McKay H Garth, Danaher Brian G, Seeley John R, Lichtenstein Edward, Gau Jeff M
Oregon Research Institute, 1715 Franklin Boulevard, Eugene, OR 97403, USA.
J Med Internet Res. 2008 Nov 18;10(5):e40. doi: 10.2196/jmir.993.
Smoking cessation remains a significant public health problem. Innovative interventions that use the Internet have begun to emerge that offer great promise in reaching large numbers of participants and encouraging widespread behavior change. To date, the relatively few controlled trials of Web-based smoking cessation programs have been limited by short follow-up intervals.
We describe the 6-month follow-up results of a randomized controlled trial in which participants recruited online were randomly assigned to either a Web-based smoking cessation program (Quit Smoking Network; QSN) or a Web-based exercise enhancement program (Active Lives) adapted somewhat to encourage smoking cessation.
The study was a two-arm randomized controlled trial that compared two Web-based smoking cessation programs: (1) the QSN intervention condition presented cognitive-behavioral strategies, and (2) the Active Lives control condition provided participants with guidance in developing a physical activity program to assist them with quitting. The QSN condition provided smoking cessation information and behavior change strategies while the Active Lives condition provided participants with physical activity recommendations and goal setting. The QSN condition was designed to be more engaging (eg, it included multimedia components) and to present much greater content than is typically found in smoking cessation programs.
Contrary to our hypotheses, no between-condition differences in smoking abstinence were found at 3- and 6-month follow-up assessments. While participants in the QSN intervention condition spent more time than controls visiting the online program, the median number of 1.0 visit in each condition and the substantial attrition (60.8% at the 6-month follow-up) indicate that participants were not as engaged as we had expected.
Contrary to our hypothesis, our test of two Web-based smoking cessation conditions, an intervention and an attention placebo control, failed to show differences at 3- and 6-month assessments. We explored possible reasons for this finding, including limited engagement of participants and simplifying program content and architecture. Future research needs to address methods to improve participant engagement in online smoking cessation programs. Possible approaches in this regard can include new informed consent procedures that better explain the roles and responsibilities of being a research participant, new program designs that add more vitality (changing content from visit to visit), and new types of reminders pushed out to participants to encourage return visits. Simplifying program content through a combination of enhanced tailoring and information architecture also merits further research attention.
戒烟仍然是一个重大的公共卫生问题。利用互联网的创新干预措施已开始出现，有望覆盖大量参与者并促进广泛的行为改变。迄今为止，相对较少的基于网络的戒烟项目对照试验受到随访间隔时间短的限制。
我们描述了一项随机对照试验的6个月随访结果，该试验中在线招募的参与者被随机分配到一个基于网络的戒烟项目（戒烟网络；QSN）或一个为鼓励戒烟而稍作调整的基于网络的运动增强项目（积极生活）。
该研究是一项双臂随机对照试验，比较了两个基于网络的戒烟项目：（1）QSN干预组呈现认知行为策略，（2）积极生活对照组为参与者提供制定体育活动计划的指导以帮助他们戒烟。QSN组提供戒烟信息和行为改变策略，而积极生活组为参与者提供体育活动建议和目标设定。QSN组的设计更具吸引力（例如，它包括多媒体组件），并且提供的内容比典型的戒烟项目要多得多。
与我们的假设相反，在3个月和6个月的随访评估中，未发现戒烟情况在组间存在差异。虽然QSN干预组的参与者访问在线项目的时间比对照组多，但每组的访问中位数为1.0次，且流失率较高（6个月随访时为60.8%），这表明参与者的参与度不如我们预期的高。
与我们的假设相反，我们对两个基于网络的戒烟条件（一个干预组和一个注意力安慰剂对照组）的测试在3个月和6个月的评估中未显示出差异。我们探讨了这一结果的可能原因，包括参与者参与度有限以及简化项目内容和架构。未来的研究需要解决提高参与者参与在线戒烟项目的方法。这方面可能的方法包括新的知情同意程序，更好地解释作为研究参与者的角色和责任；新的项目设计，增加更多活力（每次访问改变内容）；以及向参与者推送新型提醒以鼓励回访。通过增强个性化定制和信息架构相结合来简化项目内容也值得进一步的研究关注。
