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Comparative effectiveness of motivation phase intervention components for use with smokers unwilling to quit: a factorial screening experiment.

ABSTRACT: AIMS:To screen promising intervention components designed to reduce smoking and promote abstinence in smokers initially unwilling to quit. DESIGN:A balanced, four-factor, randomized factorial experiment. SETTING:Eleven primary care clinics in southern Wisconsin, USA. PARTICIPANTS:A total of 517 adult smokers (63.4% women, 91.1% white) recruited during primary care visits who were willing to reduce their smoking but not quit. INTERVENTIONS:Four factors contrasted intervention components designed to reduce smoking and promote abstinence: (1) nicotine patch versus none; (2) nicotine gum versus none; (3) motivational interviewing (MI) versus none; and (4) behavioral reduction counseling (BR) versus none. Participants could request cessation treatment at any point during the study. MEASUREMENTS:The primary outcome was percentage change in cigarettes smoked per day at 26?weeks post-study enrollment; the secondary outcomes were percentage change at 12 weeks and point-prevalence abstinence at 12 and 26 weeks post-study enrollment. FINDINGS:There were few main effects, but a significant four-way interaction at 26?weeks post-study enrollment (P?=?0.01, ??=?0.12) revealed relatively large smoking reductions by two component combinations: nicotine gum combined with BR and BR combined with MI. Further, BR improved 12-week abstinence rates (P?=?0.04), and nicotine gum, when used without MI, increased 26-week abstinence after a subsequent aided quit attempt (P?=?0.01). CONCLUSIONS:Motivation-phase nicotine gum and behavioral reduction counseling are promising intervention components for smokers who are initially unwilling to quit.

SUBMITTER: Cook JW

PROVIDER: S-EPMC4681585 | biostudies-literature | 2016 Jan

REPOSITORIES: biostudies-literature

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Comparative effectiveness of motivation phase intervention components for use with smokers unwilling to quit: a factorial screening experiment.

Cook Jessica W JW Collins Linda M LM Fiore Michael C MC Smith Stevens S SS Fraser David D Bolt Daniel M DM Baker Timothy B TB Piper Megan E ME Schlam Tanya R TR Jorenby Douglas D Loh Wei-Yin WY Mermelstein Robin R

Addiction (Abingdon, England) 20151119 1

<h4>Aims</h4>To screen promising intervention components designed to reduce smoking and promote abstinence in smokers initially unwilling to quit.<h4>Design</h4>A balanced, four-factor, randomized factorial experiment.<h4>Setting</h4>Eleven primary care clinics in southern Wisconsin, USA.<h4>Participants</h4>A total of 517 adult smokers (63.4% women, 91.1% white) recruited during primary care visits who were willing to reduce their smoking but not quit.<h4>Interventions</h4>Four factors contrast ...[more]

PMID: 26582140

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Project description:IntroductionMost people who smoke cigarettes are not willing (ie, not ready) to make a quit attempt (QA) at any given time. Unfortunately, interventions intended to increase QAs and the success of QAs are only modestly effective. Identifying processes leading to QAs and quitting success could guide intervention development.Aims and methodsThis is a secondary analysis of a randomized factorial trial of 6 weeks of motivation-phase interventions among primary care patients (N = 517) who were initially unwilling to quit but were willing to reduce their smoking. Using logistic regression, we controlled for treatment condition and tested whether baseline or change in smoking-related constructs after 6 weeks of treatment predicted (1) making an at least 24 h QA between weeks 6 and 26 and (2) quitting success at week 26 (7-day point-prevalence abstinence among those who made a QA). Predictors included cigarettes/day, time to first cigarette, motivation to quit, quitting self-efficacy, anticipated urges to smoke if quit, positive affect, negative affect, and time spent around others who smoke.ResultsIn multivariable models that included all smoking-related constructs, changes in the following variables predicted initiating a QA above and beyond other variables: greater baseline time to first cigarette (odds ratio [OR] = 1.60), increases in time to first cigarette (OR = 1.27), and increases in quitting self-efficacy (OR = 1.14). Increased motivation to quit predicted conversion of a QA into quitting success at 26 weeks (OR = 1.36).ConclusionPredictors of making a QA differed from predictors of quitting success. Predictors of QAs and success could each serve as important treatment targets of motivation-phase interventions.ImplicationsMotivation-phase interventions for people initially unwilling to quit smoking cigarettes may be improved by striving to increase their (1) time to first cigarette and quitting self-efficacy to promote QAs and (2) motivation to quit to promote quit success. Future experimental tests of such interventions are needed to identify causal determinants of QAs and quitting success.

Project description:BackgroundAlthough physical activity can mitigate disease trajectories and improve and sustain mental health, many people have become less physically active during the COVID-19 pandemic. Personal information technology, such as activity trackers and chatbots, can technically converse with people and possibly enhance their autonomous motivation to engage in physical activity. The literature on behavior change techniques (BCTs) and self-determination theory (SDT) contains promising insights that can be leveraged in the design of these technologies; however, it remains unclear how this can be achieved.ObjectiveThis study aimed to evaluate the feasibility of a chatbot system that improves the user's autonomous motivation for walking based on BCTs and SDT. First, we aimed to develop and evaluate various versions of a chatbot system based on promising BCTs. Second, we aimed to evaluate whether the use of the system improves the autonomous motivation for walking and the associated factors of need satisfaction. Third, we explored the support for the theoretical mechanism and effectiveness of various BCT implementations.MethodsWe developed a chatbot system using the mobile apps Telegram (Telegram Messenger Inc) and Google Fit (Google LLC). We implemented 12 versions of this system, which differed in 3 BCTs: goal setting, experimenting, and action planning. We then conducted a feasibility study with 102 participants who used this system over the course of 3 weeks, by conversing with a chatbot and completing questionnaires, capturing their perceived app support, need satisfaction, physical activity levels, and motivation.ResultsThe use of the chatbot systems was satisfactory, and on average, its users reported increases in autonomous motivation for walking. The dropout rate was low. Although approximately half of the participants indicated that they would have preferred to interact with a human instead of the chatbot, 46.1% (47/102) of the participants stated that the chatbot helped them become more active, and 42.2% (43/102) of the participants decided to continue using the chatbot for an additional week. Furthermore, the majority thought that a more advanced chatbot could be very helpful. The motivation was associated with the satisfaction of the needs of competence and autonomy, and need satisfaction, in turn, was associated with the perceived system support, providing support for SDT underpinnings. However, no substantial differences were found across different BCT implementations.ConclusionsThe results provide evidence that chatbot systems are a feasible means to increase autonomous motivation for physical activity. We found support for SDT as a basis for the design, laying a foundation for larger studies to confirm the effectiveness of the selected BCTs within chatbot systems, explore a wider range of BCTs, and help the development of guidelines for the design of interactive technology that helps users achieve long-term health benefits.

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Comparative effectiveness of motivation phase intervention components for use with smokers unwilling to quit: a factorial screening experiment.

Publications

Comparative effectiveness of motivation phase intervention components for use with smokers unwilling to quit: a factorial screening experiment.

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