title: Design Considerations for mHealth Programs Targeting Smokers Not Yet Ready to Quit: Results of a Sequential Mixed-Methods Study.
abstract: BACKGROUND
  Mobile health (mHealth) smoking cessation programs are typically designed for smokers who are ready to quit smoking. In contrast, most smokers want to quit someday but are not yet ready to quit. If mHealth apps were designed for these smokers, they could potentially encourage and assist more people to quit smoking. No prior studies have specifically examined the design considerations of mHealth apps targeting smokers who are not yet ready to quit.
  
  
  OBJECTIVE
  To inform the user-centered design of mHealth apps for smokers who were not yet ready to quit by assessing (1) whether these smokers were interested in using mHealth tools to change their smoking behavior; (2) their preferred features, functionality, and content of mHealth programs addressing smoking; and (3) considerations for marketing or distributing these programs to promote their uptake.
  
  
  METHODS
  We conducted a sequential exploratory, mixed-methods study. Qualitative interviews (phase 1, n=15) were completed with a demographically diverse group of smokers who were smartphone owners and wanted to quit smoking someday, but not yet. Findings informed a Web-based survey of smokers from across the United States (phase 2, n=116). Data were collected from April to September, 2016.
  
  
  RESULTS
  Findings confirmed that although smokers not yet ready to quit are not actively seeking treatment or using cessation apps, most would be interested in using these programs to help them reduce or change their smoking behavior. Among phase 2 survey respondents, the app features, functions, and content rated most highly were (1) security of personal information; (2) the ability to track smoking, spending, and savings; (3) content that adaptively changes with one's needs; (4) the ability to request support as needed; (5) the ability to earn and redeem awards for program use; (6) guidance on how to quit smoking; and (7) content specifically addressing management of nicotine withdrawal, stress, depression, and anxiety. Results generally did not vary by stage of change for quitting smoking (precontemplation vs contemplation). The least popular feature was the ability to share progress via social media. Relevant to future marketing or distribution considerations, smokers were price-sensitive and valued empirically validated programs. Program source, expert recommendations, and user ratings were also important considerations.
  
  
  CONCLUSIONS
  Smokers who are not yet ready to quit represent an important target group for intervention. Study findings suggest that many of these individuals are receptive to using mHealth tools to reduce or quit smoking, despite not having made a commitment to quit yet. The preferences for specific mHealth intervention features, functionality, and content outlined in this paper can aid addiction treatment experts, design specialists, and software developers interested in creating engaging interventions for smokers who want to quit in the future but are not yet committed to this important health goal.
authors.affiliation: Kaiser Permanente Washington Health Research Institute (formerly, Group Health Research Institute), Seattle, WA, United States.
authors.forename: Jennifer B
authors.identifier: http://orcid.org/0000-0002-2094-9147
authors.initials: JB
authors.lastname: McClure
authors.affiliation: Fred Hutchinson Cancer Research Center, Seattle, WA, United States.
authors.forename: Jaimee
authors.identifier: http://orcid.org/0000-0001-9604-5489
authors.initials: J
authors.lastname: Heffner
authors.affiliation: Fred Hutchinson Cancer Research Center, Seattle, WA, United States.|School of Public Health, University of Washington, Seattle, WA, United States.
authors.forename: Sarah
authors.identifier: http://orcid.org/0000-0002-4624-1868
authors.initials: S
authors.lastname: Hohl
authors.affiliation: Kaiser Permanente Washington Health Research Institute (formerly, Group Health Research Institute), Seattle, WA, United States.
authors.forename: Predrag
authors.identifier: http://orcid.org/0000-0002-4570-703X
authors.initials: P
authors.lastname: Klasnja
authors.affiliation: Betty Irene School of Nursing, University of California, Davis, Sacramento, CA, United States.
authors.forename: Sheryl L
authors.identifier: http://orcid.org/0000-0002-6325-9349
authors.initials: SL
authors.lastname: Catz
keywords: mobile health; motivation; smartphone; smoking cessation; telemedicine; tobacco