Abstract
Background: Young adults with serious mental illness (SMI) are over twice as likely to smoke cigarettes than those in the general population, but little research has evaluated the efficacy of interventions for this group. While smartphone apps are a promising tool to address this need, their usability should be evaluated among young adults with psychotic disorders, whose symptoms and cognitive impairments may be a barrier to app use.Methods: We compared usability and acceptability of National Cancer Institute apps (QuitGuide and quitSTART) between young adult smokers with SMI psychotic disorders and other SMI diagnoses. We evaluated objective app usability at the initial study visit and following 2 weeks of independent use via a video-recorded task-completion protocol. Perceptions of usability and acceptability were assessed with semi-structured interviews. Engagement was assessed with backend app use data.Results: Participants had a mean age of 29 years old (SD = 4). Of the participants without psychotic disorders (n = 10), all were diagnosed with SMI post-traumatic stress disorder (SMI-PTSD). QuitGuide objective task completion rates were high and similar between diagnosis groups, whereas quitSTART task completion was initially lower among users with psychotic disorder compared to users with SMI-PTSD at Visit 1, and improved by Visit 2. Mean app interactions, mean days of use, and median completed notifications were dramatically higher among quitSTART users compared to QuitGuide users. Compared to quitSTART users with SMI-PTSD, quitSTART users with psychotic disorders had similar daily app interactions over the first week of use (mean 3.8 ± 2.4 interactions), and numerically lower mean daily app interactions during the second week (1.9 ± 1.5 vs. 3.4 ± 2.5), whereas completed notifications remained stable among quitSTART users in both diagnosis groups over time. Qualitative comments indicated general acceptability of both apps among both diagnosis groups.Conclusions: Both QuitGuide and quitSTART were usable and appealing among young adult smokers with psychotic disorders and SMI-PTSD, although quitSTART engendered a dramatically greater level of engagement compared to QuitGuide. Initial coaching to support initiation and app notifications to promote prolonged engagement may be important for young adult smokers with psychotic disorders. Replication and efficacy testing for quitSTART is warranted.
Highlights
While the overall rate of smoking in the United States continues to decline, smoking rates remain higher and cessation rates remain lower for people with serious mental illness (SMI; such as schizophrenia and severe mood or anxiety disorders) compared to the general population [1,2,3]
Smoking cessation apps are a promising tool based on testing among general population adults [e.g., [10, 11]], but no research has evaluated their impact in young adults with SMI
The psychosis and SMI-PTSD groups were similar, though there was a lower proportion of female participants in the psychosis group (n = 1, 14% vs. n = 6, 60%)
Summary
While the overall rate of smoking in the United States continues to decline, smoking rates remain higher and cessation rates remain lower for people with serious mental illness (SMI; such as schizophrenia and severe mood or anxiety disorders) compared to the general population [1,2,3]. We previously conducted focus groups among young adults with SMI that identified an interest in using smoking cessation apps during a quit attempt as well as an interest in a variety of app features related to smoking and quitting [12]. These young adults did not specify an interest in addressing their mental illness within a smoking cessation app, suggesting that apps with evidence-based smoking cessation content designed for the general public may be appealing to this group.
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