A Behavioral Activation Mobile Health App for Smokers With Depression: Development and Pilot Evaluation in a Single-Arm Trial.

Jaimee L Heffner,Jonathan B Bricker,Noreen L Watson,Melissa Gasser,Edit Serfozo,Laura Macpherson,Kristin E Mull

doi:10.2196/13728

Abstract

BackgroundThe integration of Behavioral Activation Treatment for Depression (BAT-D) into smoking cessation interventions is a promising approach to address depression as a barrier to quitting. However, this approach has only been tested as a face-to-face intervention, which has low reach.ObjectiveThe aims of the study were to develop a BAT-D mobile health app with high potential reach and determine its feasibility, acceptability, and preliminary effects on theory-based behavioral processes of behavioral activation, reduced depressive symptoms, and smoking cessation.MethodsFollowing a user-centered design process consisting of competitive analysis, focus groups, and prototype testing, we conducted a single-arm pilot trial of Actify!, a BAT-D app for depressed smokers. Participants used SmokefreeTXT along with Actify! to provide cessation content that had not yet been built into the app for this initial phase of pilot testing. Participants in the trial were current, daily smokers with mild to moderate depressive symptoms. We examined use outcomes for all enrolled participants and process and cessation outcomes at 6 weeks postenrollment for study completers (16/17, 94% retention).ResultsRegarding acceptability, average number of log-ins per participant was 16.6 (SD 13.7), and 63% (10/16) reported being satisfied overall with the app. Posttreatment interviews identified some usability challenges (eg, high perceived burden of planning and scheduling values-based activities). There was a significant decrease in depressive symptoms from baseline to follow-up (mean change in Patient Health Questionnaire–9 scores was –4.5, 95% CI –7.7 to –1.3; P=.01). Additionally, carbon monoxide (CO)-confirmed, 7-day point prevalence abstinence (PPA) at 6-week follow-up was 31% (5/16), and the 30-day PPA was 19% (3/16).ConclusionsResults demonstrate promising engagement with Actify! and potential for impact on theory-based change processes and cessation outcomes. Preliminary quit rates compare favorably to previous trials of smoking cessation apps for the general population (ie, short-term, self-reported 30-day quit rates in the 8% to 18% range) and a previous trial of face-to-face BAT-D for depressed smokers (ie, CO-confirmed, 7-day PPA rate of 17% at end of treatment).

Highlights

Cigarette smoking remains the leading preventable cause of death in the United States as well as the leading cause of cancer-related mortality, accounting for 32% of all cancer deaths [1,2]
Behavioral Activation Treatment for Depression (BAT-D) provides an integrative, behavioral theory–based approach to address depressive symptoms in the context of a smoking cessation intervention, as reinforcement theory holds that both smoking and depressed behaviors are maintained by limited reward for alternative, healthy behaviors [11]
We developed a BAT-D mobile health app for smoking cessation to extend the reach of this promising intervention to the estimated 13 to 16 million smokers with smartphones who have depressive symptoms [8,15,16,17], the vast majority of whom will not seek face-to-face counseling

Summary

Introduction

Cigarette smoking remains the leading preventable cause of death in the United States as well as the leading cause of cancer-related mortality, accounting for 32% of all cancer deaths [1,2]. Behavioral Activation Treatment for Depression (BAT-D) is a promising approach for improving smoking cessation outcomes among smokers with depressive symptoms [9]. The integration of Behavioral Activation Treatment for Depression (BAT-D) into smoking cessation interventions is a promising approach to address depression as a barrier to quitting. This approach has only been tested as a face-to-face intervention, which has low reach. Objective: The aims of the study were to develop a BAT-D mobile health app with high potential reach and determine its feasibility, acceptability, and preliminary effects on theory-based behavioral processes of behavioral activation, reduced depressive symptoms, and smoking cessation. Preliminary quit rates compare favorably to previous trials of smoking cessation apps for the general population (ie, short-term, self-reported 30-day quit rates in the 8% to 18% range) and a previous trial of face-to-face BAT-D for depressed smokers (ie, CO-confirmed, 7-day PPA rate of 17% at end of treatment)

Objectives

Methods

Results

Discussion

Conclusion