Ulm Clayton, Chen Sixia, Fleshman Brianna, Benson Lizbeth, Kendzor Darla E, Frank-Pearce Summer, Neil Jordan M, Vidrine Damon, Businelle Michael S, De La Torre Irene
Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Heatlh Sciences Center, Oklahoma City, OK, United States.
JMIR Form Res. 2024 Jun 7;8:e56003. doi: 10.2196/56003.
Efficacy of smartphone-based interventions depends on intervention content quality and level of exposure to that content. Smartphone-based survey completion rates tend to decline over time; however, few studies have identified variables that predict this decline over longer-term interventions (eg, 26 weeks).
This study aims to identify predictors of survey completion and message viewing over time within a 26-week smoking cessation trial.
This study examined data from a 3-group pilot randomized controlled trial of adults who smoke (N=152) and were not ready to quit smoking within the next 30 days. For 182 days, two intervention groups received smartphone-based morning and evening messages based on current readiness to quit smoking. The control group received 2 daily messages unrelated to smoking. All participants were prompted to complete 26 weekly smartphone-based surveys that assessed smoking behavior, quit attempts, and readiness to quit. Compliance was operationalized as percentages of weekly surveys completed and daily messages viewed. Linear regression and mixed-effects models were used to identify predictors (eg, intervention group, age, and sex) of weekly survey completion and daily message viewing and decline in compliance over time.
The sample (mean age 50, SD 12.5, range 19-75 years; mean years of education 13.3, SD 1.6, range 10-20 years) was 67.8% (n=103) female, 74.3% (n=113) White, 77% (n=117) urban, and 52.6% (n=80) unemployed, and 61.2% (n=93) had mental health diagnoses. On average, participants completed 18.3 (71.8%) out of 25.5 prompted weekly surveys and viewed 207.3 (60.6%) out of 345.1 presented messages (31,503/52,460 total). Age was positively associated with overall weekly survey completion (P=.003) and daily message viewing (P=.02). Mixed-effects models indicated a decline in survey completion from 77% (114/148) in the first week of the intervention to 56% (84/150) in the last week of the intervention (P<.001), which was significantly moderated by age, sex, ethnicity, municipality (ie, rural/urban), and employment status. Similarly, message viewing declined from 72.3% (1533/2120) in the first week of the intervention to 44.6% (868/1946) in the last week of the intervention (P<.001). This decline in message viewing was significantly moderated by age, sex, municipality, employment status, and education.
This study demonstrated the feasibility of a 26-week smartphone-based smoking cessation intervention. Study results identified subgroups that displayed accelerated rates in the decline of survey completion and message viewing. Future research should identify ways to maintain high levels of interaction with mobile health interventions that span long intervention periods, especially among subgroups that have demonstrated declining rates of intervention engagement over time.
ClinicalTrials.gov NCT03405129; https://clinicaltrials.gov/ct2/show/NCT03405129.
基于智能手机的干预措施的效果取决于干预内容的质量以及对该内容的接触程度。基于智能手机的调查完成率往往会随着时间下降；然而，很少有研究确定在长期干预（如26周）中预测这种下降的变量。
本研究旨在确定在一项为期26周的戒烟试验中，随着时间推移调查完成情况和信息查看情况的预测因素。
本研究分析了一项针对吸烟者（N = 152）且在未来30天内不打算戒烟的成年人的3组试点随机对照试验的数据。在182天里，两个干预组根据当前戒烟意愿接收基于智能手机的早晚信息。对照组接收两条与吸烟无关的每日信息。所有参与者都被提示完成26项基于智能手机的每周调查，这些调查评估吸烟行为、戒烟尝试和戒烟意愿。依从性通过完成的每周调查百分比和查看的每日信息百分比来衡量。使用线性回归和混合效应模型来确定每周调查完成情况、每日信息查看情况以及依从性随时间下降的预测因素（如干预组、年龄和性别）。
样本（平均年龄50岁，标准差12.5，范围19 - 75岁；平均受教育年限13.3年，标准差1.6，范围10 - 20年）中女性占67.8%（n = 103），白人占74.3%（n = 113），城市居民占77%（n = 117），失业者占52.6%（n = 80），有心理健康诊断的占61.2%（n = 93）。平均而言，参与者完成了25.5项提示的每周调查中的18.3项（71.8%），查看了345.1条呈现信息中的207.3条（60.6%）（总共31,503/52,460条）。年龄与每周总体调查完成情况（P = .003）和每日信息查看情况（P = .02）呈正相关。混合效应模型表明，调查完成率从干预第一周的77%（114/148）下降到干预最后一周的56%（84/150）（P < .001），年龄、性别、种族、直辖市（即农村/城市）和就业状况对其有显著调节作用。同样，信息查看率从干预第一周的72.3%（总2120条中的1533条）下降到干预最后一周的44.6%（总1946条中的868条）（P < .001）。信息查看率的这种下降受到年龄、性别、直辖市、就业状况和教育程度的显著调节。
本研究证明了为期26周的基于智能手机的戒烟干预措施的可行性。研究结果确定了在调查完成率和信息查看率下降方面显示出加速趋势的亚组。未来的研究应该确定如何在长期干预期间保持与移动健康干预的高水平互动，特别是在那些随着时间推移干预参与率已显示出下降趋势的亚组中。
ClinicalTrials.gov NCT03405129；https://clinicaltrials.gov/ct2/show/NCT
