Improving Adherence to Smoking Cessation Treatment: Intervention Effects in a Web-Based Randomized Trial
Improving Adherence to Smoking Cessation Treatment: Intervention Effects in a Web-Based Randomized Trial
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DOI：
10.1093/ntr/ntw282
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发表时间：
2017-03-01
影响因子：
4.7
通讯作者：
Abrams，David B.
中科院分区：
文献类型：
--
作者：
Graham，Amanda L.;Papandonatos，George D.;Abrams，David B.
背景基于网络的戒烟干预措施可以为广大人群提供循证治疗，但有效性往往受到对已证实的治疗成分依从性不足的限制。本研究评估了社会网络（SN）干预和免费尼古丁替代疗法（NRT）的影响，坚持循证戒烟治疗的组成部分，在基于Web的intervention.MethodsA的背景下，成年美国吸烟者（N= 5290）的样本通过BecomeAnEX.org，免费戒烟网站招募。吸烟者被随机分为四组：（1）单独使用交互式循证戒烟网站（WEB）;（2）WEB与SN干预相结合，旨在将参与者融入在线社区（WEB+SN）;（3）WEB+免费NRT（WEB+NRT）;（4）所有治疗的组合（WEB+SN+NRT）。3个月随访时评估的依从性结果如下：网站利用率指标、技能培训成分的使用、治疗内社会支持和药物治疗的使用。结果WEB +SN+NRT在网站利用率指标、实用咨询工具的使用、治疗内社会支持和NRT使用方面优于所有其他指标。这是唯一的干预措施，以促进发送私人信息和浏览社区网页在WEB上。这两个社交网络在在线社区参与度的大多数指标上都优于WEB。两个NRT武器显示更高的药物使用相比，WEB单独。ConclusionsThis study demonstrated the effectiveness of two approaches for improving adhesion to evidence-based components of smoking caution treatment.药物供应和社会网络参与的综合方法可以提高遵守已知的组件，以改善cations.ImplicationsThis研究表明，药物供应和社会网络整合的综合方法，当通过在线程序提供时，可以提高遵守所有三个建议的组成部分，以证据为基础的戒烟计划（技能培训，社会支持和药物治疗的使用）。尼古丁替代疗法--当作为一个综合项目的一部分提供时--会增加对其他项目元素的坚持，这反过来又会增强其自身的治疗效果。明确关注提高治疗依从性的方法是确定优化干预有效性的杠杆点的重要第一步。
BackgroundWeb-based smoking cessation interventions can deliver evidence-based treatments to a wide swath of the population, but effectiveness is often limited by insufficient adherence to proven treatment components. This study evaluated the impact of a social network (SN) intervention and free nicotine replacement therapy (NRT) on adherence to evidence-based components of smoking cessation treatment in the context of a Web-based intervention.MethodsA sample of adult U.S. smokers (N= 5290) was recruited via BecomeAnEX.org, a free smoking cessation Web site. Smokers were randomized to one of four arms: (1) an interactive, evidence-based smoking cessation Web site (WEB) alone; (2) WEB in conjunction with an SN intervention designed to integrate participants into the online community (WEB+SN); (3) WEB plus free NRT (WEB+NRT); and (4) the combination of all treatments (WEB+SN+NRT). Adherence outcomes assessed at 3-month follow-up were as follows: Web site utilization metrics, use of skills training components, intratreatment social support, and pharmacotherapy use.ResultsWEB+SN+NRT outperformed all others on Web site utilization metrics, use of practical counseling tools, intratreatment social support, and NRT use. It was the only intervention to promote the sending of private messages and the viewing of community pages over WEB alone. Both social network arms outperformed WEB on most metrics of online community engagement. Both NRT arms showed higher medication use compared to WEB alone.ConclusionsThis study demonstrated the effectiveness of two approaches for improving adherence to evidence-based components of smoking cessation treatment. Integrated approaches to medication provision and social network engagement can enhance adherence to components known to improve cessation.ImplicationsThis study demonstrated that an integrated approach to medication provision and social network integration, when delivered through an online program, can enhance adherence across all three recommended components of an evidence-based smoking cessation program (skills training, social support, and pharmacotherapy use). Nicotine replacement therapy—when provided as part of an integrated program—increases adherence to other program elements, which in turn augment its own therapeutic effects. An explicit focus on approaches to improve treatment adherence is an important first step to identifying leverage points for optimizing intervention effectiveness.