Optimizing Text Messaging to Improve Adherence to Web-Based Cessation Treatment

 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预防性干预措施。互联网为循证戒烟治疗提供了一个有前途的提供渠道，并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寻求戒烟帮助。研究表明，各种互联网程序的戒烟率为7-28%，使用强度与更高的戒烟率之间存在正相关关系。然而，大多数吸烟者很少参与即使是设计最好的戒烟网站，由于有效治疗成分的使用有限，减少了其影响。在互联网行为改变计划中，注意到遵守情况不佳。移动的设备的普及及其在促进其他健康行为改变领域的依从性方面的有效性使其成为解决基于网络的干预措施中的依从性的有前途的工具。短信可供使用且易于使用;短信可主动提示/提醒并鼓励继续探索网络干预措施;互动短信可促进参与核心互联网干预措施。我们已经确定了短信干预的4个方面，可以提高其在促进遵守基于网络的戒烟计划的有效性：个性化（是/否），整合（是/否），动态定制（是/否），和消息强度（标准/递减）。该两阶段研究的第一阶段将使用2水平全因子设计来测试这4个实验特征对基于网络的干预依从性的影响。第一阶段的主要结局是依从性的综合指标，包括登录次数、网站停留时间、页面浏览量和使用交互式网站组件来预测禁欲。参与者将是N=860名成年吸烟者，他们是已建立的互联网戒烟计划的新注册用户，并参加其短信计划。在第一阶段的基础上，我们将优化我们的短信干预，以整合所有实验特征，这些特征对依从性产生积极影响。II期将是一项2组随机试验，比较基于网络的戒烟计划（WEB）单独和与最佳依从性短信干预（WEB+OA_TXT）联合对9个月时30天时点戒烟率的有效性。第二阶段的参与者将是N=600名成年吸烟者，他们是已建立的互联网戒烟计划的新注册用户，并参加了短信。我们将研究是否3个月的措施，坚持调解治疗效果的结果。提高对经证实的基于网络的戒烟干预措施的依从性对于利用这种“广泛接触”治疗方式的潜在公共卫生影响至关重要。拟议的研究在使用优化的短信干预以提高依从性方面具有创新性。研究结果将为其他领域的依从性研究提供信息，并将增加有关互联网戒烟计划和机制的整体有效性的知识基础，通过这些计划和机制，可以改善其对吸烟流行率的影响。

 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 preventive intervention. The Internet offers a promising delivery channel for evidence-based cessation treatment and the potential for enormous public health impact (reach x efficacy). Millions of smokers use the Internet for cessation assistance each year. Studies have shown quit rates of 7-28% across various Internet programs, and a positive relationship between intensity of use and higher abstinence rates. However, most smokers engage minimally with even the best designed cessation websites, diminishing their impact due to limited use of effective treatment components. Poor adherence has been noted across Internet behavior change programs. The ubiquity of mobile devices and their effectiveness in promoting adherence in other areas of health behavior change make them a promising tool to address adherence in web-based interventions. Text messaging is accessible and easy to use; messages can proactively prompt/remind and encourage continued exploration of a web-based intervention; interactive text messaging can facilitate engagement with core Internet intervention components. We have identified 4 aspects of a text message intervention that may enhance its effectiveness in promoting adherence to a web-based cessation program: personalization (yes/no), integration (yes/no), dynamic tailoring (yes/no), and message intensity (standard/decreasing). Phase I of this two-phase study will use a 2-level full factorial design to test the impact of these 4 experimental features on adherence to a web-based intervention. The primary outcome in Phase I will be a composite metric of adherence that incorporates number of logins, time on site, page views, and use of interactive site components shown to predict abstinence. Participants will be N=860 adult smokers that are new registered users of an established Internet cessation program and enroll in its text message program. Based on Phase I, we will optimize our text message intervention to incorporate all experimental features shown to positively impact adherence. Phase II will be a 2-arm randomized trial to compare the efficacy of a web-based cessation program (WEB) alone and in conjunction with the optimal-adherence text messaging intervention (WEB+OA_TXT) on 30-day point prevalence abstinence at 9 months. Phase II participants will be N=600 adult smokers that are new registered users of an established Internet cessation program and enroll in text messaging. We will examine whether 3 month measures of adherence mediate treatment effects on outcome. Improving adherence to proven web-based cessation interventions is critical to leverage the potential public health impact of this "broad reach" treatment modality. The proposed study is innovative in its use of an optimized text messaging intervention to improve adherence. Study findings will inform adherence research in other areas and will add to the growing knowledge base about the overall effectiveness of Internet cessation programs and mechanisms through which their population impact on smoking prevalence can be improved.