Exploring Community Smokers’ Perspectives for Developing a Chat-Based Smoking Cessation Intervention Delivered Through Mobile Instant Messaging: Qualitative Study

Abstract

Background Advances in mobile communication technologies provide a promising avenue for the delivery of tobacco dependence treatment. Although mobile instant messaging (IM) apps (eg, WhatsApp, Facebook messenger, and WeChat) are an inexpensive and widely used communication tool, evidence on its use for promoting health behavior, including smoking cessation, is scarce. Objective This study aims to explore the perception of using mobile IM as a modality to deliver a proposed chat intervention for smoking cessation in community smokers in Hong Kong, where the proportion of smartphone use is among the highest in the world. Methods We conducted 5 focus group, semistructured qualitative interviews on a purposive sample of 15 male and 6 female current cigarette smokers (age 23-68 years) recruited from the community in Hong Kong. All interviews were audiotaped and transcribed. Two investigators independently analyzed the transcripts using thematic analyses. Results Participants considered mobile IM as a feasible and acceptable platform for the delivery of a supportive smoking cessation intervention. The ability to provide more personalized and adaptive behavioral support was regarded as the most valued utility of the IM–based intervention. Other perceived utilities included improved perceived psychosocial support and identification of motivator to quit. In addition, participants provided suggestions on the content and design of the intervention, which may improve the acceptability and usability of the IM–based intervention. These include avoiding health warning information, positive messaging, using former smokers as counselors, and adjusting the language style (spoken vs written) according to the recipients’ preference. Conclusions This qualitative study provides the first evidence that mobile IM may be an alternative mobile health platform for the delivery of a smoking cessation intervention. Furthermore, the findings inform the development of a chat-based, IM smoking cessation program being evaluated in a community trial.

Chat-based instant messaging support integrated with brief interventions for smoking cessation: a community-based, pragmatic, cluster-randomised controlled trial

“…The chat-based intervention focused on identifying a value to increase commitment to quit by using ACT, which might be particularly effective in participants who did not have a motivator to quit and not as effective in those who already had a reason to quit. 10 Our results also corroborate previous qualitative findings in the USA that smokers not interested in quitting might be receptive to mHealth support, which was regarded as a novel way to change their smoking behaviour. 32 The mean cost of recruiting a participant and delivering brief advice at baseline was low (US$8•2), suggesting a high scalability of the proactive, lay counsellor-delivered treatment model in places where health-care resources are scarce (eg, in low-income and middle-income countries).…”

“…Details of the design and content of the chat-based intervention have been described elsewhere. 10,21 Briefly, a smoking cessation counsellor interacted with a participant in real time and provided personalised, theory-based cessation support. The acceptance and commitment therapy (ACT) is a counselling model focusing on increasing psychological capacity to accept unpleasant experiences while committing to value-guided behavioural change.…”

“…Our pilot trial 9 found counsellor-moderated WhatsApp social groups to be effective in preventing relapse among individuals who had recently quit. Our formative qualitative study 10 of community smokers showed that mobile instant messaging is a feasible and acceptable platform for chat-based smoking cessation support.…”

“…15 We developed a chat-based smoking cessation support programme delivered through instant messaging, which was designed to improve abstinence by providing theorybased behavioural support and increasing the use of smoking cessation services. 10 In this trial, we assessed the effect of chat-based instant messaging support, which was integrated with brief interventions from the AWARD model, on abstinence among proactively-recruited smokers from community sites in Hong Kong.…”

Mobile chat-based support plus nicotine replacement therapy sampling to promote smoking cessation for community smokers: A randomized controlled trial

“…WhatsApp and WeChat) have become popular because they are cheaper and more attractive than SMS 12 . Our formative qualitative study, which interviewed 21 smokers in 5 focus groups, supports the acceptability and feasibility of mobile instant messaging for chatbased SC support 13 . Our recent randomized controlled trial (RCT) on 1185 community-based smokers has shown that combined 3 months of chat-based support with brief advice intervention (vs brief advice alone) increased validated smoking abstinence (8% vs 5%, p=0.040) and SC service use (17% vs 4%, p<0.001) at 6 months follow-up 14 .…”