Chat-based instant messaging support combined with brief smoking cessation interventions for Chinese community smokers in Hong Kong: Rationale and study protocol for a pragmatic, cluster-randomized controlled trial

• Published in: Contemporary clinical trials Vol. 77; pp. 70 - 75
• Main Authors: Luk, Tzu Tsun, Li, William Ho Cheung, Cheung, Derek Yee Tak, Wong, Sze Wing, Kwong, Antonio Cho Shing, Lai, Vienna Wai Yin, Chan, Sophia Siu-chee, Lam, Tai Hing, Wang, Man Ping
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.02.2019
• Subjects: Acceptance and Commitment Therapy - methods; Adult; Age Factors; Aged; Asian People; Chat intervention; Digital health; Female; Hong Kong; Humans; Instant messaging; Intention; Male; mHealth; Middle Aged; Mobile Applications; Pragmatic Clinical Trials as Topic; Research Design; Self Efficacy; Sex Factors; Single-Blind Method; Smoking Cessation - methods; Socioeconomic Factors; Text Messaging; Tobacco dependence treatment; WhatsApp; Young Adult; Hong Kong; mHealth; Tobacco dependence treatment; Chat intervention; Digital health; WhatsApp; Instant messaging
• ISSN: 1551-7144; 1559-2030; 1559-2030
• DOI: 10.1016/j.cct.2018.12.013

Novel approaches to engage community smokers in smoking cessation are needed as smokers typically lack motivation to quit or use evidence-based tobacco dependence treatment. Mobile instant messaging apps (e.g., WhatsApp, Facebook Messenger) are widely used but under-studied as a mobile health modality for delivering smoking cessation support. This paper presents the rationale and study design of a trial which aims to evaluate the effectiveness of a chat-based intervention using mobile instant messaging combined with brief interventions for community smokers. This is a two-arm, parallel, accessor-blinded, pragmatic cluster-randomized controlled trial on an estimated 1172 daily cigarette smokers aged ≥18 years proactively recruited from 68 community sites (cluster) throughout Hong Kong. Subjects in intervention group received three months of chat-based, instant messaging support guided by acceptance and commitment therapy and other behavioural change techniques, integrated with brief advice and active referral to a smoking cessation service using the AWARD (Ask, Warn, Advise, Refer, Do-it-again) intervention model. Control group received brief advice to quit plus a self-help booklet at baseline. Outcomes were assessed at 1-, 2-, 3- and 6-month after baseline. The primary outcome is abstinence validated by exhaled carbon monoxide (<4 ppm) and salivary cotinine (<10 ng/mL) at 6-month after baseline. Primary analyses will be based on intention-to-treat. This is the first trial examining the effectiveness of a chat-based cessation support programme combined with brief interventions in promoting abstinence. The intervention model can be adapted for other behavioural change treatments and more advanced digital smoking cessation intervention.