Abstract

Mobile instant messaging apps offer a modern way to deliver personalised smoking cessation support through real-time, interactive messaging (chat). In this trial, we aimed to assess the effect of chat-based instant messaging support integrated with brief interventions on smoking cessation in a cohort of smokers proactively recruited from the community. In this two-arm, pragmatic, cluster-randomised controlled trial, we recruited participants aged 18 years or older who smoked at least one cigarette per day from 68 community sites in Hong Kong, China. Community sites were computer randomised (1:1) to the intervention group, in which participants received chat-based instant messaging support for 3 months, offers of referral to external smoking cessation services, and brief advice, or to the control group, in which participants received brief advice alone. The chat-based intervention included personalised behavioural support and promoted use of smoking cessation services. Masking of participants and the research team was not possible, but outcome assessors were masked to group assignment. The primary outcome was smoking abstinence validated by exhaled carbon monoxide concentrations lower than 4 parts per million and salivary cotinine concentrations lower than 10 ng/mL at 6 months after treatment initiation (3 months after the end of treatment). The primary analysis was by intention to treat and accounted for potential clustering effect by use of generalised estimating equation models. This trial is registered with ClinicalTrials.gov, number NCT03182790. Between June 18 and Sept 30, 2017, 1185 participants were randomly assigned to either the intervention (n=591) or control (n=594) groups. At the 6-month follow-up (77% of participants retained), the proportion of validated abstinence was significantly higher in the intervention group than in the control group (48 [8%] of 591 in intervention vs 30 [5%] of 594 in control group, unadjusted odds ratio 1·68, 95% CI 1·03-2·74; p=0·040). Engagement in the chat-based support in the intervention group was low (17%), but strongly predicted abstinence with or without use of external smoking cessation services. Chat-based instant messaging support integrated with brief cessation interventions increased smoking abstinence and could complement existing smoking cessation services. Hong Kong Council on Smoking and Health.

Highlights

  • Advances in mobile technologies have provided a new avenue for mobile phone-based interventions for smoking cessation

  • Personalised, chat-based support provided in real time by counsellors is an emerging area in mental health care,[7] but no study has yet assessed its effect on smoking abstinence

  • We identified a relevant Cochrane review of mobile phone-based interventions in general, three meta-analyses focusing on text-messaging support, a systematic review on smartphone apps, and a systematic review on social media

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Summary

Introduction

Advances in mobile technologies have provided a new avenue for mobile phone-based interventions (mHealth) for smoking cessation. Randomised trials have found mobile text messaging through short message service (SMS) to be effective for smoking cessation,[1,2] primarily by increasing perceived psychosocial support.[3] Whether more interactive and adaptive mHealth platforms, including smartphone apps and social networking tools, could further improve smoking cessation outcomes remains inconclusive.[4,5,6] Personalised, chat-based support provided in real time by counsellors is an emerging area in mental health care,[7] but no study has yet assessed its effect on smoking abstinence. Our formative qualitative study[10] of community smokers showed that mobile instant messaging is a feasible and acceptable platform for chat-based smoking cessation support

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