A Smartphone App to Assist Smoking Cessation Among Aboriginal Australians: Findings From a Pilot Randomized Controlled Trial

Abstract

Background Mobile health (mHealth) apps have the potential to increase smoking cessation, but little research has been conducted with Aboriginal communities in Australia. Objective We conducted a pilot study to assess the feasibility and acceptability and explore the effectiveness of a novel mHealth app to assist Aboriginal people to quit smoking. Methods A pilot randomized controlled trial (RCT) and process evaluation comprising usage analytics data and in-depth interviews was conducted. Current Aboriginal smokers (>16 years old), who were willing to make a quit attempt in the next month, were recruited from Aboriginal Community Controlled Health Services and a government telephone coaching service. The intervention was a multifaceted Android or iOS app comprising a personalized profile and quit plan, text and in-app motivational messages, and a challenge feature allowing users to compete with others. The comparator was usual cessation support services. Outcome data collection and analysis were conducted blinded to treatment allocation. The primary outcome was self-reported continuous smoking abstinence verified by carbon monoxide breath testing at 6 months. Secondary outcomes included point prevalence of abstinence and use of smoking cessation therapies and services. Results A total of 49 participants were recruited. Competing service delivery priorities, the lack of resources for research, and lack of support for randomization to a control group were the major recruitment barriers. At baseline, 23/49 (47%) of participants had tried to quit in recent weeks. At 6-month follow-up, only 1 participant (intervention arm) was abstinent. The process evaluation highlighted low to moderate app usage (3-10 new users per month and 4-8 returning users per month), an average of 2.9 sessions per user per month and 6.3 min per session. Key themes from interviews with intervention participants (n=15) included the following: (1) the powerful influence of prevailing social norms around acceptability of smoking; (2) high usage of mobile devices for phone, text, and social media but very low use of other smartphone apps; (3) the role of family and social group support in supporting quit attempts; and (4) low awareness and utilization of smoking cessation support services. Despite the broad acceptability of the app, participants also recommended technical improvements to improve functionality, greater customization of text messages, integration with existing social media platforms, and gamification features. Conclusions Smoking cessation apps need to be integrated with commonly used functions of mobile phones and draw on social networks to support their use. Although they have the potential to increase utilization of cessation support services and treatments, more research is needed to identify optimal implementation models. Robust evaluation is critical to determine their impact; however, an RCT desi...

Effectiveness of mobile applications to quit smoking: Systematic review and meta-analysis

“…Qualitative analysis was performed with four studies, but the quantitative analysis was only carried out with the studies of Buller et al 35 , Danaher al. 34 , and Baskerville et al 36 , given the impossibility of calculating the RR for the study by Peiris et al 33 .…”

“…In fact, four of them compared different versions of the same application (one more extensive version and another much smaller), and 1 was not a clinical trial but a cross-sectional study evaluating the characteristics of users of web-based programs or websites for mobiles ( Figure 1 ). The characteristics of the four studies 33 - 36 selected are summarized in Table 1 . Qualitative analysis was performed with four studies, but the quantitative analysis was only carried out with the studies of Buller et al 35 , Danaher al.…”

“…In the study of Peiris et al 33 , 49 current Aboriginal smokers (aged >16 years), who were willing to make a quit attempt in the next month, and with access to an iPhone or Android smartphone participated in the clinical trial. The intervention consisted of a personalized profile and quit plan, text and in-app motivational message.…”

Supports Used by Aboriginal and Torres Strait Islander Women for Their Health, including Smoking Cessation, and a Baby’s Health: A Cross-Sectional Survey in New South Wales, Australia

“…There has only been one trial of a targeted smoking cessation app for Aboriginal and Torres Strait Islanders, which had poor uptake and implementation challenges impacting on feasibility, which demonstrates the challenges of research in this field [ 39 ]. The uptake of the app might have been different if the app had been available on ‘general release’ through app stores [ 39 ]. The trustworthiness of apps or the lack of culturally targeted apps may reflect the lower use of apps in the women we surveyed.…”

Peace of mind: A community-industry-academic partnership to adapt dementia technology for Anishinaabe communities on Manitoulin Island

“…The general exploration of mHealth or eHealth applications among adults supports the feasibility and indicates a general interest in technologies, though economic and connectivity limitations in rural and remote areas are always a strong concern. 15 , 21 – 23 None of the products reviewed in a recent systematic review of mHealth technologies who engaged Indigenous communities included products specific to issues of aging. 24 Finally, with dementia-specific surveillance technology research, not one of the surveillance technology products described in several systematic reviews reported the inclusion of Indigenous or American Indian communities.…”