Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States.
Hollings Cancer Center, Charleston, SC, United States.
J Med Internet Res. 2024 Aug 28;26:e52919. doi: 10.2196/52919.
To address enduring age-related tobacco disparities, it is critical to promote cessation treatment among older adults (aged 65+ years). Digital health platforms offer opportunities for wide dissemination of evidence-based behavioral cessation support. However, existing digital cessation treatments are not tailored to unique aging-related needs and preferences, resulting in low uptake. Detailed information is needed about how to best adapt these treatments for this age group.
We aimed to collect detailed, hypothesis-generating information about expectations and preferences for cessation digital treatment among older adults who smoke cigarettes.
Semistructured interviews were conducted with adults aged 65+ years currently smoking or who had quit within the past month. Interviews included open-ended questions regarding prior experiences with digital health platforms and expectations and preferences for cessation treatment via various modalities (app-delivered, texting-based, or videoconferencing counseling). Interviews also elicited questions regarding digital modalities that integrated social components (app-delivered social forums and group videoconferencing counseling). Using an iterative, team-based approach, the thematic analysis identified meaningful themes. Interviews were supplemented with quantitative measures assessing sociodemographics, digital literacy, and physical health symptoms.
Participants (12/20, 60% men; 15/20, 75% White; 4/20, 20% Black or African American; 1/20, 5% Asian) were currently smoking (17/20, 85%) or had recently quit (3/20, 15%). Thematic analysis identified 3 meaningful themes across all digital modalities: convenience, accessibility, and personalization. Expected benefits of digital platforms included convenient treatment access, without reliance on transportation. Participants preferred treatments to be personalized and deliver content or strategies beyond standard education. Most (17/20, 85%) were unfamiliar with cessation apps but found them appealing given the potential for offering a novel quitting strategy. App ease of use (eg, easy navigation) was preferred. Half (10/20, 50%) would try a texting-based intervention, with many preferring texting with a counselor rather than automated messaging. Most (17/20, 85%) would use videoconferencing and expected this modality to deliver better quality counseling than via telephone. Expected videoconferencing challenges included looking presentable onscreen, technological difficulties, and privacy or security. Videoconferencing was regarded as the most personalized digital treatment, yet benefits unique to app-delivered and texting-based treatments included anonymity and access to treatment 24/7. Participants expected integrating social components into digital treatment to be useful for quit success and social connection, yet were concerned about possible interpersonal challenges.
Because a long history of quit attempts and familiarity with standard quitting advice is common among older adults who smoke cigarettes, digital platforms might offer appealing and novel strategies for cessation that are accessible and convenient. Overall, this population was open to trying digital cessation treatments and would prefer that these platforms prioritize ease of use and personalized content. These findings challenge the bias that older adults are uninterested or unwilling to engage with digital treatments for behavioral health.
为了解决长期存在的与年龄相关的烟草差异问题，必须促进老年（65 岁以上）人群的戒烟治疗。数字健康平台为传播基于证据的行为戒烟支持提供了机会。然而，现有的数字戒烟治疗方法并没有针对老年人独特的与年龄相关的需求和偏好进行定制，导致使用率较低。需要详细了解如何最好地为这一年龄组调整这些治疗方法。
我们旨在收集关于 65 岁以上吸烟成年人对戒烟数字治疗的期望和偏好的详细、生成假设的信息。
对目前吸烟或在过去一个月内戒烟的 65 岁及以上成年人进行半结构式访谈。访谈包括有关数字健康平台既往使用经验的开放性问题，以及对各种模式（应用程序提供、基于短信的、视频咨询）的戒烟治疗的期望和偏好。访谈还询问了有关整合社交功能的数字模式的问题（应用程序提供的社交论坛和小组视频咨询）。使用迭代、基于团队的方法，主题分析确定了有意义的主题。访谈还辅以评估社会人口统计学、数字素养和身体健康症状的定量措施。
参与者（20 人中有 12 人，占 60%；15 人中有 15 人，占 75%；白人；4 人中有 20%，占 20%；黑人或非裔美国人；1 人中有 5%，占 5%）目前正在吸烟（20 人中有 17 人，占 85%）或最近已戒烟（20 人中有 3 人，占 15%）。跨所有数字模式的主题分析确定了 3 个有意义的主题：便利性、可及性和个性化。数字平台的预期益处包括方便治疗，无需依赖交通。参与者希望治疗个性化，并提供超出标准教育的内容或策略。大多数（20 人中有 17 人，占 85%）不熟悉戒烟应用程序，但由于它们提供了新颖的戒烟策略而很有吸引力。应用程序易于使用（例如，易于导航）是首选。一半（20 人中有 10 人，占 50%）会尝试基于短信的干预，许多人更喜欢与顾问而不是自动短信进行短信交流。大多数（20 人中有 17 人，占 85%）会使用视频咨询，并期望这种模式比通过电话提供更好的咨询质量。预期的视频咨询挑战包括在屏幕上看起来得体、技术困难以及隐私或安全问题。视频咨询被认为是最个性化的数字治疗方法，但应用程序提供和基于短信的治疗方法的独特优势包括匿名性和 24/7 获得治疗。参与者期望将社交功能整合到数字治疗中，这对戒烟成功和社交联系很有用，但他们担心可能存在人际挑战。
由于年长的吸烟者通常有长期的戒烟尝试史和熟悉标准的戒烟建议，数字平台可能为他们提供了有吸引力的、新颖的戒烟策略，这些策略具有可及性和便利性。总体而言，该人群愿意尝试数字戒烟治疗，并且更希望这些平台优先考虑易用性和个性化内容。这些发现挑战了老年人对行为健康的数字治疗不感兴趣或不愿意接受的偏见。
