title: Mobile Phone Apps for Smoking Cessation: Quality and Usability Among Smokers With Psychosis.
abstract: BACKGROUND
  Smoking is one of the top preventable causes of mortality in people with psychotic disorders such as schizophrenia. Cessation treatment improves abstinence outcomes, but access is a barrier. Mobile phone apps are one way to increase access to cessation treatment; however, whether they are usable by people with psychotic disorders, who often have special learning needs, is not known.
  
  
  OBJECTIVE
  Researchers reviewed 100 randomly selected apps for smoking cessation to rate them based on US guidelines for nicotine addiction treatment and to categorize them based on app functions. We aimed to test the usability and usefulness of the top-rated apps in 21 smokers with psychotic disorders.
  
  
  METHODS
  We identified 766 smoking cessation apps and randomly selected 100 for review. Two independent reviewers rated each app with the Adherence Index to US Clinical Practice Guideline for Treating Tobacco Use and Dependence. Then, smokers with psychotic disorders evaluated the top 9 apps within a usability testing protocol. We analyzed quantitative results using descriptive statistics and t tests. Qualitative data were open-coded and analyzed for themes.
  
  
  RESULTS
  Regarding adherence to practice guidelines, most of the randomly sampled smoking cessation apps scored poorly-66% rated lower than 10 out of 100 on the Adherence Index (Mean 11.47, SD 11.8). Regarding usability, three common usability problems emerged: text-dense content, abstract symbols on the homepage, and subtle directions to edit features.
  
  
  CONCLUSIONS
  In order for apps to be effective and usable for this population, developers should utilize a balance of text and simple design that facilitate ease of navigation and content comprehension that will help people learn quit smoking skills.
authors.affiliation: Health Promotion Research Center at Dartmouth, Department of Psychiatry, Dartmouth Hitchcock Medical Center, Concord, NH, United States.
authors.forename: Joelle C
authors.identifier: http://orcid.org/0000-0001-6278-8305
authors.initials: JC
authors.lastname: Ferron
authors.affiliation: Center for Technology and Behavioral Health, Department of Psychiatry, Dartmouth College, Lebanon, NH, United States.
authors.forename: Mary F
authors.identifier: http://orcid.org/0000-0002-0713-8745
authors.initials: MF
authors.lastname: Brunette
authors.affiliation: Center for Technology and Behavioral Health, Department of Psychiatry, Dartmouth College, Lebanon, NH, United States.
authors.forename: Pamela
authors.identifier: http://orcid.org/0000-0003-1733-6072
authors.initials: P
authors.lastname: Geiger
authors.affiliation: Center for Technology and Behavioral Health, Department of Psychiatry, Dartmouth College, Lebanon, NH, United States.
authors.forename: Lisa A
authors.identifier: http://orcid.org/0000-0001-6429-0965
authors.initials: LA
authors.lastname: Marsch
authors.affiliation: Health Promotion Research Center at Dartmouth, The Dartmouth Institute, Dartmouth College, Lebanon, NH, United States.
authors.forename: Anna M
authors.identifier: http://orcid.org/0000-0001-5980-3850
authors.initials: AM
authors.lastname: Adachi-Mejia
authors.affiliation: Health Promotion Research Center at Dartmouth, The Dartmouth Institute, Dartmouth College, Lebanon, NH, United States.
authors.forename: Stephen J
authors.identifier: http://orcid.org/0000-0002-7985-2905
authors.initials: SJ
authors.lastname: Bartels
keywords: mHealth; mobile apps; psychotic disorders; schizophrenia; smoking cessation