Metaphor-Based Smoking Cessation Intervention

Metaphor-Based Smoking Cessation Intervention: A Randomized Controlled Trial

This study aims to evaluate the effectiveness and participant experiences of a WeChat-delivered, metaphor-based smoking cessation intervention.

Study Overview

• Status: Not yet recruiting
• Conditions: Smoking Cessation; Mobile Health
• Intervention / Treatment: Other: Health warning leaflet; Behavioral: Metaphor-based smoking cessation intervention; Behavioral: 5A's/5R's advice

Detailed Description

This randomized controlled trial evaluates a WeChat-delivered, metaphor-based smoking cessation intervention. Participants in the intervention group will receive staged cessation messages that use metaphors to explain smoking urges, nicotine dependence, behavior change, coping strategies, and relapse prevention. The intervention will also include self-monitoring, personalized feedback, and a personalized journey map to help participants recognize their progress during the cessation process.

Participants in the control group will receive brief smoking cessation advice. The study will compare the two groups in terms of smoking cessation outcomes. It will also assess participants' perceptions of the intervention, including the usefulness and comprehensibility of the metaphors, willingness to engage with the intervention, immersion in the cessation process, perceived support, and overall satisfaction.

• Study Type: Interventional
• Enrollment (Estimated): 200
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Xue Weng; Phone Number: 3621259; Email: xueweng@bnu.edu.cn

Study Locations

• China
  • Guangdong
    • Zhuhai, Guangdong, China, 519087
      • Beijing Normal University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

1. aged 18 and above, reside in Zhuhai for the next 6 months;
2. smoke at least 1 cigarette or use e-cigarettes daily;
3. Having a smartphone and a WeChat account, being able to use WeChat skillfully.

Exclusion Criteria:

1. Smokers who have communication barrier (either physically or cognitively);
2. Smokers who are currently participating in other SC programmes or services

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Control group; 5A's/5R's advice + health warning leaflet	Other: Health warning leaflet; The health warning leaflet provides essential information on the dangers of secondhand and thirdhand smoke. It outlines how exposure to these forms of smoke can harm both smokers and non-smokers, particularly children, by increasing the risk of respiratory illnesses and other health issues.; Behavioral: 5A's/5R's advice; The 5A's approach (Ask, Advise, Assess, Assist, and Arrange) will be used for participants who are ready to quit, and the 5R's approach (Relevance, Risks, Rewards, Roadblocks, and Repetition) will be used for participants who are not ready to quit.
Experimental: Metaphor-based intervention group; Metaphor-based smoking cessation intervention + 5A's/5R's advice + health warning leaflet	Other: Health warning leaflet; The health warning leaflet provides essential information on the dangers of secondhand and thirdhand smoke. It outlines how exposure to these forms of smoke can harm both smokers and non-smokers, particularly children, by increasing the risk of respiratory illnesses and other health issues.; Behavioral: Metaphor-based smoking cessation intervention; Participants will receive a 100-day, WeChat-delivered smoking cessation intervention using metaphors such as "fog" and "restart" to describe smoking urges, nicotine dependence, and the process of behavior change. The intervention will provide staged messages on smoking-trigger identification, self-monitoring, action planning, coping strategies, environmental modification, social support, and relapse prevention, together with personalized feedback and a personalized journey map to help participants review their cessation experiences and progress.; Behavioral: 5A's/5R's advice; The 5A's approach (Ask, Advise, Assess, Assist, and Arrange) will be used for participants who are ready to quit, and the 5R's approach (Relevance, Risks, Rewards, Roadblocks, and Repetition) will be used for participants who are not ready to quit.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Biochemical validated quit rate at 6 months follow-up	The primary outcomes are biochemically validated quit rate (exhaled carbon monoxide < 4 ppm or salivary cotinine < 30 ng/ml)	6 months follow-up

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Self-reported 7-day point prevalence quit rate	Self-reported 7-day point prevalence quit rate in the two groups	3 and 6 months follow-up
Smoking reduction rate	Rate of smoking reduction by at least half of baseline amount in the two groups	3 and 6 months follow-up
Eligibility rate	the percentage of eligible smokers out of the total number of smokers screened	baseline
Consent rate	the percentage of eligible smokers who agree to participate out of the total number of eligible smokers	baseline
Biochemical validated quit rate at 3 months follow-up	biochemically validated quit rate (exhaled carbon monoxide < 4 ppm or salivary cotinine < 30 ng/ml)	3 months follow-up
Intervention Engagement	Participants' engagement with the intervention, including self-reported reading of WeChat cessation messages, interaction with the health assistant, and viewing of the personalized journey map.	3 months follow-up
Perceived Usefulness of Metaphors	Participants' perceived usefulness of the metaphors used in the intervention. Responses will be assessed using a 7-point Likert scale.	3 months follow-up
Narrative Engagement in the Smoking Cessation Journey	Participants' engagement with the journey-based intervention, including whether the staged challenge design increased their motivation to persist, whether they were interested in subsequent stages, and whether they felt immersed in the smoking cessation journey. Responses will be assessed using a 7-point Likert scale.	3 months follow-up

Collaborators and Investigators

• Sponsor: Beijing Normal University
• Investigators: Principal Investigator: Xue Weng, Beijing Normal University

Study record dates

Study Major Dates

• Study Start (Estimated): September 1, 2026
• Primary Completion (Estimated): June 30, 2027
• Study Completion (Estimated): December 31, 2027

Study Registration Dates

• First Submitted: August 31, 2026
• First Submitted That Met QC Criteria: August 31, 2026
• First Posted (Actual): September 3, 2026

Study Record Updates

• Last Update Posted (Actual): September 3, 2026
• Last Update Submitted That Met QC Criteria: August 31, 2026
• Last Verified: August 1, 2026

More Information

Terms related to this study

• Keywords: Smoking cessation; Tobacco use; Metaphor-based intervention
• Additional Relevant MeSH Terms: Behavior; Health Behavior; Smoking Cessation; Tobacco Use
• Other Study ID Numbers: Metaphor Cessation Trial

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No