See Me Smoke-Free: Protocol for a Research Study to Develop and Test the Feasibility of an mHealth App for Women to Address Smoking, Diet, and Physical Activity

Abstract

BackgroundThis paper presents the protocol for an ongoing research study to develop and test the feasibility of a multi-behavioral mHealth app. Approximately 27 million women smoke in the US, and more than 180,000 women die of illnesses linked to smoking annually. Women report greater difficulties quitting smoking. Concerns about weight gain, negative body image, and low self-efficacy may be key factors affecting smoking cessation among women. Recent studies suggest that a multi-behavioral approach, including diet and physical activity, may be more effective at helping women quit. Guided imagery has been successfully used to address body image concerns and self-efficacy in our 3 target behaviors—exercise, diet and smoking cessation. However, it has not been used simultaneously for smoking, diet, and exercise behavior in a single intervention. While imagery is an effective therapeutic tool for behavior change, the mode of delivery has generally been in person, which limits reach. mHealth apps delivered via smart phones offer a unique channel through which to distribute imagery-based interventions.ObjectiveThe objective of our study is to evaluate the feasibility of an mHealth app for women designed to simultaneously address smoking, diet, and physical activity behaviors. The objectives are supported by three specific aims: (1) develop guided imagery content, user interface, and resources to reduce weight concern, and increase body image and self-efficacy for behavior change among women smokers, (2) program a prototype of the app that contains all the necessary elements of text, graphics, multimedia and interactive features, and (3) evaluate the feasibility, acceptability, and preliminary efficacy of the app with women smokers.MethodsWe created the program content and designed the prototype application for use on the Android platform in collaboration with 9 participants in multiple focus groups and in-depth interviews. We programmed and tested the application’s usability with 6 participants in preparation for an open, pre- and posttest trial. Currently, we are testing the feasibility and acceptability of the application, evaluating the relationship of program use to tobacco cessation, dietary behaviors, and physical activity, and assessing consumer satisfaction with approximately 70 women smokers with Android-based smart phones.ResultsThe study was started January 1, 2014. The app was launched and feasibility testing began in April 1, 2015. Participants were enrolled from April 1-June 30, 2015. During that time, the app was downloaded over 350 times using no paid advertising. Participants were required to use the app “most days” for 30 days or they would be dropped from the study. We enrolled 151 participants. Of those, 78 were dropped or withdrew from the study, leaving 73 participants. We have completed the 30-day assessment, with a 92% response rate. The 90-day assessment is ongoing. During the final phase of the study, we will be conducting data analyses and disseminating study findings via presentations and pu...

A Scoping Review of Health Outcomes Examined in Randomized Controlled Trials Using Guided Imagery

“…Guided imagery could prove to be a valuable intervention strategy because this technique can be delivered using web- and telephone-based methods while emerging research is testing its suitability using mobile applications. 43 Population-based research testing the efficacy and effectiveness of guided imagery on health behaviors such as diet, exercise, and smoking cessation could yield important insights into its usefulness for public health practitioners in the prevention and/or management of chronic disease.…”

User Participation and Engagement With the See Me Smoke-Free mHealth App: Prospective Feasibility Trial

“…The SMSF feasibility trial was a single arm, within-subjects, prospective cohort study (ClinicalTrials.gov NCT02972515). Details of this trial, including eligibility criteria, have been described elsewhere [ 7 ]. Briefly, the SMSF app delivered five imagery audio files, one of which was a general introduction to guided imagery [ 9 ].…”

“…Individuals who installed the app and completed app setup during the recruitment period (April 1, 2015 to July 31, 2015) were invited to participate in the feasibility study. Individuals were eligible for participation if they identified as female, were at least 18 years old, smoked in the last 30 days, lived in the United States, used an Android phone, agreed to use the app “most days for 30 days,” spoke English, and had a valid email address [ 7 ]. After eligibility screening, eligible individuals consenting to study participation and completing the baseline survey were enrolled ( participants ).…”

“…The SMSF mHealth app was developed to help women quit smoking by targeting concerns about body weight, body image, and self-efficacy through the use of guided imagery audio files that address smoking, diet, and exercise [ 7 ]. The development of SMSF has been reported elsewhere [ 8 ].…”

Development and evaluation of the See Me Smoke-Free multi-behavioral mHealth app for women smokers

“…A complete description of the study protocol is contained in a previous paper [64]. Briefly, the See Me Smoke-Free app was available for free download from the Google Play Store.…”