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

 描述(由申请人提供)：降低人口吸烟流行率是一项紧迫的公共卫生优先事项，比几乎任何其他预防性干预措施都能挽救更多的生命和金钱。互联网为以证据为基础的戒烟治疗提供了一个有希望的提供渠道，并有可能产生巨大的公共健康影响(达到x效果)。每年有数以百万计的吸烟者使用互联网帮助戒烟。研究表明，在不同的互联网项目中，戒烟率为7%-28%，使用强度与更高的禁酒率之间存在正相关关系。然而，大多数吸烟者最少接触到即使是设计最好的戒烟网站，由于有限使用有效的治疗组件，他们的影响会减弱。在互联网行为改变计划中，人们注意到遵守情况很差。移动设备的无处不在及其在促进健康行为改变的其他领域的遵守方面的有效性，使其成为解决基于网络的干预措施中遵守问题的有希望的工具。短信易于获取和使用；短信可以主动提示/提醒和鼓励继续探索基于网络的干预措施；交互式短信可以促进与核心互联网干预组件的接触。我们已经确定了短信干预的4个方面，它们可以增强其在促进遵守基于网络的戒烟计划方面的有效性：个性化(是/否)、整合(是/否)、动态定制(是/否)和消息强度(标准/减少)。这项两阶段研究的第一阶段将使用两水平完全析因设计来测试这4个实验特征对坚持基于网络的干预的影响。第一阶段的主要结果将是一个遵守情况的综合衡量标准，其中包括登录数量、在网站上的时间、页面浏览量以及用于预测禁欲的互动网站组件的使用情况。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，并登记在其短信计划中。在第一阶段的基础上，我们将优化我们的短信干预，以纳入所有被证明对遵从性产生积极影响的实验功能。第二阶段将是一项双臂随机试验，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)联合使用对9个月后30天的时点戒断的疗效。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，并登记在短信中。我们将检查3个月的依从性措施是否会中介治疗对结果的影响。提高对经过验证的基于网络的戒烟干预措施的遵从性，对于利用这种“广泛”治疗方式的潜在公共健康影响至关重要。这项拟议的研究在使用优化的短信干预以提高遵从性方面具有创新性。研究结果将为其他领域的坚持研究提供信息，并将增加有关互联网戒烟计划和机制的总体有效性的日益增长的知识库，通过这些机制，可以改善其人口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.