Feasibility and Engagement of a Mobile App Preparation Program (Kwit) for Smoking Cessation in an Ecological Context: Quantitative Study (Preprint)

Abstract

BACKGROUND Mobile health apps can facilitate access to effective treatment and therapeutic information services. However, the real-world effectiveness of mobile apps for smoking cessation and their potential impact in everyday settings remain unclear. OBJECTIVE In an ecological context, this study aimed to estimate the engagement rate of a mobile app–based smoking cessation preparation program and its potential impact on users’ willingness, ability, and readiness to quit smoking. METHODS A total of 2331 “organic users” (ie, users who discover and install a mobile app on their own, without any prompts) chose 1 of 2 program versions of the mobile app (Kwit): the basic version or the premium version. Both versions were identical in design, with 4 more evidence-based content items and strategies in the premium version. Outcomes were analyzed based on automated data registered in the app (engagement rate, motivation to quit, motivation type, motivation levels, and satisfaction level). Mann-Whitney and <i>χ</i><sup>2</sup> tests were used to compare the results of both groups. RESULTS As expected, in the ecological context, a high dropout rate was observed at different moments. A significant difference was observed between the 2 versions (n=2331; <i>χ</i><sup>2</sup><sub>1</sub>=5.4; <i>P</i>=.02), with a proportionally higher engagement rate in the premium version (premium=4.7% vs basic=2%). Likewise, differences were also observed between the 2 groups in terms of reasons to quit (n=2331; <i>χ</i><sup>2</sup><sub>4</sub>=19; <i>P</i>≤.001; V=0.08), motivation type (n=2331; <i>χ</i><sup>2</sup><sub>7</sub>=14.7; <i>P</i>=.04), and motivation level. Users of the app’s premium version more frequently reported “well-being” (23.3% vs 17.9%) and “planning a pregnancy” (7.4% vs 4.4%) as their primary reasons for quitting smoking compared to those with the basic version. Moreover, they reported being more likely to be driven in the smoking cessation process by intrinsic motivation (premium=28% vs basic=20.4%), as well as feeling significantly more willing (<i>z</i> score=156,055; <i>P</i>≤.001; Cohen <i>d</i>=0.15), able (<i>z</i> score=172,905; <i>P</i>=.04; Cohen <i>d</i>=0.09), and ready (<i>z</i> score=166,390; <i>P</i>=.005; Cohen <i>d</i>=0.12) to stop smoking than users who had the basic version before completion of the preparation program. Among participants who finished each version of the program (premium: 9/189, 4.8%; basic: 47/2142, 2.19%), significant improvements in motivation levels were observed in both groups, although in different areas for each group (willingness levels for the premium group and ability for the basic group). CONCLUSIONS These results suggest that even in ecological contexts where engagement rates are meager, the Kwit preparation program can address ambivalence by increasing willingness to change, self-confidence, and readiness to quit among its users, especially those who feel less able to do so. Further development and evaluations are needed to better understand determinants for regular mobile health apps.