methods</h4>Adult inpatient and outpatient smokers with computer and smartphone access were recruited face to face and via telephone interviews from Metropolitan Hospitals in Brisbane, Australia. Participants were randomized 1:1 to the intervention (requested to download the "My QuitBuddy" smoking cessation app on their smartphone) or the control group (provided access to a tailored smoking cessation support webpage [Quit HQ]). The My QuitBuddy app is freely available from app stores and provides personalized evidenced-based smoking cessation support. Quit HQ offers regular email support over 12 weeks. No training or instructions on the use of these e-resources were given to participants. Outcomes at 3 months included recruitment and retention rates, use and acceptability of e-resource (User Version of the Mobile App Rating Scale [uMARS]), changes in quitting motivation (10-point scale), and self-reported smoking abstinence.<h4>Results</h4>We randomized 64 of 231 potentially eligible individuals (27.7%). The mean age of participants was 62 (SD 8). Nicotine dependence was moderate (mean Heaviness of Smoking Index [HSI] 2.8 [SD 1.2]). At 3 months the retention rate was (58/64, 91%). A total of 15 of 31 participants in the intervention arm (48%) used the app at least once, compared with 10 of 33 (30%) in the control arm. uMARS scores for e-resource use and acceptability were statistically similar (P=.29). Motivation to quit was significantly higher in the intervention arm compared with the control arm (median 6 [IQR 4-8] versus 4 [IQR 4-5], respectively, P=.02). According to the intention-to-treat analysis, smoking abstinence was nonsignificantly higher in the intervention group (4/31 [13%], 95% CI 4%-30%, versus 2/33 [6%], 95% CI 1%-20%; P=.42). The estimated number needed to treat was 14.<h4>Conclusions</h4>Internet and mHealth smoking cessation resources appear acceptable to a minority of older smokers. Smokers who engaged with the allocated e-resources rated them equally, and there were trends toward greater uptake, increased motivation, and higher abstinence rates in the app group; however, only the change in motivation reached statistical significance (median score 6 versus 4, respectively, P=.02). This results of this pilot study suggest that apps may improve quit outcomes in older adults who are willing to use them. Further research into user-app interactions should be undertaken to facilitate improvements in app design and consumer engagement. These favorable trends should be explored in larger trials with sufficient statistical power.<h4>Trial registration</h4>Australian New Zealand Clinical Trials Registry ACTRN12619000159156; http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=376849&isReview=true.
Project description:BACKGROUND:Although there are more than 60 smartphone apps for smoking cessation in China, many of them do not include the content and features that health care professionals and smokers prefer-which may make them impractical, unengaging, and ineffective. Therefore, we investigated both health care providers' and smokers' preferences for features of future smoking cessation apps. OBJECTIVE:This study aimed to investigate Chinese health care providers' and smokers' desired features of a smoking cessation app, with the goal of providing design recommendations for app designers and researchers. METHODS:Both Chinese smokers who own smartphones (n=357) and Chinese health care providers (n=224) responded to a survey collecting data on their sociodemographic characteristics and opinions on the importance of 20 smoking cessation app design features studied in previous US research. RESULTS:Chinese health care providers expressed strong support of smoking cessation apps on a number of attitude indicators (range 153/224, 68.3% to 204/224, 91.1%). They rated nearly all (18/20) features as very or extremely important (range 52.2%-83.4%) and rated nearly all features (17/20) as more important than the smokers did. More than 60% of smokers rated the following 4 features as very or extremely important: allow sharing the process of smoking cessation with family members and friends (216/319, 67.7%), helping smokers track their progress (such as the amount of smoking per day; 213/319, 66.8%), helping with the side effects of medications and nicotine withdrawal symptoms (201/319, 63.0%), and adapting to ongoing needs and interests of smokers (194/319, 60.8%). Contrary to a similar study of US smokers and health care providers, Chinese smokers and providers rated reputation and ability to communicate with family members and friends as important features, whereas Chinese smokers rated privacy and security as less important. CONCLUSIONS:The design of future smoking cessation and health behavior change apps should consider perspectives of both providers and smokers as well as the role of culture.
Project description:<h4>Background</h4>The mobile app market differs from country to country, and to date, no previous review of the content quality of smoking cessation apps has been conducted in France.<h4>Objective</h4>This study aimed to examine the general quality of the most popular smoking cessation apps in France and also determine the degree to which apps adhere to established behavioral and cognitive techniques (BCTs) proven effective in clinical practice.<h4>Methods</h4>A systematic research of smoking cessation apps was conducted in both the Google Play Store and Apple Store in the French market. The general quality of popular apps was rated with the Mobile App Rating Scale (MARS), and the therapeutic quality was assessed with the ratio of adherence of the behavior change technique taxonomy for smoking cessation treatment.<h4>Results</h4>A total of 14 mobile apps met all the inclusion criteria of the content analysis. The interrater reliability varied from "substantial" (0.79) to "almost perfect" (0.9) for the two measures. The mean MARS score was 3.5 out of 5 (median 3.6, IQR 0.6 [3.2-3.8]). The findings suggest that popular apps focus primarily on the functionality dimension of the MARS scale (4.2/5). The mean number of BCTs was 22, with a large difference between apps (minimum 4, maximum 38). At least half of the apps addressed motivation (8.8/14, 63%) and advised on using behavioral skills in order to quit smoking or stay a nonsmoker (8.7/14, 62%). However, only a handful of apps gathered important information (5.9/14, 42%) in order to deliver proper advice regarding the use of approved medication or the implementation of behavioral techniques (4.3/14, 31%). The mean MARS score was positively correlated with the price (r=0.70, P=.007) and the number of BCTs used (r=0.67, P=.01). User rating was not correlated with any quality scale (P=.67).<h4>Conclusions</h4>The content quality of popular smoking cessation apps in France varied by app type and price. Most popular apps propose in general good quality content but lack implementation of evidence-based BCTs associated with effectiveness on smoking cessation treatment. Further research is needed to evaluate the improvement in the content quality of smoking cessation apps in France.
Project description:OBJECTIVE:To assess the efficacy of an interactive smoking cessation decision-aid application (pp) compared with a smoking cessation static information app on continuous abstinence. DESIGN:Automated double-blind randomised controlled trial with 6 months follow-up (2014-2015). SETTING:Smartphone-based. PARTICIPANTS:684 participants (daily smokers of cigarettes, 18 years old or over) recruited passively from app stores in the USA, Australia, UK and Singapore, and randomised to one of two sub-apps. INTERVENTIONS:Behavioural, decision-aid, smartphone application. MAIN OUTCOMES:Continuous abstinence at 10 days, 1?month, 3 months and 6 months. RESULTS:Smokers who received the decision-aid app were more likely to be continuously abstinent at 1?month compared with the information-only app (28.5% vs 16.9%; relative risk (RR) 1.68; 95%?CI 1.25 to 2.28). The effect was sustained at 3 months (23.8% vs 10.2%; RR 2.08; 95%?CI 1.38 to 3.18) and 6 months (10.2% vs 4.8%; RR 2.02; 95%?CI 1.08 to 3.81). Participants receiving the decision-aid app were also more likely to have made an informed choice (31.9% vs 19.6%) and have lower decisional conflict (19.5% vs 3.9%). CONCLUSION:A smartphone decision-aid app with support features significantly increased smoking cessation and informed choice. With an increasing number of smokers attempting to quit, unassisted evidence-based decision-aid apps can provide an effective and user-friendly option to many who are making quit decisions without healthcare professionals. TRIAL REGISTRATION NUMBER:ACTRN12613000833763.
Project description:Background:Only a few digital interventions have been developed for pregnant smokers, and little is known about the acceptability and usability of smartphone apps to aid cessation in pregnancy. This study aimed to explore pregnant smokers' views on the design, content and usability of a pregnancy-specific smoking cessation app in order to inform intervention development and optimisation. Methods:Ten interviews were conducted and the 'think-aloud' protocol was used in order to explore participants' views about a smoking cessation smartphone app ('SmokeFree Baby'). The data were subsequently thematically analysed. Participants were 18 and over, pregnant, and daily or weekly cigarette smokers. Results:Three main themes were identified: views about the design elements, mode of delivery and content of the intervention. App design was considered as an important element that might influence potential users' engagement with the intervention. Participants felt that the intervention content was educational, motivational and non-judgemental. However, it was emphasised that the app should provide further options for personalisation and include more practical features. Conclusions:Delivering smoking cessation support via a smartphone app can be feasible and acceptable for pregnant smokers. They appear to value content that is motivational, educational and personalised, and meeting these requirements may be important for user experience and promoting engagement with the intervention.
Project description:BACKGROUND:Smoking rates of Australians with severe mental illness (SMI) are disproportionately higher than the general population. Despite the rapid growth in mobile health (mHealth) apps, limited evidence exists to inform their design for SMI populations. OBJECTIVE:This study aimed to explore the feasibility, acceptability, and utility of adapting a novel smoking cessation app (Kick.it) to assist smokers with SMI to prevent smoking relapse and quit. METHODS:Using co-design, two in-depth interviews with 12 adult smokers and ex-smokers with SMI were conducted in this qualitative study. Stage 1 interviews explored participants' smoking-related experiences and perceptions of social support for smoking cessation, informed the development of the stage 2 interview schedule, and provided context for participants' responses to the second interview. Stage 2 interviews explored participants' perceptions of the feasibility, utility, and acceptability of the app features for SMI populations. RESULTS:People with SMI perceived mHealth interventions to support their quit smoking attempts as feasible, acceptable, and useful. Key emerging themes included personalization of the app to users' psychosocial needs, a caring app to mediate self-esteem and self-efficacy, an app that normalizes smoking relapse and multiple quit attempts, a strong focus on user experience to improve usability, and a social network to enhance social support for smoking cessation. CONCLUSIONS:This study gained an in-depth understanding of the lived experiences of smoking and quitting among people with SMI and their perception of the Kick.it app features to help inform the tailoring of the app. Specific program tailoring is required to assist them in navigating the complex interactions between mental illness and smoking in relation to their psychosocial well-being and capacity to quit. This study describes the adaptations required for the Kick.it app to meet the specific needs and preferences of people with SMI. Results of this study will guide the tailoring of the Kick.it app for SMI populations. The study findings can also inform a co-design process for the future development and design of smoking cessation apps for SMI populations.
Project description:OBJECTIVES:To investigate whether and how user data are shared by top rated medicines related mobile applications (apps) and to characterise privacy risks to app users, both clinicians and consumers. DESIGN:Traffic, content, and network analysis. SETTING:Top rated medicines related apps for the Android mobile platform available in the Medical store category of Google Play in the United Kingdom, United States, Canada, and Australia. PARTICIPANTS:24 of 821 apps identified by an app store crawling program. Included apps pertained to medicines information, dispensing, administration, prescribing, or use, and were interactive. INTERVENTIONS:Laboratory based traffic analysis of each app downloaded onto a smartphone, simulating real world use with four dummy scripts. The app's baseline traffic related to 28 different types of user data was observed. To identify privacy leaks, one source of user data was modified and deviations in the resulting traffic observed. MAIN OUTCOME MEASURES:Identities and characterisation of entities directly receiving user data from sampled apps. Secondary content analysis of company websites and privacy policies identified data recipients' main activities; network analysis characterised their data sharing relations. RESULTS:19/24 (79%) of sampled apps shared user data. 55 unique entities, owned by 46 parent companies, received or processed app user data, including developers and parent companies (first parties) and service providers (third parties). 18 (33%) provided infrastructure related services such as cloud services. 37 (67%) provided services related to the collection and analysis of user data, including analytics or advertising, suggesting heightened privacy risks. Network analysis revealed that first and third parties received a median of 3 (interquartile range 1-6, range 1-24) unique transmissions of user data. Third parties advertised the ability to share user data with 216 "fourth parties"; within this network (n=237), entities had access to a median of 3 (interquartile range 1-11, range 1-140) unique transmissions of user data. Several companies occupied central positions within the network with the ability to aggregate and re-identify user data. CONCLUSIONS:Sharing of user data is routine, yet far from transparent. Clinicians should be conscious of privacy risks in their own use of apps and, when recommending apps, explain the potential for loss of privacy as part of informed consent. Privacy regulation should emphasise the accountabilities of those who control and process user data. Developers should disclose all data sharing practices and allow users to choose precisely what data are shared and with whom.