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Comparing two web-based smoking cessation programs: randomized controlled trial.

McKay HG, Danaher BG, Seeley JR, Lichtenstein E, Gau JM - J. Med. Internet Res. (2008)

Bottom Line: Contrary to our hypotheses, no between-condition differences in smoking abstinence were found at 3- and 6-month follow-up assessments.Possible approaches in this regard can include new informed consent procedures that better explain the roles and responsibilities of being a research participant, new program designs that add more vitality (changing content from visit to visit), and new types of reminders pushed out to participants to encourage return visits.Simplifying program content through a combination of enhanced tailoring and information architecture also merits further research attention.

View Article: PubMed Central - HTML - PubMed

Affiliation: Oregon Research Institute, 1715 Franklin Boulevard, Eugene, OR 97403, USA.

ABSTRACT

Background: Smoking cessation remains a significant public health problem. Innovative interventions that use the Internet have begun to emerge that offer great promise in reaching large numbers of participants and encouraging widespread behavior change. To date, the relatively few controlled trials of Web-based smoking cessation programs have been limited by short follow-up intervals.

Objective: We describe the 6-month follow-up results of a randomized controlled trial in which participants recruited online were randomly assigned to either a Web-based smoking cessation program (Quit Smoking Network; QSN) or a Web-based exercise enhancement program (Active Lives) adapted somewhat to encourage smoking cessation.

Methods: The study was a two-arm randomized controlled trial that compared two Web-based smoking cessation programs: (1) the QSN intervention condition presented cognitive-behavioral strategies, and (2) the Active Lives control condition provided participants with guidance in developing a physical activity program to assist them with quitting. The QSN condition provided smoking cessation information and behavior change strategies while the Active Lives condition provided participants with physical activity recommendations and goal setting. The QSN condition was designed to be more engaging (eg, it included multimedia components) and to present much greater content than is typically found in smoking cessation programs.

Results: Contrary to our hypotheses, no between-condition differences in smoking abstinence were found at 3- and 6-month follow-up assessments. While participants in the QSN intervention condition spent more time than controls visiting the online program, the median number of 1.0 visit in each condition and the substantial attrition (60.8% at the 6-month follow-up) indicate that participants were not as engaged as we had expected.

Conclusions: Contrary to our hypothesis, our test of two Web-based smoking cessation conditions, an intervention and an attention placebo control, failed to show differences at 3- and 6-month assessments. We explored possible reasons for this finding, including limited engagement of participants and simplifying program content and architecture. Future research needs to address methods to improve participant engagement in online smoking cessation programs. Possible approaches in this regard can include new informed consent procedures that better explain the roles and responsibilities of being a research participant, new program designs that add more vitality (changing content from visit to visit), and new types of reminders pushed out to participants to encourage return visits. Simplifying program content through a combination of enhanced tailoring and information architecture also merits further research attention.

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Related in: MedlinePlus

Survival analysis of program engagement over time by condition
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figure3: Survival analysis of program engagement over time by condition

Mentions: We examined the pattern of participant exposure over time by condition. For purposes of this analysis, we defined exposure as the number of days elapsed between each participant’s date of randomization/enrollment and the date of his/her last website visit to view program content. We applied the Kaplan-Meier survival analysis to these data, which allowed us to examine the timing of the last visit by condition (see Figure 3). By definition, all participants had a last visit since all participants stopped visiting at some point following enrollment. Note that Figure 3 shows a steep downward slope in last program visits soon after program enrollment, indicating that most participants stopped visiting the program soon after they started. There were notable drops in subsequent participation at times that corresponded with the follow-up assessments. While QSN had somewhat longer estimated survival time (mean = 36.71 days, SE = 2.18) than the Active Lives condition (mean = 30.86, SE = 2.02), the Kaplan-Meier survival tests revealed that the overall trajectory of these post-enrollment program visit curves did not significantly differ by condition: Breslow (2.30, P = .13) and Log Rank Mantel-Cox (1.97, P = .16).


Comparing two web-based smoking cessation programs: randomized controlled trial.

McKay HG, Danaher BG, Seeley JR, Lichtenstein E, Gau JM - J. Med. Internet Res. (2008)

Survival analysis of program engagement over time by condition
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC2630830&req=5

figure3: Survival analysis of program engagement over time by condition
Mentions: We examined the pattern of participant exposure over time by condition. For purposes of this analysis, we defined exposure as the number of days elapsed between each participant’s date of randomization/enrollment and the date of his/her last website visit to view program content. We applied the Kaplan-Meier survival analysis to these data, which allowed us to examine the timing of the last visit by condition (see Figure 3). By definition, all participants had a last visit since all participants stopped visiting at some point following enrollment. Note that Figure 3 shows a steep downward slope in last program visits soon after program enrollment, indicating that most participants stopped visiting the program soon after they started. There were notable drops in subsequent participation at times that corresponded with the follow-up assessments. While QSN had somewhat longer estimated survival time (mean = 36.71 days, SE = 2.18) than the Active Lives condition (mean = 30.86, SE = 2.02), the Kaplan-Meier survival tests revealed that the overall trajectory of these post-enrollment program visit curves did not significantly differ by condition: Breslow (2.30, P = .13) and Log Rank Mantel-Cox (1.97, P = .16).

Bottom Line: Contrary to our hypotheses, no between-condition differences in smoking abstinence were found at 3- and 6-month follow-up assessments.Possible approaches in this regard can include new informed consent procedures that better explain the roles and responsibilities of being a research participant, new program designs that add more vitality (changing content from visit to visit), and new types of reminders pushed out to participants to encourage return visits.Simplifying program content through a combination of enhanced tailoring and information architecture also merits further research attention.

View Article: PubMed Central - HTML - PubMed

Affiliation: Oregon Research Institute, 1715 Franklin Boulevard, Eugene, OR 97403, USA.

ABSTRACT

Background: Smoking cessation remains a significant public health problem. Innovative interventions that use the Internet have begun to emerge that offer great promise in reaching large numbers of participants and encouraging widespread behavior change. To date, the relatively few controlled trials of Web-based smoking cessation programs have been limited by short follow-up intervals.

Objective: We describe the 6-month follow-up results of a randomized controlled trial in which participants recruited online were randomly assigned to either a Web-based smoking cessation program (Quit Smoking Network; QSN) or a Web-based exercise enhancement program (Active Lives) adapted somewhat to encourage smoking cessation.

Methods: The study was a two-arm randomized controlled trial that compared two Web-based smoking cessation programs: (1) the QSN intervention condition presented cognitive-behavioral strategies, and (2) the Active Lives control condition provided participants with guidance in developing a physical activity program to assist them with quitting. The QSN condition provided smoking cessation information and behavior change strategies while the Active Lives condition provided participants with physical activity recommendations and goal setting. The QSN condition was designed to be more engaging (eg, it included multimedia components) and to present much greater content than is typically found in smoking cessation programs.

Results: Contrary to our hypotheses, no between-condition differences in smoking abstinence were found at 3- and 6-month follow-up assessments. While participants in the QSN intervention condition spent more time than controls visiting the online program, the median number of 1.0 visit in each condition and the substantial attrition (60.8% at the 6-month follow-up) indicate that participants were not as engaged as we had expected.

Conclusions: Contrary to our hypothesis, our test of two Web-based smoking cessation conditions, an intervention and an attention placebo control, failed to show differences at 3- and 6-month assessments. We explored possible reasons for this finding, including limited engagement of participants and simplifying program content and architecture. Future research needs to address methods to improve participant engagement in online smoking cessation programs. Possible approaches in this regard can include new informed consent procedures that better explain the roles and responsibilities of being a research participant, new program designs that add more vitality (changing content from visit to visit), and new types of reminders pushed out to participants to encourage return visits. Simplifying program content through a combination of enhanced tailoring and information architecture also merits further research attention.

Show MeSH
Related in: MedlinePlus