development and evaluation of smokefree baby: a smoking cessation smartphone app for pregnant...
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Development and evaluation of SmokeFree Baby:
A smoking cessation smartphone app for
pregnant smokers
Ildiko Tombor, PhD Student
Health Behaviour Research Centre
UCL Tobacco and Alcohol Research Group (UTARG)
SSA annual conference 2014
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Professor Robert West
Professor Susan Michie
Dr Lion Shahab
Dr Jamie Brown
David Crane
Dr Joanne NealeDr Caitlin NotleyAleksandra HerbecMilagros RuizFarah Desai & the Pregnancy NetworkClaire GarnettDaniel WestJamie West Matthew West
Research team Contributors
Funding
Acknowledgements
Background
Next steps
Intervention development
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CHDStroke
AtherosclerosisCOPD
Pneumonia
PeriodontitisNuclear cataract
At least 13 different types of
cancer
Preterm deliveryPlacental abruptionPlacenta previaLow birth weightSudden infant death syndromeFetal growth restriction
Decreased lung function Middle ear diseaseBehaviour and learning problems
Smoking during pregnancy: Health effects
U.S. Department of Health and Human Services, 2004, 2006, 2014; Ross et al., 2014
5NHS Information Centre. Infant Feeding Survey, 2010
Smoking during pregnancy: Prevalence
26% smoke in the 12 months before or during
pregnancy
12% smoke throughout pregnancy
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Smoking during pregnancy: Support
Low uptake and poor adherence among pregnant smokers5,8.
• Insufficient evidence of its safety and efficacy5
• Combination NRT can be effective6
• Better health of the infants at age 27
• Face-to-face/telephone/group support1
• Financial incentives1-3
• Self-help materials2,4
Numerous barriers: fear of judgment and disappointment, poor access to support etc. 9
Behavioural supportNicotine Replacement Therapy
1Chamberlain et al., 2013; 2Bauld & Coleman, 2009; 3Higgins et al., 2012; 4Naughton et al., 2008; 5Coleman et al., 2012; 6LBrose et al., 2013; 7Cooper et al., 2014; 8Tappin et al., 2010; 9Ingall et al., 2010.
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Digital smoking cessation interventions
• Digital aids can be effective in the general population1-6
• Heterogeneity in quality, outcomes and design
• Lack or poor description of intervention content
• Poor adherence to established guidelines
• Effectiveness is yet to be confirmed in pregnancy
1Myung et al., 2009; 2Shahab & McEwen, 2009,; 3Whittaker et al., 2009; 4Civljak et al., 2010; 5Hutton et al., 2011; 6Chen et al., 2012; 7Brown et al., 2014; 8Devris et al., 2013; 9Naughton et al., 2012; 10Pollak et al., 2013; 11Herbec et al., 2014
• Relative benefit in low socioeconomic groups (‘StopAdvisor’)7
• Women and young people are more likely to engage with digital aids8
• Websites, text-messaging can be feasible and acceptable for pregnant smokers9-11
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Theoretical basis
West & Brown, 2013
Michie et al., 2011
Evidence-baseTransparency in reporting
Multi-phase strategy
A priori principles
Collins et al., 2011
Craig et al., 2008
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Development stagePhase 1 –
Exploratory work
Identify theoretical base
&Review of the
literature
Exploratory work&
Needs assessment(Study 1-6)
Step 1Step 1
Step 2Step 2
Development stagePhase 2 –
Intervention design
Feasibility & Piloting stage
Piloting phases
Identify intervention components
Step 3Step 3
Design prototype intervention
Step 4Step 4
User testing and refinement of the
SmokeFree Baby app
Step 5Step 5
Evaluation of intervention components
Step 6Step 6
1. Positive smoker identity as a barrier to quitting smoking [published in: Drug Alcohol Depen, 2013, 133(2)]
2. Post-quit non-smoker identity as a predictor of maintained quit success [under review: in Addictive Behaviors]
3. Meta-ethnographic systematic review of smoker identity [accepted in: Health Psychology]
4. Health Care providers views on digital interventions [in press: Journal of Smoking Cessation]
5. COM-B behavioural analysis of pregnant smokers [paper in preparation]
6. Behaviour change techniques used in a smoking cessation website for pregnant smokers (‘MumsQuit’) [paper in preparation]
Target behaviour
Goal setting
Review goal
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Social support
Pre-quit features
Feedback & RewardEngagement
8080
Built-in user testing
Push notifications
Self-monitoring
12Minimal
Identity change
Intensive
To foster a new ‘non-smoker’ identity (reflective motivation) •Building on identity motives (continuity, belonging, meaning etc.) (Vignoles et al., 2011)
•Providing potential role models•Facilitating emotional attachment with the baby
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Stress relief
Minimal Intensive
To improve mental skills to cope with stress and negative emotional states (psychological capability)
•Facilitating action planning•Prompting relaxation exercise
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Health effects
Minimal Intensive
To improve knowledge of health consequences of smoking and benefits of quitting (psychological capability) •Delivering content through interactive features•Using a life-span perspective to provide information about health consequences
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Face-to-Face support
Minimal Intensive
To provide easy access to and facilitate the uptake of stop-smoking support resources in the locality (physical opportunity) •Including videos of a real-life advisor talking about the support offered•Providing access to quitlines and local services
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Behavioural substitution
Minimal Intensive
To provide distraction from urges to smoke (automatic motivation)•Facilitating action planning•Using built-in distraction quiz•Using built-in distraction game
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Factorial experiment (25 design) to test the effectiveness (main effects) of individual intervention components (‘modules’)
Think-aloud user-testing study with pregnant smokers
Analysis of helpfulness/usability ratings of intervention contents
What happens next?
www.smokefreebaby.co.uk
