Using WhatsApp and Facebook Online Social Groups for Smoking Relapse Prevention for Recent Quitters: A Pilot Pragmatic Cluster Randomized Controlled Trial

Yee Tak Derek Cheung, Ching Han Helen Chan, Chi-Keung Jonah Lai, Wai Fung Vivian Chan, Man Ping Wang, Ho Cheung William Li, Sophia Siu Chee Chan, Tai-Hing Lam, Yee Tak Derek Cheung, Ching Han Helen Chan, Chi-Keung Jonah Lai, Wai Fung Vivian Chan, Man Ping Wang, Ho Cheung William Li, Sophia Siu Chee Chan, Tai-Hing Lam

Abstract

Background: Quit attempters often have episodes of smoking relapse before they eventually quit. Interactive text messaging through mobile phones has been shown to increase abstinence. This service can be potentially applied on the platform of a social networking service to help quitters maintain abstinence.

Objective: Our aim was to determine if the group discussion and reminders via the WhatsApp or Facebook social group were effective to prevent smoking relapse in quitters who had stopped smoking recently.

Methods: This was a single-blinded, parallel, 3-arm pilot cluster randomized controlled trial allocating recent quitters, who had completed an 8-week treatment and reported abstinence for at least 7 days, to WhatsApp (n=42), Facebook (n=40), and a control group (n=54). The 2 intervention groups participated in a 2-month online group discussion with either WhatsApp or Facebook moderated by a trained smoking cessation counselor and received a self-help booklet on smoking cessation. The control group only received the booklet. The primary outcome was the 2- and 6-month relapse rates, defined as the proportion of participants who smoked at least 5 cigarettes in 3 consecutive days.

Results: Fewer participants in the WhatsApp group (17%, 7/42) reported relapse than the control group (42.6%, 23/54) at 2-month (OR 0.27, 95% CI 0.10-0.71) and 6-month (40.5%, 17/42 vs 61.1%, 33/54; OR 0.43, 95% CI 0.19-0.99) follow-ups. The Facebook group (30.0%, 12/40) had an insignificantly lower relapse rate than the control group (42.6%, 23/54) at 2-month (OR 0.58, 95% CI 0.24-1.37) and 6-month (52.5%, 13/40 vs 61.1%, 33/54; OR 0.70, 95% CI 0.31-1.61) follow-ups. The WhatsApp social groups had more moderators' posts (median 60, IQR 25 vs median 32, IQR 7; P=.05) and participants' posts (median 35, IQR 50 vs median 6, IQR 9; P=.07) than their Facebook counterparts, but the difference was insignificant.

Conclusions: The intervention via the WhatsApp social group was effective in reducing relapse probably because of enhanced discussion and social support. Inactive discussion in the Facebook social group might have attributed to the lower effectiveness.

Clinicaltrial: Clinicaltrials.gov NCT02007369; https://ichgcp.net/clinical-trials-registry/NCT02007369 (Archived by WebCite® at http://www.webcitation.org/6c3RbltQG).

Keywords: relapse prevention; smoking cessation; social media; social networking.

Conflict of interest statement

Conflicts of Interest: The study was funded by Tung Wah Group of Hospitals Integrated Centre on Smoking Cessation, which was funded by Tobacco Control Office of Department of Health. Prof Tai-hing Lam is the principal investigator of the FAMILY project, which was funded by the Hong Kong Jockey Club Charities Trust. All other authors do not have connection with the tobacco, alcohol, pharmaceutical, or gaming industries, and nobody was substantially funded by one of these organizations.

Figures

Figure 1
Figure 1
CONSORT flow diagram of the pilot randomized controlled trial. AUDIT: The Alcohol Use Disorders Identification Test.
Figure 2
Figure 2
Screenshots of the WhatsApp (Left side) and Facebook (Right side) online social groups.

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