Smoking Cessation
Conditions
Keywords
smoking cessation, active referral, IM
Brief summary
This study aims to assess the effect of personalized support using instant messaging application on smoking cessation in smokers proactively recruited from smoking hotspots in Hong Kong.
Detailed description
Detailed Description: With the advancement of information communication technologies (ICTs), instant messaging applications (IM Apps, e.g. WhatsApp and WeChat) can be used for providing synchronous, personalized, interactive interventions for health promotion. This study proposes to apply IM Apps for enhancing our tested brief smoking cessation (SC) intervention model from AWARD to e-AWARD (AWARD: Ask, Warn, Advise, Refer, Do-it-again,) without medications to increase SC in smokers proactively recruited in smoking hotspots in Hong Kong. Such smokers are the majority and have low quit rate. IM Apps allows trained SC advisors to proactively deliver personalized SC advices, response to smokers' needs promptly, and provide psychosocial support. No similar trials are found in PubMed, Cochrane Library and trial registries (ClinicalTrials.gov & ISRCTN) (except the pilot trial of this study). The aims of this study are as follows: 1. To assess the main effect of the personalized support using instant messaging applications (Intervention) vs. Control group on biochemical validated smoking abstinence at 6-month and 12-month. 2. To assess the effects on self-reported past 7-day abstinence, 24-week continuous abstinence, smoking reduction, self-efficacy of quitting, intention to quit, quit attempts and SC medications and services use at 6-month and 12-month. 3. To identify the mediators, which can inform mechanisms of the intervention on SC. 4. To evaluate the cost-effectiveness of the above interventions. 5. To understand the effects subjects' experience of IM support on SC using a qualitative study approach.
Interventions
BEHAVIORALAWARD advice
At baseline, brief smoking cessation advice following AWARD model will be delivered to subjects within about 2 to 5 minutes: * Ask about smoking history and habit * Warn about the risks of smoking using a leaflet * Advise to quit smoking as soon as possible and use nicotine replacement therapy (NRT) or SC services * Refer subjects to free smoking cessation services in Hong Kong if they agree * Do it again: smokers who have tried to quit but relapsed will be encouraged to quit again and those who have reduced smoking will be advised to further reduce or quit smoking
BEHAVIORALMessage on general health delivered by short message service (SMS)
After baseline, regular messages using SMS will be sent to subjects with similar frequency to Intervention group. The messages include information on general health and reminders on follow-up surveys and biochemical validation for quitting.
BEHAVIORALHealth warning leaflet
At baseline, an A5-sized leaflet will be given to subjects, which includes information about risks of smoking, pictures of smoking-related diseases, and smoking cessation services provided in Hong Kong.
BEHAVIORALActive referral to smoking cessation (SC) services
At baseline, subjects will be encouraged to seek smoking cessation services in Hong Kong. If subjects agree, their contact information will be sent to the preferred service providers for a quick appointment and follow-up.
A total of pre-set 26 messages will be sent to subjects through WhatsApp 12 weeks after baseline to remind the quit date and to encourage abstinence. Messages are tailored based on subjects' sociodemographic characteristics and smoking habit following Social Cognitive Theory and Transtheoretical Model. Messages will be sent with the schedule of once daily for 1 week (the week across the quit date), 3 times a week for 4 weeks (2 weeks each before and after the week with quit date) and once a week for remaining 7 weeks. The schedule will be adjusted according to the quit date and also smokers' requests. The format of regular messages will mainly be text-based but also include pictures, animations and videos.
BEHAVIORALPsychosocial support and referral to SC services through IM
Personalized interactive text or voice conversation will be provided by trained smoking cessation advisors through WhatsApp for 3 months after baseline. Advisors will periodically proactively send messages to subjects to initiate the conversation (e.g. asking recent progress of smoking cessation) and deliver evidence-based advice. Advisors will also actively refer subjects, if they have expressed the need, to smoking cessation services providers. A standard operation algorithm for advisors used in the pilot feasibility trial will be modified for the use.
Sponsors
The University of Hong Kong
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
TRIPLE (Subject, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* Adult smokers aged 18+ who smoke cigarette(s) daily. * Exhaled carbon monoxide (CO) level of 4ppm or above. * Having smartphones with IM Apps (WhatsApp) and have experience in using. * Hong Kong residents able to read and communicate in Chinese (Cantonese or Putonghua).
Exclusion criteria
* Smokers who have psychiatric/psychological diseases or are on regular psychotropic medications. * Smokers who are using SC medication, NRT, other SC services or projects.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Biochemically-validated abstinence at 6-month | 6-month after baseline | Defined as exhaled carbon monoxide \<4ppm |
| Biochemically-validated abstinence at 12-month | 12-month after baseline | Defined as exhaled carbon monoxide \<4ppm |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Smoking reduction | 6-month and 12-month after baseline | Self-reported reduction in the number of cigarettes smoked daily by at least 50% of the baseline amount |
| Perceived importance, confidence and difficulties of quitting | 6-month and 12-month after baseline | Perceived importance, confidence and difficulties of quitting measured on a scale of 0-10 and a higher score indicates a stronger perception |
| Intention to quit | 6-month and 12-month after baseline | Any intention to quit smoking (yes/no) from baseline |
| Self-reported past 7-day abstinence | 6-month and 12-month after baseline | Self-reported no cigarette smoking (even a single puff) in the past 7 days |
| Smoking cessation medication use | 6-month and 12-month after baseline | Any use of nicotine replacement therapy from baseline |
| Smocking cessation services use | 6-month and 12-month after baseline | Any use of counselling, hotline, SC clinics and other SC services from baseline |
| Quit attempts | 6-month and 12-month after baseline | Number of quit attempts from baseline |
| Self-reported 24-week continuous abstinence | 6-month and 12-month after baseline | Self-reported no cigarette smoking (even a single puff) in the past 24 weeks |
Countries
Hong Kong
Contacts
Primary ContactFleur Lee, MPhil
Outcome results
None listed