Prioritizing the mHealth Design Space: A Mixed-Methods Analysis of Smokers’ Perspectives

Abstract

BackgroundSmoking remains the leading cause of preventable disease and death in the United States. Therefore, researchers are constantly exploring new ways to promote smoking cessation. Mobile health (mHealth) technologies could be effective cessation tools. Despite the availability of commercial quit-smoking apps, little research to date has examined smokers’ preferred treatment intervention components (ie, design features). Honoring these preferences is important for designing programs that are appealing to smokers and may be more likely to be adopted and used.ObjectiveThe aim of this study was to understand smokers’ preferred design features of mHealth quit-smoking tools.MethodsWe used a mixed-methods approach consisting of focus groups and written surveys to understand the design preferences of adult smokers who were interested in quitting smoking (N=40). Focus groups were stratified by age to allow differing perspectives to emerge between older (>40 years) and younger (<40 years) participants. Focus group discussion included a “blue-sky” brainstorming exercise followed by participant reactions to contrasting design options for communicating with smokers, providing social support, and incentivizing program use. Participants rated the importance of preselected design features on an exit survey. Qualitative analyses examined emergent discussion themes and quantitative analyses compared feature ratings to determine which were perceived as most important.ResultsParticipants preferred a highly personalized and adaptive mHealth experience. Their ideal mHealth quit-smoking tool would allow personalized tracking of their progress, adaptively tailored feedback, and real-time peer support to help manage smoking cravings. Based on qualitative analysis of focus group discussion, participants preferred pull messages (ie, delivered upon request) over push messages (ie, sent automatically) and preferred interaction with other smokers through closed social networks. Preferences for entertaining games or other rewarding incentives to encourage program use differed by age group. Based on quantitative analysis of surveys, participants rated the importance of select design features significantly differently (P<.001). Design features rated as most important included personalized content, the ability to track one’s progress, and features designed to help manage nicotine withdrawal and medication side effects. Design features rated least important were quit-smoking videos and posting on social media. Communicating with stop-smoking experts was rated more important than communicating with family and friends about quitting (P=.03). Perceived importance of various design features varied by age, experience with technology, and frequency of smoking.ConclusionsFuture mHealth cessation aids should be designed with an understanding of smokers’ needs and preferences for these tools. Doing so does not guarantee treatment effectiveness, but balancing user preferences with best-practice treatment considerations could enhance program adoption a...

Lessons from Practice

“…Clients, however, prefer “pull” over “push” messages due to the perception that poorly timed interventions run the risk of reminding them about smoking or they tend to dismiss them [27]. Clients also prefer interventions that are of interest to them, tips that are achievable and relatable to them [48], and rewards that are meaningful to them.…”

“…More importantly, these efforts can help reduce stigma and isolation in a client’s immediate network, adding to social incentives to quit. However, prior research suggests that not every client may prefer social support [27,49]. For facilitating nuanced preferences, clients may make visible to the network what kind of support they are seeking or not seeking during quitting smoking [57] (if they wish to disclose).…”

“…Recent independent survey studies in the US [42] and Australia [67] showed providers have primarily positive attitudes towards potential use of technology for smoking cessation support. Both providers and clients preferred features in applications that allow users to track their progress, personalize, match, and adapt to changing interests and needs of clients, and help manage withdrawal symptoms and medication needs for nicotine addiction [27,42]. However, majority of providers did not consider current apps to be effective for smoking cessation [42].…”

“…While previous studies describe client preferences from technology, it is also important to incorporate provider perspectives in design of technology for treatment of nicotine addiction [27,42]. Providers have a wealth of experiential knowledge in how to individualize counseling for people working to quit smoking.…”

Design Considerations for mHealth Programs Targeting Smokers Not Yet Ready to Quit: Results of a Sequential Mixed-Methods Study

“…Participants were presented a list of 42 specific mobile app features, functionality, and content topics and asked to rate how important or how appealing they found each of them. Item selection was based on a similar scale previously used to assess interest in mHealth app content and features among smoking cessation treatment experts and smokers [13,14], but modified to include additional response options based on the target audience, phase 1 results, and input from the authors. Importance and appeal were each rated on a 4-point Likert scale ranging from “not at all” to “very” important or appealing.…”