title: Evaluating an Adaptive and Interactive mHealth Smoking Cessation and Medication Adherence Program: A Randomized Pilot Feasibility Study.
abstract: BACKGROUND
  Mobile health (mHealth) interventions hold great promise for helping smokers quit since these programs can have wide reach and facilitate access to comprehensive, interactive, and adaptive treatment content. However, the feasibility, acceptability, and effectiveness of these programs remain largely untested.
  
  
  OBJECTIVE
  To assess feasibility and acceptability of the My Mobile Advice Program (MyMAP) smoking cessation program and estimate its effects on smoking cessation and medication adherence to inform future research planning.
  
  
  METHODS
  Sixty-six smokers ready to quit were recruited from a large regional health care system and randomized to one of two mHealth programs: (1) standard self-help including psychoeducational materials and guidance how to quit smoking or (2) an adaptive and interactive program consisting of the same standard mHealth self-help content as controls received plus a) real-time, adaptively tailored advice for managing nicotine withdrawal symptoms and medication side-effects and b) asynchronous secure messaging with a cessation counselor. Participants in both arms were also prescribed a 12-week course of varenicline. Follow-up assessments were conducted at 2 weeks post-target quit date (TQD), 3 months post-TQD, and 5 months post-TQD. Indices of program feasibility and acceptability included acceptability ratings, utilization metrics including use of each MyMAP program component (self-help content, secure messaging, and adaptively tailored advice), and open-ended feedback from participants. Smoking abstinence and medication adherence were also assessed to estimate effects on these treatment outcomes.
  
  
  RESULTS
  Utilization data indicated the MyMAP program was actively used, with higher mean program log-ins by experimental than control participants (10.6 vs 2.7, P<.001). The majority of experimental respondents thought the MyMAP program could help other people quit smoking (22/24, 92%) and consistently take their stop-smoking medication (17/22, 97%) and would recommend the program to others (20/23, 87%). They also rated the program as convenient, responsive to their needs, and easy to use. Abstinence rates at 5-month follow-up were 36% in the experimental arm versus 24% among controls (odds ratio 1.79 [0.61-5.19], P=.42). Experimental participants used their varenicline an average of 46 days versus 39 among controls (P=.49). More than two-thirds (22/33, 67%) of experimental participants and three-quarters (25/33, 76%) of controls prematurely discontinued their varenicline use (P=.29).
  
  
  CONCLUSIONS
  The MyMAP intervention was found to be feasible and acceptable. Since the study was not powered for statistical significance, no conclusions can be drawn about the program's effects on smoking abstinence or medication adherence, but the overall study results suggest further evaluation in a larger randomized trial is warranted.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT02136498; https://clinicaltrials.gov/ct2/show/NCT02136498 (Archived by WebCite at http://www.webcitation.org/6jT3UMFLj).
authors.affiliation: Group Health Research Institute, Seattle, WA, United States. McClure.J@ghc.org.
authors.forename: Jennifer B
authors.identifier: http://orcid.org/0000-0002-2094-9147
authors.initials: JB
authors.lastname: McClure
authors.forename: Melissa L
authors.identifier: http://orcid.org/0000-0003-3886-1394
authors.initials: ML
authors.lastname: Anderson
authors.forename: Katharine
authors.identifier: http://orcid.org/0000-0003-1933-4425
authors.initials: K
authors.lastname: Bradley
authors.forename: Lawrence C
authors.identifier: http://orcid.org/0000-0001-9861-1800
authors.initials: LC
authors.lastname: An
authors.forename: Sheryl L
authors.identifier: http://orcid.org/0000-0002-6325-9349
authors.initials: SL
authors.lastname: Catz
keywords: eHealth; mHealth; mobile health; secure messaging; smoking; tobacco use cessation; varenicline