A recommender system to quit smoking with mobile motivational messages: study protocol for a randomized controlled trial

Abstract

Background: Smoking cessation is the most common preventative for an array of diseases, including lung cancer and chronic obstructive pulmonary disease. Although there are many efforts advocating for smoking cessation, smoking is still highly prevalent. For instance, in the USA in 2015, 50% of all smokers attempted to quit smoking, and only 5-7% of them succeeded - with slight deviation depending on external assistance. Previous studies show that computer-tailored messages which support smoking abstinence are effective. The combination of health recommender systems and behavioral-change theories is becoming increasingly popular in computer-tailoring. The objective of this study is to evaluate patients's smoking cessation rates by means of two randomized controlled trials using computer-tailored motivational messages. A group of 100 patients will be recruited in medical centers in Taiwan (50 patients in the intervention group, and 50 patients in the control group), and a group of 1000 patients will be recruited on-line (500 patients in the intervention group, and 500 patients in the control group). The collected data will be made available to the public in an open-source data portal.

Methods: Our study will gather data from two sources. The first source is a clinical pilot in which a group of patients from two Taiwanese medical centers will be randomly assigned to either an intervention or a control group. The intervention group will be provided with a mobile app that sends motivational messages selected by a recommender system that takes the user profile (including gender, age, motivations, and social context) and similar users' opinions. For 6 months, the patients' smoking activity will be followed up, and confirmed as "smoke-free" by using a test that measures expired carbon monoxide and urinary cotinine levels. The second source will be a public pilot in which Internet users wanting to quit smoking will be able to download the same mobile app as used in the clinical pilot. They will be randomly assigned to a control group that receives basic motivational messages or to an intervention group, that receives personalized messages by the recommender system. For 6 months, patients in the public pilot will be assessed periodically with self-reported questionnaires.

Discussion: This study will be the first to use the I-Change behavioral-change model in combination with a health recommender system and will, therefore, provide relevant insights into computer-tailoring for smoking cessation. If our hypothesis is validated, clinical practice for smoking cessation would benefit from the use of our mobile solution.

Trial registration: ClinicalTrials.gov, ID: NCT03108651 . Registered on 11 April 2017.

Keywords: App; Behavioral change; Computer-tailoring; Health recommender systems; Messages; Mobile; Motivational; Smoking cessation.

Conflict of interest statement

Authors’ information

Santiago Hors-Fraile is currently pursuing a double PhD from Maastricht University and the University of Seville. His research focuses on tailoring motivational messages to improve engagement and achieve behavioral changes using health recommender systems. He studied for a MSc in computer engineering at the University of Seville, Spain, and a MSc in software engineering at Cranfield University, UK. He also studied a short-term program in healthcare digital marketing in Madrid, Spain, and several international gamification courses. He has been working in the design and development of serious games and gamified apps of European projects since 2012, as well as in successful gamified learning solutions for both healthcare professionals and patients in the pharmaceutical industry sector.

Shwetambara Malwade, is a researcher and project manager at the International Center for Health Information Technology, Taipei Medical University, in Taipei, Taiwan. She studied for a Bachelor’s degree in homoeopathic medicine and surgery, from India and a Master’s in biomedical informatics, in Taiwan. She has also completed several courses on the MOOCs platform. Her research interests are mHealth, wearable devices, long-term care of elderly patients, and social networking in healthcare. Her studies covered topics such as wearable devices among the elderly population, social media in healthcare, misleading information on the internet and virtual reality.

Dimitris Spachos is a research associate and PhD student in the Medical Education Informatics Group at the Medical School of AUTH. He holds a Bachelor’s degree in mathematics (2002), a Bachelor’s degree in informatics (2005), and a MSc in informatics (2008) from Aristotle University of Thessaloniki. He has over 14 years of working experience in EU projects and 4 years of teaching informatics in Greek higher education. He is a Drupal expert and passionate about the web, open-source and semantic technologies.

Dr. Luis Fernandez-Luque is a PhD in Telemedicine from University of Tromsø (Norway) and computer engineer from the University of Seville (Spain). He has been doing eHealth research for the last 10 years in Norway (Norut), Spain (Polytechnic University of Valencia) and the USA (University of Minnesota, and Harvard Medical School), and is a founding partner of Salumedia. Currently, he works as an eHealth researcher in the Qatar Computing Research Institute at Qatar Foundation. He specialises in eHealth, mHealth, health games, and health social media and currently serves as the Chairman of the Social Media Working Group of the International Medical Informatics Association. He has been actively involved in the organization of international conferences. His research and opinion letters have been published in leading journals such as the Journal of Medical Internet Research, the British Medical Journal, and The Lancet.

Dr. Chien-Tien Su is the Associate Professor at the School of Public Health in Taipei Medical University and Director of the department of Family Medicine at Taipei Medical University Hospital, Taipei, Taiwan. He is a consulting physician at the Department of Family Medicine for the past 20 years. He specializes in preventive medicine and health promotion.

Dr. Wei-Li Jeng is a consulting physician at Wellcome Clinic, in Taipei, Taiwan. He has been in medical practice for more than 20 years. He was a consulting physician at the Department of Internal Medicine and Family Medicine at Cardinal Tien Hospital, Taiwan, until 2006. Further, he has continued his medical practice in the Wellcome Clinic in Taipei.

Dr. Shabbir Syed-Abdul, is a leading researcher and a principal investigator at the International Center for Health Information Technology and an associate professor at the Graduate Institute of Biomedical Informatics, Taipei, Taiwan. He is an educator for MOOCs on FutureLearn, one of his latest course is on INTERNET OF THINGS FOR ACTIVE AGING. His major research interests are longterm care, telemedicine, mHealth, translational medicine, big-data analysis and visualization, artificial intelligence, personal health records, digital epidemiology, and social network in healthcare and hospital information systems and has managed to publish about 60 SCI papers in the last 5 years.

Professor Panagiotis Bamidis is currently an associate professor of medical education informatics in the Medical School of Aristotle University of Thessaloniki, Greece. He has founded and has been leading four research groups, namely, in medical education informatics, in assistive technologies and silver science, in applied and affective neuroscience, and in health services research. In the last 8 years, he has been the coordinator of five large European projects (http://captain-eu.org, www.SmokeFreeBrain.org; www.meducator.net; www.longlastingmemories.eu, www.epblnet.eu, www.childrenhealth.eu) as well as the principal investigator for many national- and international-funded projects. He is the President of the Hellenic Biomedical Technology Society (ELEBIT), the International Society of Applied Neuroscience (SAN), a member of the administration boards of other societies and patient associations. He is/has been the chairman/organizer of some 13 international conferences and several national biomedical technology conferences. In 2017, he became a visiting professor of medical education technology, innovation and change for the Leeds Institute of Medical Education (LIME) of the University of Leeds, UK.

Professor Yu-Chuan (Jack) Li, has been a pioneer of medical informatics research in Asia. He served as a vice president of Taipei Medical University (TMU) (2009–2011) and currently, is the Dean of the College of Medical Science and Technology since 2011 and a professor of the Graduate Institute of Biomedical Informatics since 1998. He has been principle investigator of many national and international projects in the domain of electronic health record, patient safety informatics and medical elearning. He is an author of 130 scientific papers and three college-level textbooks. His main areas of expertise are: medical decision support systems, patient safety information systems, and medical big data analytics.

Ethics approval and consent to participate

This study has been approved by the Ethical Committee of Taipei Medical University – Joint Institutional Review Board (TMU-JIRB).

Consent for publication

Not applicable.

Competing interests

LFL is the owner of Salumedia Tecnologías. SHF is its CEO and administrator. Salumedia Tecnologías is a company contributed to the development of the app used in this study. The rest of the authors declare that they have no competing interests.

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Figures

Fig. 1

Difference of enrollment, intervention, and assessments periods in the clinical and public pilots

Fig. 2

Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) Schedule of enrollment, interventions, and assessments

Fig. 3

Screenshots of the app (English and Mandarin versions) showing different sections