Automated Digital Interventions and Smoking Cessation: Systematic Review and Meta-analysis Relating Efficiency to a Psychological Theory of Intervention Perspective

Abstract

Background Smoking remains a highly significant preventable global public health problem. In this context, digital interventions offer great advantages in terms of a lack of biological side effects, possibility of automatic delivery, and consequent human resource savings relative to traditional interventions. Such interventions have been studied in randomized controlled trials (RCTs) but have not been systematically reviewed with the inclusion of text-based and multiplatform-based interventions. In addition, this area has not been evaluated from the perspective of the psychological theoretical basis of intervention. Objective The aim of this paper is to assess the efficiency of digital interventions in RCT studies of smoking cessation and to evaluate the effectiveness of the strategies used for digital interventions. Methods An electronic search of RCTs was conducted using PubMed, Embase, and the Cochrane Library by June 30, 2021. Eligible studies had to compare automated digital intervention (ADI) to the use of a self-help guideline or no intervention. Participants were current smokers (aged 16 years or older). As the main outcome, abstinence after endpoint was extracted from the studies. Systematic review and meta-analysis were conducted to assess the efficiency of ADIs. Metaregressions were conducted to assess the relationship between intervention theory and effectiveness. Results A total of 19 trials (15,472 participants) were included in the analysis. The overall abstinence rate (95% CI) at the endpoint was 17.8% (17.0-18.7). The overall risk ratio of the intervention group compared to the controls at the endpoint was 17.8% (17.0-18.7). Cochrane risk-of-bias tool for randomized trials (ROB 2) suggested that most of the studies had a low risk of bias (56.3%). Psychological theory–related constructs or predictors, which refer to other theory-based concepts (rather than only behavioral theory) such as craving or anxiety, are associated with effectiveness. Conclusions This study found that ADI had a clear positive effect compared to self-help guidelines or to no intervention, and effectiveness was associated with theory-related constructs or predictors. ADIs should be promoted by policy makers and clinical practitioners to address the huge gap between the need for smoking cessation and availability of traditional treatment resources. Possible increases in ADI efficiency may be achieved by optimally integrating psychotherapeutic theories and techniques. Trial Registration PROSPERO CRD42021256593; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=256593

Applications of digital health approaches for cardiometabolic diseases prevention and management in the Western Pacific region

“…of studies Population Digital intervention Control Countries/regions No. of studies in WPR a Combined effects b 1 Smoking cessation Sha L, 2022 9 19 High risk (smoker) Short messaging service Mobile Apps None Self-help guideline Asia (nWPR) (n = 2) Europe (n = 7) South America (n = 1) North America (n = 5) WPR (n = 3) Multi-center (the US, UK, Australia, and Singapore) (n = 1) Australia (n = 1) China (n = 2) New Zealand (n = 1) Singapore (n = 1) Benefits for smoking cessation, pooled RR = 1.6 (95% CI: 1.3, 1.9) 2 Smoking cessation Kock L, 2019 10 42 High risk (smoker) Short messaging service Mobile Apps Usual care Mixed Asia (nWPR) (n = 1) Europe (n = 8) North America (n = 30) WPR (n = 3) Australia (n = 2) China (n = 1) Benefits for smoking cessation, pooled RR = 1.6 (95% CI: 1.4, 1.8) 3 Smoking cessation Whittaker R, 2019 11 26 High risk (smoker) Short messaging service Mobile Apps None Self-help guideline Europe (n = 7) North America (n = 9) WPR (n = 9) Multi-center (the US, UK, Australia, and Singapore) (n = 1) Australia (n = 4) China (n = 4) New Zealand (n = 2) Singapore (n = 1) Benefits for smoking cessation, pooled RR = 1·5 (95% CI: 1.2, 2.0) 4 Healthy diet Beck Silva KB, 2022 12 13 General Internet-based services Usual care Asia (nWPR) (n = 1) Europe (n = 5) North America (n = 7) NA Benefits for reducing consumption of fats, pooled SMD = −0.1 (95% CI: −0.2, −0.1) 5 Healthy diet, Exercise, Weight loss Robert C, 2021 1...…”

“…Various ICTs were used for daily tasks and schedule management in behavior intervention. 9 , 10 , 11 , 13 , 17 Wearable devices and/or videoconferencing for exercise, and mobile apps used for recording diet, were also effective for behavior interventions. 15 , 16 , 18 …”

The Impact of Digital Health on Smoking Cessation

“…After 3 months, e-visit participants, when compared with usual treatment participants, were 4.13 (95% CI 1.06-16.10; P =.04) times more likely to have reduced their number of cigarettes smoked per day by at least 50%. In a recent systematic review that evaluated the efficacy of digital interventions in randomized clinical trial studies of smoking cessation, 19 trials (15,472 participants) were included in the analysis, and the overall abstinence rate (percentage of participants who did not smoke during a follow-up period of at least 3 months) at the end point was 17.8% (95% CI 17%-18.7%); the authors concluded that digital health had a clear positive effect when compared to self-help guidelines or no intervention [ 35 ].…”

“…It is therefore clear that it is necessary to carry out interventions that do not imply the need for pharmacological treatment and to have data on efficacy and efficiency that support their generalization to the smoking population. Other reviews that address this topic have been performed [ 33 - 35 ]. However, this viewpoint paper is not so much a review in itself, but rather an update on the state of digital health in general and its impact on smoking cessation programs.…”

Do medications increase the efficacy of digital interventions for smoking cessation? Secondary results from the iCanQuit randomized trial

“…Taking into account this small body of research, novel scientific knowledge would be gained from examining the question of whether pharmacotherapy improves the efficacy of existing digital interventions shown efficacious for smoking cessation. Given that digital interventions are becoming the most common self-help intervention for smoking [3,30,31], understanding whether or not medications improve the efficacy of smoking cessation apps is a timely question.…”