Effectiveness of a Web-Based Multiple Tailored Smoking Cessation Program: A Randomized Controlled Trial Among Dutch Adult Smokers

Abstract

BackgroundDistributing a multiple computer-tailored smoking cessation intervention through the Internet has several advantages for both provider and receiver. Most important, a large audience of smokers can be reached while a highly individualized and personal form of feedback can be maintained. However, such a smoking cessation program has yet to be developed and implemented in the Netherlands.ObjectiveTo investigate the effects of a Web-based multiple computer-tailored smoking cessation program on smoking cessation outcomes in a sample of Dutch adult smokers.MethodsSmokers were recruited from December 2009 to June 2010 by advertising our study in the mass media and on the Internet. Those interested and motivated to quit smoking within 6 months (N = 1123) were randomly assigned to either the experimental (n = 552) or control group (n = 571). Respondents in the experimental group received the fully automated Web-based smoking cessation program, while respondents in the control group received no intervention. After 6 weeks and after 6 months, we assessed the effect of the intervention on self-reported 24-hour point prevalence abstinence, 7-day point prevalence abstinence, and prolonged abstinence using logistic regression analyses.ResultsOf the 1123 respondents, 449 (40.0%) completed the 6-week follow-up questionnaire and 291 (25.9%) completed the 6-month follow-up questionnaire. We used a negative scenario to replace missing values. That is, we considered respondents lost to follow-up to still be smoking. The computer-tailored program appeared to have significantly increased 24-hour point prevalence abstinence (odds ratio [OR] 1.85, 95% confidence interval [CI] 1.30–2.65), 7-day point prevalence abstinence (OR 2.17, 95% CI 1.44–3.27), and prolonged abstinence (OR 1.99, 95% CI 1.28–3.09) rates reported after 6 weeks. After 6 months, however, no intervention effects could be identified. Results from complete-case analyses were similar.ConclusionsThe results presented suggest that the Web-based computer-tailored smoking cessation program had a significant effect on abstinence reported after a 6-week period. At the 6-month follow-up, however, no intervention effects could be identified. This might be explained by the replacement of missing values on the primary outcome measures due to attrition using a negative scenario. While results were similar when using a less conservative scenario (ie, complete-case analyses), the results should still be interpreted with caution. Further research should aim at identifying strategies that will prevent high attrition in the first place and, subsequently, to identify the best strategies for dealing with missing data when studies have high attrition rates.Trial RegistrationDutch Trial Register NTR1351; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=1351 (Archived by WebCite at http://www.webcitation.org/67egSTWrz)

Process Evaluation of the First Computer Tailored Program for Smoking Cessation among Romanian Smokers

“…Similar with other studies (Diskstra et al, 1998;Te Poel et al, 2009;Smit et al, 2012), around 19% of the participants did not fill in the process evaluation questionnaire and the results are based only on self reported data. The intervention did not provide medical treatment, only counselling, but it offered information about way they could get more medical advice and help.…”

“…The tailored intervention was based on previously developed computer-tailored smoking cessation interventions (Diskstra et al, 1998;Te Poel et al, 2009;Smit et al, 2012) while the I-Change model served as the theoretical framework (De Vries et al, 2003). A library with messages which might be needed was created.…”

“…After filling in the questionnaire, feedback messages were selected from the library of messages developed previously based on the characteristics of each participant. Feedback messages were tailored to several respondent characteristics (Diskstra et al, 1998;Te Poel et al, 2009;Smit et al, 2012): gender, cognitive variables (attitude, social influence, and self-efficacy), intention to quit smoking, goal and relapse prevention strategies (action and coping plans), and smoking behaviour. Feedback messages were combined into one personalized 9 to 11 pages letter.…”

Predictors of successful and unsuccessful quit attempts among smokers motivated to quit

“…After providing online informed consent, participants were randomized into the intervention group or the no intervention control group using a computer software randomization device, allocating approximately 50% of respondents to either group. Full details about the RCT can be found elsewhere (Smit et al, 2012).…”

“…Despite using the motivation to quit as an inclusion criterion, however, smoking cessation intervention studies still show that many smokers do not make a quit attempt during the study period, or do make a quit attempt but relapse to smoking soon after their attempt (Hoving et al, 2010;Smit et al, 2012;Te Poel et al, 2009). It is therefore important to not only identify the predictors of undertaking a quit attempt, but also to investigate the predictors of quit attempt success among smokers participating in smoking cessation intervention studies.…”