Effectiveness of Message Frame-Tailoring in a Web-Based Smoking Cessation Program: Randomized Controlled Trial

Abstract

Background The content of online computer-tailored interventions is often determined to match an individual’s characteristics, beliefs, and behavioral factors. These content-tailored interventions lead to better message processing and a higher likelihood of behavior change such as smoking cessation. However, a meta-analysis of online computer-tailored interventions showed that effect sizes, albeit positive, remain small, suggesting room for improvement. A promising strategy to enhance the effectiveness of online computer-tailored interventions is to tailor the message frame (ie, how a message is communicated) based on the preferred communication style of the user in addition to content-tailoring. One factor that determines an individual’s communication style preference is the need for autonomy; some individuals prefer an autonomy-supportive communication style (offering choice and use of suggestive language), whereas others might prefer a directive communication style, which is replete with imperatives and does not provide choice. Tailoring how messages are presented (eg, based on the need for autonomy) is called message frame-tailoring. Objective The aim of the present study was to test the effectiveness of message frame-tailoring based on the need for autonomy, in isolation and in combination with content-tailoring, within the context of an online computer-tailored smoking cessation intervention. The primary outcome measure was the 7-day point-prevalence of smoking abstinence. Secondary outcomes were perceived message relevance, self-determined motivation to quit smoking, and sociocognitive beliefs. Methods A randomized controlled trial with a 2 (message frame-tailoring vs no message frame-tailoring) by 2 (content-tailoring vs no content-tailoring) design was conducted among adult smokers intending to quit smoking (N=273). Results Structural equation modeling revealed that the content-tailored condition increased smoking abstinence rates 1 month after the start of the intervention (beta=.57, P=.02). However, neither message frame-tailoring nor its interaction with content-tailoring significantly predicted smoking abstinence. In our model, message frame-tailoring, content-tailoring, as well as their interaction significantly predicted perceived relevance of the smoking cessation messages, which consequently predicted self-determined motivation. In turn, self-determined motivation positively affected attitudes and self-efficacy for smoking cessation, but only self-efficacy consequently predicted smoking abstinence. Participants in the control condition perceived the highest level of message relevance (mean 4.78, SD 1.27). However, messages that were frame-tailored for individuals with a high need for autonomy in combination with content-tailored messages led to significantly higher levels of perceived message relevance (mean 4.83, SD 1.03) compared to those receiving content-tailored messages only (mean 4.24, SD 1.05, P=.003). Conclusions Message frame-tailoring based on the need for autonomy seems to be an effective addition to conventional content-tailoring techniques in online smoking cessation interventions for people with a high need for autonomy; however, this is not effective in its current form for people with a low need for autonomy. Trial Registration Dutch Trial Register (NL6512/NRT-6700); https://www.trialregister.nl/trial/6512

Communicating risk to promote colorectal cancer screening: a multi-method study to test tailored versus targeted message strategies

“…Greater perceived message relevance was associated with higher perceived susceptibility, which in turn predicted CRC screening intentions. These findings support previous literature on the benefits of tailored risk messages [ 5 , 6 , 11 , 40 , 41 ] and provide further insight into the theoretical mechanisms that underlie the efficacy of this approach.…”

A Web-Based Intervention to Increase Smokers’ Intentions to Participate in a Cessation Study Offered at the Point of Lung Screening: Factorial Randomized Trial

“…Past studies have demonstrated baseline cognitive perceptions about quitting as a predictor of enrollment in cessation trials [ 44 , 53 ]. Consistent with the elaboration likelihood model, greater perceptions of message relevance are associated with high-involvement processing and greater motivations to adhere to recommendations made within a message [ 20 , 54 , 55 ]. Perceived message relevance has been demonstrated to be important at predicting intentions within other smoking behavior contexts, but is a novel finding in predicting research participation.…”

Tailored Web-Based Smoking Interventions and Reduced Attrition: Systematic Review and Meta-Analysis

“…At the time of the search update, the full text of Kahler [ 34 ] was not available, and thus, the details required for the meta-analysis could not be extracted. Additionally, due to unclear details regarding the control intervention, we excluded the study by Altendorf et al [ 35 ].…”

“…When the 6 studies [ 23 - 25 , 28 , 30 , 35 ] that reported attrition at 3-month follow-up were pooled ( Figure 4 ), no significant differences were found in the risk of attrition between the tailored interventions and their untailored controls (RR=0.99, 95% CI 0.95-1.04; P =.80) with high heterogeneity in the estimate ( I 2 =73%). This finding suggests that tailoring had no effect on dropout attrition at 3-month follow-up.…”