Effects of a Mobile App Called Quittr, Which Utilizes Premium Currency and Games Features, on Improving Engagement With Smoking Cessation Intervention: Pilot Randomized Controlled Trial

Abstract

Background Numerous mobile health (mHealth) apps have been developed to support smokers attempting to quit smoking. Although these apps have been reported to be successful, only modest improvements in the quit rate have been measured. It has been proposed that efforts to improve user engagement and retention may improve the quit rate further. Owing to the high cost of smoking-related disease, it is considered worthwhile to pursue even small improvements. Objective The aim of this study was to test a novel smartphone app that leverages premium currency strategies developed by the mobile games industry in an attempt to improve engagement and retention with a smoking cessation intervention. Methods We designed and developed a smoking cessation app called “Quittr” in line with previously developed smoking cessation mHealth apps. In addition to this established framework, we added a stand-alone fully featured city-building clicker-style game called “Tappy Town,” and a premium virtual currency called “QuitCoins.” The user earns QuitCoins for using the app in a way that contributes positively toward their quit attempt, and they can redeem these coins in Tappy Town for bonuses. To establish whether these features improved engagement and retention, we ran a 5-month randomized controlled trial where the intervention group had the full app with the extra games features, while the control group had the standard app only. Recruitment was performed via web-based advertising. Participants (N=175) had no direct contact with the researchers or other support staff. Results No significant differences in terms of engagement, retention, or smoking outcomes were found between the control and intervention groups. However, survey data indicated that the majority of the participants valued Tappy Town (10/17, 59%) and the QuitCoins rewards system (13/17, 77%). Usage data also suggested that Tappy Town was widely played and was generally appealing to users (mean total time spent in app, control group: 797 seconds vs intervention group: 3502 seconds, P<.001). Analysis of the results suggests that users in the intervention group may have been negatively affected by the aspects of the chosen design, and some theories were explored to explain this unexpected outcome. Conclusions Although the novel features of the Quittr app failed to improve the key outcomes measured in this study, there were enough positive indications to warrant further exploration of the concept. Additional research will be required to identify and correct any design flaws that may have adversely affected our participants before a follow-up study can be completed. Trial Registration Australian and New Zealand Clinical Trials Register ACTRN12617000491369; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372661&isReview=true

Developing a Game (Inner Dragon) Within a Leading Smartphone App for Smoking Cessation: Design and Feasibility Evaluation Study

“…Our study of Inner Dragon contributes to the developing literature about the feasibility, engagement, and effectiveness of gamified smoking cessation apps. A small number of such apps have been developed and evaluated, including Crush the Crave [ 23 , 24 ], QuitIT [ 26 , 27 ], Quittr [ 28 , 29 ], and Tobbstop [ 30 , 31 ]. Overall, the literature highlights low user engagement for gamified smoking cessation apps.…”

“…QuitIT users also had low user engagement, with only 40% of participants reporting that they played the game [ 27 ]. User engagement was high among the Quittr users with access to the Tappy Town game (mean of 58.4 min of using the app over a 28-day trial) [ 29 ] and the Tobbstop app in which 65.9% of participants successfully used the app [ 31 ]. In comparison, 75% (18/24) of our study’s participants used the Inner Dragon game in the Smoke Free app at least once throughout the 28-day trial, resulting in relatively high user engagement compared with other apps.…”

“…Several gamified apps have been developed to help people quit smoking, such as Cigbreak [ 22 ], Crush the Crave [ 23 , 24 ], Inspired [ 25 ], QuitIT [ 26 , 27 ], Quittr [ 28 , 29 ], and Tobbstop [ 30 , 31 ]. A small number of randomized controlled trials of these apps have been conducted, and they have generally found that users were satisfied with the gamified app, but most did not experience significant increases in smoking abstinence [ 23 , 27 , 29 , 31 ]. User engagement and retention of these apps also varied, with each study adopting a different approach to measurement (eg, number of game “episodes” completed or minutes played).…”

The current evidence for substance use disorder apps

“…While these findings are encouraging, it remains clear that achieving mHealth app engagement and retention remains challenging, despite the ostensible benefits of gamification. This is further illustrated in a recent RCT exploring the impact of sophisticated gamification elements of the 'Quittr' app, featuring a craving distraction game with a virtual currency incentivisation system, on intervention engagement, retention and smoking outcomes among 175 smokers interested in quitting, relative to a nongamified version of the app [27]. While participants in the gamified version spent significantly more time on the app, the control group achieved significantly better median reductions in daily cigarette use than the intervention group (12 versus 0 CPD).…”

Evaluation of the smoking cessation effects of QuitAction, a smartphone WeChat platform

“…These mobile smoking cessation platforms are effective and eliminate the time and space limitations of outpatient smoking cessation services. In addition, the platforms are inexpensive, easy to use, and can be used by many users simultaneously 5 , 6 . These include SmartQuit, SmokeFree28, and Q Sense 7 .…”