Department of General Practice, Academic Medical Centre Amsterdam, Amsterdam University Medical Centres, Amsterdam, Netherlands.
Amsterdam Public Health Research Institute, Amsterdam, Netherlands.
J Med Internet Res. 2023 Aug 22;25:e45223. doi: 10.2196/45223.
Digital interventions are increasingly used to support smoking cessation. Ex-smokers iCoach was a widely available app for smoking cessation used by 404,551 European smokers between June 15, 2011, and June 21, 2013. This provides a unique opportunity to investigate the uptake of a freely available digital smoking cessation intervention and its effects on smoking-related outcomes.
We aimed to investigate whether there were distinct trajectories of iCoach use, examine which baseline characteristics were associated with user groups (based on the intensity of use), and assess if and how these groups were associated with smoking-related outcomes.
Analyses were performed using data from iCoach users registered between June 15, 2011, and June 21, 2013. Smoking-related data were collected at baseline and every 3 months thereafter, with a maximum of 8 follow-ups. First, group-based modeling was applied to detect distinct trajectories of app use. This was performed in a subset of steady users who had completed at least 1 follow-up measurement. Second, ordinal logistic regression was used to assess the baseline characteristics that were associated with user group membership. Finally, generalized estimating equations were used to examine the association between the user groups and smoking status, quitting stage, and self-efficacy over time.
Of the 311,567 iCoach users, a subset of 26,785 (8.6%) steady iCoach users were identified and categorized into 4 distinct user groups: low (n=17,422, 65.04%), mild (n=4088, 15.26%), moderate (n=4415, 16.48%), and intensive (n=860, 3.21%) users. Older users and users who found it important to quit smoking had higher odds of more intensive app use, whereas men, employed users, heavy smokers, and users with higher self-efficacy scores had lower odds of more intensive app use. User groups were significantly associated with subsequent smoking status, quitting stage, and self-efficacy over time. For all groups, over time, the probability of being a smoker decreased, whereas the probability of being in an improved quitting stage increased, as did the self-efficacy to quit smoking. For all outcomes, the greatest change was observed between baseline and the first follow-up at 3 months. In the intensive user group, the greatest change was seen between baseline and the 9-month follow-up, with the observed change declining gradually in moderate, mild, and low users.
In the subset of steady iCoach users, more intensive app use was associated with higher smoking cessation rates, increased quitting stage, and higher self-efficacy to quit smoking over time. These users seemed to benefit most from the app in the first 3 months of use. Women and older users were more likely to use the app more intensively. Additionally, users who found quitting difficult used the iCoach app more intensively and grew more confident in their ability to quit over time.
数字干预措施越来越多地被用于支持戒烟。Ex-smokers iCoach 是一款广泛可用的戒烟应用程序，在 2011 年 6 月 15 日至 2013 年 6 月 21 日期间，有 404551 名欧洲吸烟者使用。这为研究免费数字戒烟干预措施的采用情况及其对吸烟相关结果的影响提供了独特的机会。
我们旨在调查 iCoach 使用是否存在不同的轨迹，研究哪些基线特征与用户群体（基于使用强度）相关，并评估这些群体与吸烟相关结果之间的关联。
使用 2011 年 6 月 15 日至 2013 年 6 月 21 日期间注册的 iCoach 用户的数据进行分析。在基线和此后每 3 个月收集一次吸烟相关数据，最多进行 8 次随访。首先，应用基于群组的建模来检测应用程序使用的不同轨迹。这是在完成至少一次随访测量的稳定用户子集上进行的。其次，使用有序逻辑回归来评估与用户群体成员资格相关的基线特征。最后，使用广义估计方程来研究用户群体与吸烟状态、戒烟阶段和自我效能随时间的关系。
在 311567 名 iCoach 用户中，确定了一个由 26785 名稳定 iCoach 用户（8.6%）组成的子集，并将其分为 4 个不同的用户群体：低（n=17422，65.04%）、轻度（n=4088，15.26%）、中度（n=4415，16.48%）和强化（n=860，3.21%）用户。年龄较大的用户和认为戒烟很重要的用户更有可能更频繁地使用该应用程序，而男性、有工作的用户、重度吸烟者和自我效能得分较高的用户则不太可能更频繁地使用该应用程序。用户群体与随后的吸烟状态、戒烟阶段和自我效能随时间的变化显著相关。对于所有群体，随着时间的推移，吸烟者的概率降低，而处于改善的戒烟阶段的概率增加，戒烟的自我效能也随之增加。对于所有结果，最大的变化发生在基线和 3 个月时的第一次随访之间。在强化用户群体中，最大的变化发生在基线和 9 个月的随访之间，而中度、轻度和低度用户的观察到的变化逐渐减少。
在稳定的 iCoach 用户子集中，更频繁地使用应用程序与更高的戒烟率、更高的戒烟阶段和更高的戒烟自我效能有关。这些用户似乎在使用应用程序的头 3 个月中获益最大。女性和年龄较大的用户更有可能更频繁地使用该应用程序。此外，认为戒烟困难的用户更频繁地使用 iCoach 应用程序，并且随着时间的推移对自己的戒烟能力越来越有信心。
