Pilot Randomized Controlled Trial of a Novel Smoking Cessation App Designed for Individuals With Co-Occurring Tobacco Use Disorder and Serious Mental Illness

Vilardaga, Roger; Rizo, Javier; Palenski, Paige; Mannelli, Paolo; Oliver, Jason A.; McClernon, F. Joseph

doi:10.1093/ntr/ntz202

Cited by 38 publications

(59 citation statements)

References 45 publications

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“…Compared with recently reported data among middle-aged adults with SMI who were trying to quit smoking, QuitGuide usability scores were lower among these young adult participants [41]. Among middle-aged adults with SMI, the mean SUS score for young adults was 78.4 (SD 16.5), compared with 64 (SD 18) in this study.…”

Section: Comparison With Previous Workcontrasting

confidence: 93%

“…Nevertheless, our QuitGuide findings appear similar to those from other studies. In the study of middle-aged adults with SMI by Vilardaga et al [ 41 ], participants used the app on 32 (SD 24.5) days during the 120-day trial period, whereas the young adults in this study used the app on 4.6 days during our 13-day study period. Bricker et al [ 55 , 56 ] have previously assessed QuitGuide as a comparator app for evaluating novel cessation apps among middle-aged general population smokers trying to quit.…”

Section: Discussionmentioning

confidence: 91%

“…The System Usability Scale (SUS) [ 39 ] is a validated questionnaire widely used to assess the usability of various technologies [ 22 , 40 , 41 ]. Scores range from 0 to 100, with values between 68 and 70 representing the average usability [ 42 , 43 ].…”

Section: Methodsmentioning

confidence: 99%

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Usability and Acceptability of Two Smartphone Apps for Smoking Cessation Among Young Adults With Serious Mental Illness: Mixed Methods Study

Gowarty¹,

Longacre²,

Vilardaga³

et al. 2021

JMIR Ment Health

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Background Young adults with serious mental illness (SMI) have higher smoking rates and lower cessation rates than young adults without SMI. Scalable interventions such as smartphone apps with evidence-based content (eg, the National Cancer Institute’s [NCI’s] QuitGuide and quitSTART) could increase access to potentially appealing and effective treatment for this group but have yet to be tested in this population. Objective The goal of this user-centered design study is to determine the user experience (including usability and acceptability) of 2 widely available apps developed by the NCI—QuitGuide and quitSTART—among young adult tobacco users with SMI. Methods We conducted usability and acceptability testing of QuitGuide and quitSTART among participants with SMI aged between 18 and 35 years who were stable in community mental health treatment between 2019 and 2020. Participants were randomly assigned to use QuitGuide or quitSTART on their smartphones. App usability was evaluated at baseline and following a 2-week field test of independent use via a video-recorded task completion protocol. Using a mixed method approach, we triangulated 4 data sources: nonparticipant observation, open-ended interviews, structured interviews (including the System Usability Scale [SUS]), and backend app use data obtained from the NCI. Quantitative data were analyzed using descriptive statistics, and qualitative data were analyzed using thematic analysis. Results Participants were 17 smokers who were not interested in quitting, with a mean age of 29 (SD 4) years; 41% (n=7) presented with psychotic disorders. Participants smoked an average of 15 (SD 7) cigarettes per day. The mean SUS scores for QuitGuide were similar at visits one and two (mean 64, SD 18 and mean 66, SD 18, respectively). The mean SUS scores for quitSTART numerically increased from visit one (mean 55, SD 20) to visit two (mean 64, SD 16). Acceptability scores followed the same pattern. Observed task completion rates were at least 75% (7/9 for QuitGuide, 6/8 for quitSTART) for both apps at both visits for all but 2 tasks. During the 13-day trial period, QuitGuide and quitSTART users interacted with their assigned app on an average of 4.6 (SD 2.8) days versus 10.8 (SD 3.5) days, for a mean total of 5.6 (SD 3.8) interactions versus 41 (SD 26) interactions, and responded to a median of 1 notification (range 0-8) versus 18.5 notifications (range 0-37), respectively. Qualitative comments indicated moderate to high satisfaction overall but also included concerns about the accuracy of the apps’ feedback. Conclusions Both QuitGuide and quitSTART had acceptable levels of usability and mixed levels of acceptability among young adults with SMI. The higher level of engagement with quitSTART suggests that quitSTART may be a favorable tool for young adult smokers with SMI. However, clinical support or coaching may be needed to overcome initial usability issues.

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Section: Comparison With Previous Workcontrasting

confidence: 93%

Section: Discussionmentioning

confidence: 91%

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Usability and Acceptability of Two Smartphone Apps for Smoking Cessation Among Young Adults With Serious Mental Illness: Mixed Methods Study

Gowarty¹,

Longacre²,

Vilardaga³

et al. 2021

JMIR Ment Health

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“…In an early stage study of user experiences of smokers with serious mental illness (n=5), the NCI smartphone app QuitPal received a SUS score of 66 [ 65 ]. In a larger trial in the same study population, participants were randomized to use the NCI app QuiteGuide or the investigator developed app Learn to Quit [ 66 ]. In this study, SUS scores were 78 and 85, respectively, for the apps QuitGuide and Learn to Quit.…”

Section: Discussionmentioning

confidence: 99%

A Smoking Cessation App for Nondaily Smokers (Version 2 of the Smiling Instead of Smoking App): Acceptability and Feasibility Study

Hoeppner¹,

Siegel²,

Carlon³

et al. 2021

JMIR Form Res

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Background Recent evidence highlights the significant detrimental impact of nondaily smoking on health and its disproportionate prevalence in underserved populations; however, little work has been done to develop treatments specifically geared toward quitting nondaily smoking. Objective This study aims to test the feasibility, acceptability, and conceptual underpinnings of version 2 of the Smiling Instead of Smoking (SiS2) smartphone app, which was developed specifically for nondaily smokers and uses a positive psychology approach. Methods In a prospective, single-group study, nondaily smokers (N=100) were prescribed use of the SiS2 app for 7 weeks while undergoing a quit attempt. The app assigned daily positive psychology exercises and behavioral tasks every 2 to 3 days, which guided smokers through using the smoking cessation tools offered in the app. Participants answered surveys at baseline and at 2, 6, 12, and 24 weeks postquit. Feasibility was evaluated based on app use and acceptability based on survey responses. The underlying conceptual framework was tested by examining whether theorized within-person changes occurred from baseline to end of treatment on scales measuring self-efficacy, desire to smoke, and processing of self-relevant health information (ie, pros and cons of smoking, importance of the pros and cons of quitting, and motivation). Results Participants used the SiS2 app on an average of 24.7 (SD 13.8) days out of the 49 prescribed days. At the end of treatment, most participants rated the functions of the app as very easy to use (eg, 70/95, 74% regarding cigarette log and 59/95, 62% regarding happiness exercises). The average score on the System Usability Scale was 79.8 (SD 17.3; A grade; A+ ≥84.1, B+ <78.8). Most participants reported that the app helped them in their quit attempt (83/95, 87%), and helped them stay positive while quitting (78/95, 82%). Large effects were found for within-person decreases in the desire to smoke (b=−1.5, 95% CI −1.9 to −1.1; P<.001; gav=1.01), the importance of the pros of smoking (b=-20.7, 95% CI −27.2 to −14.3; P<.001; gav=0.83), and perceived psychoactive benefits of smoking (b=−0.8, 95% CI −1.0 to −0.5; P<.001; gav=0.80). Medium effects were found for increases in self-efficacy for remaining abstinent when encountering internal (b=13.1, 95% CI 7.6 to 18.7; P<.001; gav=0.53) and external (b=11.2, 95% CI 6.1 to 16.1; P<.001; gav=0.49) smoking cues. Smaller effects, contrary to expectations, were found for decreases in motivation to quit smoking (P=.005) and the perceived importance of the pros of quitting (P=.009). Self-reported 30-day point prevalence abstinence rates were 40%, 56%, and 56% at 6, 12, and 24 weeks after the quit day, respectively. Conclusions The SiS2 app was feasible and acceptable, showed promising changes in constructs relevant to smoking cessation, and had high self-reported quit rates by nondaily smokers. The SiS2 app warrants testing in a randomized controlled trial.

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“…This validated questionnaire ( 37) is commonly used to assess the usability of many types of technologies, including apps among people with SMI (8,38,39). Scores range from 0 to 100, with values of 68-70 representing average usability (40,41).…”

Section: System Usability Scalementioning

confidence: 99%

Acceptability and Usability of Mobile Apps for Smoking Cessation Among Young Adults With Psychotic Disorders and Other Serious Mental Illness

2021

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Background: Young adults with serious mental illness (SMI) are over twice as likely to smoke cigarettes than those in the general population, but little research has evaluated the efficacy of interventions for this group. While smartphone apps are a promising tool to address this need, their usability should be evaluated among young adults with psychotic disorders, whose symptoms and cognitive impairments may be a barrier to app use.Methods: We compared usability and acceptability of National Cancer Institute apps (QuitGuide and quitSTART) between young adult smokers with SMI psychotic disorders and other SMI diagnoses. We evaluated objective app usability at the initial study visit and following 2 weeks of independent use via a video-recorded task-completion protocol. Perceptions of usability and acceptability were assessed with semi-structured interviews. Engagement was assessed with backend app use data.Results: Participants had a mean age of 29 years old (SD = 4). Of the participants without psychotic disorders (n = 10), all were diagnosed with SMI post-traumatic stress disorder (SMI-PTSD). QuitGuide objective task completion rates were high and similar between diagnosis groups, whereas quitSTART task completion was initially lower among users with psychotic disorder compared to users with SMI-PTSD at Visit 1, and improved by Visit 2. Mean app interactions, mean days of use, and median completed notifications were dramatically higher among quitSTART users compared to QuitGuide users. Compared to quitSTART users with SMI-PTSD, quitSTART users with psychotic disorders had similar daily app interactions over the first week of use (mean 3.8 ± 2.4 interactions), and numerically lower mean daily app interactions during the second week (1.9 ± 1.5 vs. 3.4 ± 2.5), whereas completed notifications remained stable among quitSTART users in both diagnosis groups over time. Qualitative comments indicated general acceptability of both apps among both diagnosis groups.Conclusions: Both QuitGuide and quitSTART were usable and appealing among young adult smokers with psychotic disorders and SMI-PTSD, although quitSTART engendered a dramatically greater level of engagement compared to QuitGuide. Initial coaching to support initiation and app notifications to promote prolonged engagement may be important for young adult smokers with psychotic disorders. Replication and efficacy testing for quitSTART is warranted.

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Pilot Randomized Controlled Trial of a Novel Smoking Cessation App Designed for Individuals With Co-Occurring Tobacco Use Disorder and Serious Mental Illness

Cited by 38 publications

References 45 publications

Usability and Acceptability of Two Smartphone Apps for Smoking Cessation Among Young Adults With Serious Mental Illness: Mixed Methods Study

Usability and Acceptability of Two Smartphone Apps for Smoking Cessation Among Young Adults With Serious Mental Illness: Mixed Methods Study

A Smoking Cessation App for Nondaily Smokers (Version 2 of the Smiling Instead of Smoking App): Acceptability and Feasibility Study

Acceptability and Usability of Mobile Apps for Smoking Cessation Among Young Adults With Psychotic Disorders and Other Serious Mental Illness

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