mHealth Messaging to Motivate Quitline Use and Quitting: Protocol for a Community-Based Randomized Controlled Trial in Rural Vietnam

Abstract

Background: Tobacco kills more than 8 million people each year, mostly in low- and middle-income countries. In Vietnam, 1 in every 2 male adults smokes tobacco. Vietnam has set up telephone Quitline counseling that is available to all smokers, but it is underused. We previously developed an automated and effective motivational text messaging system to support smoking cessation among US smokers.

Objective: The aim of this study is to adapt the aforementioned system for rural Vietnamese smokers to promote cessation of tobacco use, both directly and by increasing the use of telephone Quitline counseling services and nicotine replacement therapy. Moreover, we seek to enhance research and health service capacity in Vietnam.

Methods: We are testing the effectiveness of our culturally adapted motivational text messaging system by using a community-based randomized controlled trial design (N=600). Participants were randomly allocated to the intervention (regular motivational and assessment text messages) or control condition (assessment text messages only) for a period of 6 months. Trial recruitment took place in four communes in the Hung Yen province in the Red River Delta region of Vietnam. Recruitment events were advertised to the local community, facilitated by community health workers, and occurred in the commune health center. We are assessing the impact of the texting system on 6-month self-reported and biochemically verified smoking cessation, as well as smoking self-efficacy, uptake of the Quitline, and use of nicotine replacement therapy. In addition to conducting the trial, the research team also provided ongoing training and consultation with the Quitline during the study period.

Results: Site preparation, staff training, intervention adaptation, participant recruitment, and baseline data collection were completed. The study was funded in August 2017; it was reviewed and approved by the University of Massachusetts Medical School Institutional Review Board in 2017. Recruitment began in November 2018. A total of 750 participants were recruited from four communes, and 700 (93.3%) participants completed follow-up by March 2021. An analysis of the trial results is in progress; results are expected to be published in late 2022.

Conclusions: This study examines the effectiveness of mobile health interventions for smoking in rural areas in low- and middle-income countries, which can be implemented nationwide if proven effective. In addition, it also facilitates significant collaboration and capacity building among a variety of international partners, including researchers, policy makers, Quitline counselors, and community health workers.

Trial registration: ClinicalTrials.gov NCT03567993; https://ichgcp.net/clinical-trials-registry/NCT03567993.

International registered report identifier (irrid): DERR1-10.2196/30947.

Keywords: Vietnam; global health; mHealth; randomized controlled trial; smoking cessation; tobacco cessation.

Conflict of interest statement

Conflicts of Interest: None declared.

©Celine Larkin, Jessica Wijesundara, Hoa L Nguyen, Duc Anh Ha, Anh Vuong, Cuong Kieu Nguyen, Daniel Amante, Chau Quy Ngo, Phuong Thu Phan, Quyen Thi Le Pham, Binh Ngoc Nguyen, Anh Thi Phuong Nguyen, Phuong Thi Thu Nguyen, Sharina Person, Jeroan J Allison, Thomas K Houston, Rajani Sadasivam. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 07.10.2021.

Figures

Figure 1

Study scheme. *The intervention group received one-way motivational text messages (seven in the first week, two per week in weeks 2-26) to promote cessation and provide encouragement to access Quitline and free nicotine replacement therapy. They also received weekly two-way assessment text messages asking how many times they had smoked tobacco in the past 24 hours and whether they would like to receive a call from the Quitline, which is then provided. **The control group received twice-monthly two-way assessment text messages asking how many times they have smoked tobacco in the past 24 hours. SEQ-12: 12-item Smoking Self-Efficacy Questionnaire.