Peter Benda

Patterns of Use of an Automated Interactive Personalized Coaching Program for Smoking Cessation

Background The QuitCoach, an “expert system” program of tailored advice for smoking cessation developed in Australia, has been publicly available since July 2003, albeit with limited promotion. The program is designed to be used on multiple occasions, guiding the user through the process of smoking cessation in the manner of a “life coach”. Email reminders are sent at scheduled intervals to prompt optimal and repeated use. Objectives The aims of this study were to characterize QuitCoach users and to determine what characteristics of smokers affect their participation over time. Of particular interest was whether users tend to return following a relapse and, thus, use the program as a tool for relapse prevention or recovery. We also explored patterns of change associated with returns to the site, whether prompted by reminder emails or not prompted at all. Methods Between July 2003 and June 2007, 28,247 individuals completed an initial assessment on the QuitCoach, of whom 83.7% (n = 23,656) registered. Data were collected during a 10-minute online questionnaire that all users completed in order to obtain tailored cessation advice. This included questions concerning basic demographic information, quitting history, current smoking status and cigarette consumption, stage of change, and use of pharmacotherapy. Results The median age of users was 34 years, and 62% were female. Most (96%) were current smokers. Overall, 91% were planning to quit in the next 30 days, and half (49.9%) had set a quit date. Those who had recently relapsed to smoking following a quit attempt made up 37%. Among registered users, 27% returned for a second visit, a median 9 days after their first. Overall, a third visit was completed by 11% and 2% returned within 2 days. Women, older smokers, those who had recently quit, and those using pharmacotherapy were more likely to return. From the second visit on, most people who completed an assessment had quit. Likelihood of responding to a prompt to return was largely unrelated to user characteristics or cessation outcome. Conclusions Internet-based programs have considerable potential to reach large numbers of smokers at low cost. The QuitCoach is attracting considerable use, with most using it to make a quit attempt and, for those who continue to use the QuitCoach, to help them stay quit. Nonetheless, most users only visited the site once, suggesting improved strategies are needed for encouraging repeated use.

Population-level effects of automated smoking cessation help programs: a randomized controlled trial.

AIMS To test the population impact of offering automated smoking cessation interventions via the internet and/or by mobile phone. DESIGN Pragmatic randomized controlled trial with five conditions: offer of (i) minimal intervention control; (ii) QuitCoach personalized tailored internet-delivered advice program; (iii) onQ, an interactive automated text-messaging program; (iv) an integration of both QuitCoach and onQ; and (v) a choice of either alone or the combined program. SETTING Australia, via a mix of internet and telephone contacts. PARTICIPANTS A total of 3530 smokers or recent quitters recruited from those interested in quitting, and seeking self-help resources (n = 1335) or cold-contacted from internet panels (n = 2195). MEASUREMENTS The primary outcome was self-report of 6 months sustained abstinence at 7 months post-recruitment. FINDINGS Only 42.5% of those offered one of the interventions took it up to a minimal level. The intervention groups combined had a non-significantly higher 6-month sustained abstinence rate than the control [odds ratio (OR) = 1.48; 95% confidence interval (CI): 0.98-2.24] (missing cases treated as smokers), with no differences between the interventions. Among those who used an intervention, there was a significant overall increase in abstinence (OR = 1.95; CI: 1.04-3.67), but not clearly so when analysing only cases with reported outcomes. Success rates were greater among those recruited after seeking information compared to those cold-contacted. CONCLUSIONS Smokers interested in quitting who were assigned randomly to an offer of either the QuitCoach internet-based support program and/or the interactive automated text-messaging program had non-significantly greater odds of quitting for at least 6 months than those randomized to an offer of a simple information website.

Factors associated with use of automated smoking cessation interventions: findings from the eQuit study

The aim was to better understand structural factors associated with uptake of automated tailored interventions for smoking cessation. In a prospective randomized controlled trial with interventions only offered, not mandated, participants were randomized based on the following: web-based expert system (QuitCoach); text messaging program (onQ); both as an integrated package; the choice of using either or both; or a control condition informed of a static website (not considered here). Participants were 3530 smokers or recent quitters recruited from two sources; those seeking smoking cessation information, mostly recruited over the phone, and a cold-contacted group recruited from an Internet panel. More participants (60.1%) initially accepted the intervention they had been offered than used it (42.5%). Uptake of each intervention differed substantially by both recruitment source and modality (phone or web). onQ was a little more popular overall, especially in the information seeker sample. Highest overall intervention uptake occurred in the choice condition. A web-based intervention is most attractive if the offer to use is made by web, whereas a phone-based intervention is more likely to be used if the offer is made over the phone. Providing automated interventions on multiple platforms allows for maximal choice and greatest overall use of some form of help.

User assessment as input for useful geospatial representations within Mobile Location-Based Services.

Mobile Location-Based Services (mLBS) are an increasingly consumer-based concept borne from, and continually driven by, technology-centred development; as opposed to the needs of end users. Where users have been made a focus, the research generally concerns issues of overall system appearance, functionality, information content and interaction methods, with little emphasis on the component geospatial representations. This paper describes the initial stages of a research project aimed at filling this void through the application of a qualitative User-Centred Design (UCD) methodology for optimising geospatial representations within mLBS applications, in order to support a selected user group: Australian ‘leisure-based travellers’. Presented in this paper is an account of two UCD activities adopted for the research. The first, user profiling, served to define the target user population in terms of their technological, geospatial and travel experiences, using an online questionnaire. The second, user task analysis, involved in-depth interviews with a subset of users in order to obtain a deeper understanding of the geospatial goals, tasks, needs and preferences within the population, as well as the range of user differences and variability in tasks present. An overall user assessment, through combined analysis of the two result sets, highlighted considerations for the ongoing research, including a set of specific implications for the design of alternative models for geospatial services, representations and interactions. The themes described in this paper represent an initial and necessary component of UCD, which has been largely overlooked in research relating to mLBS. Whilst the focus here is on a specific user group and context of use, it is envisaged that many of the concepts tested and ratified by the resulting models will be relevant to mLBS applications in general.

Lessons from failure: re-conceiving blogging as personal change support

This paper reports on research-driven design of social technologies. It describes an exploratory field study evaluating and re-conceiving blogging technologies - a mobile phone, a mobile blog, a Weblog and synchronization software - to support personal change, in this case quitting smoking. We briefly describe the design of the blogging technologies and summarise the outcomes of their extended use by four people trying to quit smoking in terms of technology usage, domestication and acceptance and, smoking cessation. We then document some notable features of failure, both of the technology and the quit attempts, describing how understanding the nuances and subtleties of failure highlights important design considerations. Finally, we present some methodological and design recommendations emerging from: a design workshop involving the participants in the field study; and a desktop design exercise.