title: Smoking Cessation Intervention on Facebook: Which Content Generates the Best Engagement?
abstract: BACKGROUND
  Social media offer a great opportunity to deliver smoking cessation treatment to young adults, but previous online and social media interventions targeting health behavior change have struggled with low participant engagement. We examined engagement generated by content based on the Transtheoretical Model of Behavior Change (TTM) in a motivationally tailored smoking cessation intervention on Facebook.
  
  
  OBJECTIVE
  This study aimed to identify which intervention content based on the TTM (Decisional Balance and 10 processes of change) generated the highest engagement among participants in pre-action stages of change (Precontemplation, Contemplation, and Preparation).
  
  
  METHODS
  Participants (N=79, 20% female, mean age 20.8) were assessed for readiness to quit smoking and assigned to one of 7 secret Facebook groups tailored to their stage of change. Daily postings to the groups based on TTM Decisional Balance and the 10 processes of change were made by research staff over 3 months. Engagement was operationalized as the number of participant comments to each post. TTM content-based predictors of number of comments were analyzed and stratified by baseline stage of change, using negative binomial regression analyses with and without zero inflation.
  
  
  RESULTS
  A total of 512 TTM-based posts generated 630 individual comments. In Precontemplation and Contemplation groups, Decisional Balance posts generated above average engagement (P=.01 and P<.001). In Contemplation groups, posts based on the TTM processes Dramatic Relief and Self-Liberation resulted in below average engagement (P=.01 and P=.005). In Preparation groups, posts based on Consciousness Raising generated above average engagement (P=.009). Participant engagement decreased over time and differed between groups within Precontemplation and Contemplation stages, but was independent of day of the week and time of day the content was posted to the groups. No participant baseline characteristics significantly predicted engagement.
  
  
  CONCLUSIONS
  Participants not ready to quit in the next 30 days (in Precontemplation or Contemplation) engaged most when prompted to think about the pros and cons of behavior change, while those in the Preparation stage engaged most when posts increased awareness about smoking and smoking cessation. Findings support tailoring intervention content to readiness to quit and suggest intervention components that may be most effective in generating high participant engagement on social media.
authors.affiliation: Center for Tobacco Control Research and Education, University of California, San Francisco, San Francisco, CA, United States. Johannes.Thrul@ucsf.edu.
authors.forename: Johannes
authors.identifier: http://orcid.org/0000-0001-8929-9579
authors.initials: J
authors.lastname: Thrul
authors.forename: Alexandra B
authors.identifier: http://orcid.org/0000-0003-0664-4563
authors.initials: AB
authors.lastname: Klein
authors.forename: Danielle E
authors.identifier: http://orcid.org/0000-0002-9875-5713
authors.initials: DE
authors.lastname: Ramo
mesh_terms: D000328:Adult; D005260:Female; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D020407:Internet / Q000706:statistics & numerical data*; D008297:Male; D009042:Motivation; D016540:Smoking Cessation / Q000379:methods*; D061108:Social Media; D055815:Young Adult
keywords: Facebook; Transtheoretical Model; engagement; smoking cessation; young adults