Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
Ontario Tobacco Research Unit, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
J Med Internet Res. 2020 Oct 19;22(10):e16255. doi: 10.2196/16255.
The increasing number of internet users presents an opportunity to deliver health interventions to large populations. Despite their potential, many web-based interventions, including those for smoking cessation, face high rates of attrition. Further consideration of how intervention features impact attrition is needed.
The aim of this systematic review is to investigate whether tailored web-based smoking cessation interventions for smokers are associated with reduced rates of attrition compared with active or passive untailored web-based interventions. The outcomes of interest were dropout attrition at 1-, 3-, 6-, and 12-month follow-ups.
Literature searches were conducted in May 2018 and updated in May 2020 on MEDLINE (Medical Literature Analysis and Retrieval System Online), PsycINFO (Psychological Information), EMBASE (Excerpta Medica dataBASE), CINAHL (Cumulated Index to Nursing and Allied Health Literature), Scopus, and the Cochrane Tobacco Addiction Group Specialized Register with the following search terms: smoking cessation, tailored, or web- or internet-based. Included studies were published in English before or in May 2020 using a randomized controlled trial design. Studies were restricted to those with web-based delivery, a tailored intervention group, an untailored control group, and a reported outcome of smoking cessation. Studies were assessed for methodological quality using the Cochrane Risk of Bias tool. Two reviewers independently extracted the study characteristics and the number of participants lost to follow-up for each treatment group.
A total of 13 studies were included in the systematic review, of which 11 (85%) were included in the meta-analysis. Tailoring had no statistically significant effect on dropout attrition at 1-month (risk ratio [RR]=1.02, 95% CI 0.95-1.09; P=.58; I=78%), 3-month (RR=0.99, 95% CI 0.95-1.04; P=.80; I=73%), 6-month (RR=1.00, 95% CI 0.95-1.05; P=.90; I=43%), or 12-month (RR=0.97, 95% CI 0.92-1.02; P=.26; I=28%) follow-ups. Subgroup analyses suggested that there was a statistically significant effect of tailoring between the active and passive subgroups at 1-month (P=.03), 3-month (P<.001), and 6-month (P=.02) follow-ups but not at 12-month follow-up (P=.25).
The results suggest that tailoring of web-based smoking cessation interventions may not be associated with reduced rates of dropout attrition at 1-, 3-, 6-, or 12-month follow-ups. Significant differences between studies that include untailored active and passive control groups suggest that the role of tailoring may be more prominent when studies include a passive control group. These findings may be because of variability in the presence of additional features, the definition of smokers used, and the duration of smoking abstinence measured. Future studies should incorporate active web-based controls, compare the impact of different tailoring strategies, and include populations outside of the Western countries.
互联网用户数量的增加为向大量人群提供健康干预措施提供了机会。尽管有潜力，但许多基于网络的干预措施，包括戒烟干预措施，都面临着较高的退出率。需要进一步考虑干预措施的特征如何影响退出率。
本系统评价旨在调查针对吸烟者的定制化网络戒烟干预措施是否与降低与主动或被动非定制化网络干预措施相比的退出率有关。感兴趣的结果是在 1、3、6 和 12 个月随访时的辍学退出率。
于 2018 年 5 月和 2020 年 5 月对 MEDLINE（医学文献分析和检索系统在线）、PsycINFO（心理信息）、EMBASE（医学文摘在线数据库）、CINAHL（护理与联合健康文献累积索引）、Scopus 和 Cochrane 烟草成瘾组专业注册中心进行文献检索，使用以下搜索词：戒烟、定制或基于网络或互联网。纳入的研究是在使用随机对照试验设计的情况下，于 2020 年 5 月之前或之前以英文发表的。研究仅限于基于网络的交付、定制干预组、非定制对照组和报告的戒烟结果。使用 Cochrane 偏倚风险工具评估研究的方法学质量。两位审查员独立提取了每个治疗组的研究特征和失访参与者的数量。
共有 13 项研究被纳入系统评价，其中 11 项（85%）被纳入荟萃分析。定制化对 1 个月（风险比 [RR]=1.02，95%置信区间 [CI] 0.95-1.09；P=.58；I=78%）、3 个月（RR=0.99，95% CI 0.95-1.04；P=.80；I=73%）、6 个月（RR=1.00，95% CI 0.95-1.05；P=.90；I=43%）或 12 个月（RR=0.97，95% CI 0.92-1.02；P=.26；I=28%）随访的辍学退出率没有统计学意义的影响。亚组分析表明，在 1 个月（P=.03）、3 个月（P<.001）和 6 个月（P=.02）随访时，主动和被动亚组之间的定制化存在统计学显著影响，但在 12 个月随访时（P=.25）没有统计学显著影响。
结果表明，在 1、3、6 或 12 个月随访时，定制化网络戒烟干预措施可能与辍学退出率降低无关。纳入非定制化主动和被动对照组的研究之间存在显著差异，这表明当研究纳入被动对照组时，定制化的作用可能更为突出。这些发现可能是由于存在额外特征的可变性、所使用的吸烟者定义以及所测量的吸烟禁欲持续时间不同。未来的研究应纳入主动的网络对照组，比较不同定制策略的影响，并纳入西方国家以外的人群。
