This study aims to assess the effect of personalized support using instant messaging application on smoking cessation in smokers proactively recruited from smoking hotspots in Hong Kong.
Detailed Description: With the advancement of information communication technologies (ICTs), instant messaging applications (IM Apps, e.g. WhatsApp and WeChat) can be used for providing synchronous, personalized, interactive interventions for health promotion. This study proposes to apply IM Apps for enhancing our tested brief smoking cessation (SC) intervention model from AWARD to e-AWARD (AWARD: Ask, Warn, Advise, Refer, Do-it-again,) without medications to increase SC in smokers proactively recruited in smoking hotspots in Hong Kong. Such smokers are the majority and have low quit rate. IM Apps allows trained SC advisors to proactively deliver personalized SC advices, response to smokers' needs promptly, and provide psychosocial support. No similar trials are found in PubMed, Cochrane Library and trial registries (ClinicalTrials.gov \& ISRCTN) (except the pilot trial of this study). The aims of this study are as follows: 1. To assess the main effect of the personalized support using instant messaging applications (Intervention) vs. Control group on biochemical validated smoking abstinence at 6-month and 12-month. 2. To assess the effects on self-reported past 7-day abstinence, 24-week continuous abstinence, smoking reduction, self-efficacy of quitting, intention to quit, quit attempts and SC medications and services use at 6-month and 12-month. 3. To identify the mediators, which can inform mechanisms of the intervention on SC. 4. To evaluate the cost-effectiveness of the above interventions. 5. To understand the effects subjects' experience of IM support on SC using a qualitative study approach.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
TRIPLE
Enrollment
696
At baseline, brief smoking cessation advice following AWARD model will be delivered to subjects within about 2 to 5 minutes: * Ask about smoking history and habit * Warn about the risks of smoking using a leaflet * Advise to quit smoking as soon as possible and use nicotine replacement therapy (NRT) or SC services * Refer subjects to free smoking cessation services in Hong Kong if they agree * Do it again: smokers who have tried to quit but relapsed will be encouraged to quit again and those who have reduced smoking will be advised to further reduce or quit smoking
At baseline, an A5-sized leaflet will be given to subjects, which includes information about risks of smoking, pictures of smoking-related diseases, and smoking cessation services provided in Hong Kong.
School of Nursing, The University of Hong Kong
Hong Kong, Hong Kong
RECRUITINGBiochemically-validated abstinence at 6-month
Defined as exhaled carbon monoxide \<4ppm
Time frame: 6-month after baseline
Biochemically-validated abstinence at 12-month
Defined as exhaled carbon monoxide \<4ppm
Time frame: 12-month after baseline
Self-reported past 7-day abstinence
Self-reported no cigarette smoking (even a single puff) in the past 7 days
Time frame: 6-month and 12-month after baseline
Self-reported 24-week continuous abstinence
Self-reported no cigarette smoking (even a single puff) in the past 24 weeks
Time frame: 6-month and 12-month after baseline
Smoking reduction
Self-reported reduction in the number of cigarettes smoked daily by at least 50% of the baseline amount
Time frame: 6-month and 12-month after baseline
Perceived importance, confidence and difficulties of quitting
Perceived importance, confidence and difficulties of quitting measured on a scale of 0-10 and a higher score indicates a stronger perception
Time frame: 6-month and 12-month after baseline
Intention to quit
Any intention to quit smoking (yes/no) from baseline
Time frame: 6-month and 12-month after baseline
Quit attempts
Number of quit attempts from baseline
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At baseline, subjects will be encouraged to seek smoking cessation services in Hong Kong. If subjects agree, their contact information will be sent to the preferred service providers for a quick appointment and follow-up.
A total of pre-set 26 messages will be sent to subjects through WhatsApp 12 weeks after baseline to remind the quit date and to encourage abstinence. Messages are tailored based on subjects' sociodemographic characteristics and smoking habit following Social Cognitive Theory and Transtheoretical Model. Messages will be sent with the schedule of once daily for 1 week (the week across the quit date), 3 times a week for 4 weeks (2 weeks each before and after the week with quit date) and once a week for remaining 7 weeks. The schedule will be adjusted according to the quit date and also smokers' requests. The format of regular messages will mainly be text-based but also include pictures, animations and videos.
Personalized interactive text or voice conversation will be provided by trained smoking cessation advisors through WhatsApp for 3 months after baseline. Advisors will periodically proactively send messages to subjects to initiate the conversation (e.g. asking recent progress of smoking cessation) and deliver evidence-based advice. Advisors will also actively refer subjects, if they have expressed the need, to smoking cessation services providers. A standard operation algorithm for advisors used in the pilot feasibility trial will be modified for the use.
After baseline, regular messages using SMS will be sent to subjects with similar frequency to Intervention group. The messages include information on general health and reminders on follow-up surveys and biochemical validation for quitting.
Time frame: 6-month and 12-month after baseline
Smoking cessation medication use
Any use of nicotine replacement therapy from baseline
Time frame: 6-month and 12-month after baseline
Smocking cessation services use
Any use of counselling, hotline, SC clinics and other SC services from baseline
Time frame: 6-month and 12-month after baseline