title: Using text messaging to prevent relapse to smoking: intervention development, practicability and client reactions.
abstract: OBJECTIVE
  The NHS Stop Smoking Service (NHS-SSS) helps approximately half its clients to quit for 4 weeks. However, most initially successful quitters relapse within 6 months. Short message service (SMS) texting has been shown to facilitate stopping smoking. We describe the development, implementation and subsequent evaluation, in terms of practicability and client response, of an SMS text-based relapse prevention intervention (RPI) delivered within routine community and specialist National Health Service (NHS) Stop Smoking Service (SSS) provision in four Primary Care Trusts.
  
  
  METHODS
  Text messages aimed at motivation to remain abstinent, preventing careless lapses and continuing the full course of medicine for smoking cessation were developed and sent weekly to clients' mobile phones for 12 weeks and fortnightly for 6 months. They were asked to respond to some of the texts and contact the NHS SSS if they lapsed. They were also offered free nicotine mini lozenges to be sent via the mail on three occasions.
  
  
  METHODS
  NHS SSS.
  
  
  METHODS
  202 clients who had been abstinent for 4 weeks.
  
  
  METHODS
  Feasibility of introducing RPI into routine care; response to interactive messages and requests for the medication; rating of the helpfulness of RPI; self-reported and carbon monoxide (CO)-validated smoking status for up to 26 weeks.
  
  
  RESULTS
  A text-based RPI was easy to implement within the NHS SSS provided by specialist advisers, but enrollment of clients from services provided by a network of pharmacists was difficult because client contact details were often lacking. Where records of the number of people invited to RPI were available, 94% of eligible participants enrolled. The RPI was well received by both SSS clients and staff, with 70% (n = 63) of clients who completed follow-up considering the intervention helpful. Eighty-five per cent (n = 172) of clients responded to at least one of the nine interactive text messages. Sixty-four clients (32% of the total, 47% of those we managed to contact) reported continuous abstinence at 6 months. Eighteen (9%) clients who relapsed to smoking used the RPI to re-engage with the NHS SSS and 10 (5%) successfully re-established abstinence.
  
  
  CONCLUSIONS
  In smokers attending National Health Service Stop Smoking Services who are abstinent 4 weeks after their quit date, a relapse prevention intervention based on SMS text messaging was well received, and can be implemented economically and rapidly. A controlled trial is needed to establish whether it has a significant impact on relapse.
authors.affiliation: Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK. s.snuggs@qmul.ac.uk
authors.forename: Sarah
authors.initials: S
authors.lastname: Snuggs
authors.forename: Hayden
authors.initials: H
authors.lastname: McRobbie
authors.forename: Katherine
authors.initials: K
authors.lastname: Myers
authors.forename: Frances
authors.initials: F
authors.lastname: Schmocker
authors.forename: Jill
authors.initials: J
authors.lastname: Goddard
authors.forename: Peter
authors.initials: P
authors.lastname: Hajek
mesh_terms: D005240:Feasibility Studies; D006801:Humans; D009042:Motivation; D010342:Patient Acceptance of Health Care; D010865:Pilot Projects; D055502:Secondary Prevention; D057566:Self Report; D016540:Smoking Cessation / Q000379:methods*; D000074606:Smoking Prevention; D013222:State Medicine; D060145:Text Messaging; D016896:Treatment Outcome; D006113:United Kingdom