Improving Adherence to Web-based Cessation Programs: A Social Network Approach

提高对基于网络的戒烟计划的依从性：社交网络方法

• 批准号: 8464536
• 负责人: AMANDA L GRAHAM
• 金额: $ 46.74万
• 依托单位: TRUTH INITIATIVE FOUNDATION
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-07-11 至 2016-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8464536
• 关键词: Abstinence; Address; Adherence; Adult; Adverse effects; Behavior Therapy; Behavioral; Cessation of life; Clinical Practice Guideline; Communities; Counseling; Data; Dose; Economic Burden; Effectiveness; Equilibrium; Gender; Indium; Informatics; Internet; Intervention; Measures; Mediating; Mediator of activation protein; Methods; Modality; Motivation; Online Systems; Outcome; Participant; Pathway interactions; Patient Self-Report; Perception; Pharmaceutical Preparations; Pharmacological Treatment; Pharmacotherapy; Population; Prevalence; Preventive Intervention; Problem Solving; Process; Protocols documentation; Public Health; Randomized; Recruitment Activity; Self Efficacy; Smoker; Social Network; Social support; Testing; Time; Tobacco; Tobacco Dependence; Tobacco Use Cessation; Tobacco use; Translating; Treatment outcome; United States Public Health Service; Visit; Withholding Treatment; behavior change; burden of illness; comparative efficacy; cost; design; effective therapy; evidence base; improved; innovation; insight; knowledge base; member; nicotine replacement; outreach; premature; programs; public health priorities; response; skills training; smoking cessation; smoking prevalence; social networking website; social norm; theories; tool; treatment adherence; web site; web-based social networking

DESCRIPTION (provided by applicant): Reducing population smoking prevalence is an urgent public health priority that can save more lives and money than almost any other known preventive intervention. Practical counseling, social support, and nicotine replacement therapy (NRT) are components of tobacco dependence treatment that increase the chances of cessation. Web-based interventions are a promising delivery channel for tobacco dependence treatment that have the potential for enormous public health impact (reach x efficacy). Millions of smokers use the Internet for cessation assistance each year and studies have shown quit rates of 7 to 26 percent. However, most users engage only minimally with even the best designed cessation websites, diminishing their impact due to limited exposure/use of effective treatment components (an insufficient "dose"). Poor adherence is documented across a range of Internet behavior change programs. Two approaches to improve adherence to Internet cessation treatment are integrating smokers into an online social network and providing free NRT. Active participation in online communities is associated with significantly higher rates of cessation. Proactive outreach to integrate smokers into a social network can increase perceptions of support and may also increase adherence to online problem solving/skills training tools and pharmacotherapy. Removing initial cost and access barriers to NRT can introduce smokers to medication who might not otherwise try it and may increase adherent use and outcomes. Provision of NRT may also increase adherence to practical counseling tools in Web-based cessation programs as smokers look for information on its use or side effects, and adherence to Web- based social support as smokers turn to others for support while quitting. The interaction of both strategies may exert the most powerful effects on adherence to all three components of cessation treatment. This study will compare the efficacy of an interactive, evidence-based smoking cessation website (WEB) alone and in conjunction with free NRT and a theory-driven, empirically-informed social network (SN) protocol designed to integrate participants into the online community. Using a 2 (access to free NRT, no access) x 2 (SN integration, no SN) randomized, controlled factorial design with repeated measures at baseline, 3, 9, and 15 months, this study will recruit N=4,000 new members of a Web-based smoking cessation program and randomize them to: 1) WEB, 2) WEB+SN, 3) WEB+NRT, or 4) WEB+SN+NRT. Hypotheses are that all three intervention conditions will outperform WEB alone and that WEB+SN+NRT will outperform WEB+NRT and WEB+SN on 30-day point prevalence abstinence measured at the primary endpoint of 9 months and at secondary endpoints of 3 and 15 months. Secondary aims and exploratory analyses will examine theory-driven hypotheses about the mediators and moderators of treatment outcome (e.g., social norms, social support, gender, motivation). Addressing adherence to Internet cessation programs is critical and timely to leverage the potential public health impact of this "broad reach" treatment modality. The proposed study is unconventional and innovative in its use of a social network intervention approach to improve both behavioral and pharmacological treatment adherence to enhance cessation outcomes. Understanding theory and basic mechanisms of behavior change is significant not only for reducing tobacco's devastating disease burden, but also for optimizing behavior change in other arenas where treatment adherence is just as critical.

描述（由申请人提供）：减少人口吸烟率是一项紧迫的公共卫生优先事项，可以挽救更多的生命和金钱比几乎任何其他已知的预防性干预措施。实际咨询，社会支持和尼古丁替代疗法（NRT）是烟草依赖治疗的组成部分，可以增加戒烟的机会。基于网络的干预措施是烟草依赖治疗的一个有前途的提供渠道，有可能产生巨大的公共卫生影响（达到x疗效）。每年有数百万吸烟者使用互联网进行戒烟帮助，研究表明戒烟率为7%至26%。然而，即使是设计最好的戒烟网站，大多数用户也只参与最低限度的活动，由于有效治疗成分的有限暴露/使用（“剂量”不足），减少了其影响。在一系列互联网行为改变计划中，记录了不良的依从性。提高网络戒烟治疗依从性的两种方法是将吸烟者纳入在线社交网络和提供免费的NRT。积极参与在线社区与显著较高的戒烟率相关。积极主动地将吸烟者纳入社交网络可以增加对支持的看法，也可以增加对在线解决问题/技能培训工具和药物治疗的坚持。消除NRT的初始成本和获取障碍可以将吸烟者引入药物治疗，否则他们可能不会尝试它，并可能增加依从性使用和结果。提供NRT还可以增加对基于网络的戒烟计划中的实用咨询工具的依从性，因为吸烟者会寻找关于其使用或副作用的信息，以及对基于网络的社会支持的依从性，因为吸烟者在戒烟时会向他人寻求支持。这两种策略的相互作用可能对戒烟治疗的所有三个组成部分的依从性产生最强大的影响。本研究将比较交互式、循证戒烟网站（WEB）单独使用以及与免费NRT和旨在将参与者融入在线社区的理论驱动、经验丰富的社交网络（SN）协议结合使用的功效。使用2（免费NRT访问，无访问）x 2（SN整合，无SN）随机对照析因设计，在基线、3、9和15个月时重复测量，本研究将招募N= 4，000名基于网络的戒烟计划的新成员，并将其随机分配至：1）WEB，2）WEB+SN，3）WEB+NRT，或4）WEB+SN+NRT。假设所有三种干预条件均优于单独使用WEB，并且在9个月的主要终点以及3个月和15个月的次要终点测量的30天时点戒烟率方面，WEB+SN+NRT将优于WEB+NRT和WEB+SN。次要目的和探索性分析将检查关于治疗结果的中介和调节因素的理论驱动假设（例如，社会规范、社会支持、性别、动机）。解决遵守互联网戒烟计划是至关重要的，及时利用这种“广泛覆盖”的治疗方式的潜在公共卫生影响。拟议的研究是非传统的和创新的，在其使用的社会网络干预方法，以改善行为和药物治疗的依从性，以提高戒烟的结果。了解行为改变的理论和基本机制不仅对减少烟草的毁灭性疾病负担具有重要意义，而且对优化其他领域的行为改变也具有重要意义，其中治疗依从性同样重要。