Process evaluation of a mHealth program: lessons learned from Stop My Smoking USA, a text messaging-based smoking cessation program for young adults

Abstract

Objective: Report lessons learned in an RCT of Stop My Smoking (SMS) USA, a mHealth smoking cessation program for young adult smokers.

Methods: 164 18-24-year-olds were recruited nationally, online in 2011. Program evaluation data were provided at 12-week post-Quit Day.

Results: (1) Inviting participants to complete a brief text messaging survey and then asking them to complete a longer online survey resulted in the highest response rate (89%). (2) The positive tone of program messages was the most commonly noted program strength. (3) Suggested improvements included more social connectivity and additional assistance overcoming stressful situations. (4) Half of intervention participants moved through the program linearly and half went through various paths that reflected multiple relapses. Suggestions to use pharmacotherapy resulted in 22% of heavy smokers to utilize it.

Conclusion: Participant feedback provided concrete ways in which this and other young adult-focused interventions can improve messaging and program features to be even more salient.

Practice implications: Future young adult mHealth interventions could: Integrate models that are flexible to different "paths" of behavior change; address stressful life events directly and comprehensively; integrate proactive messaging that promotes pharmacotherapy options; and use text messaging as a gateway to longer online surveys.

Keywords: Hard-to-reach populations; Intervention features; Smoking cessation; Text messaging; Young adults; mHealth.

Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Figures

Figure 1

Pathing of SMS USA intervention participants based upon smoking status at 2 day and 7 day post-Quit Day Note. The 2-day and 7-day post-Quit day smoking status for the four participants who were pathed contrary to their response due to technology issues at the 7-day post-Quit day follow-up are included. The program was evaluated in a randomized controlled study in 2011 with participants who were recruited online. Content focus based on pathing based on smoking status: Early Quit: content discussed the common difficulties and discomforts associated with quitting, and emphasized the use of coping strategies. Late Quit: content encouraged participants to recognize relapse in a different way (e.g., situations, confidence, etc.) and provided actionable information about how to deal with issues that arise as a non-smoker (e.g., stress, moods). Relapse: content focused on helping the participants get back on track and to recommit to quitting Encouragement (if participant smoking at both 2-day and 7-day post-Quit Day): content focused on norms for quitting and suggested that the participant attempt to quit at later time when they were ready to try again.