Evaluation Of Effectiveness On A Smart-phone App For Smoking Cessation In China

Objective:To evaluate the acceptability and effectiveness of the Chinese version of QuitGuide,a Smart-phone App for Smoking Cessation from the National Cancer Institute of the United States.Methods:The two-armed randomized controlled trial was conducted to evaluate the Chinese version of QuitGuide.We recruited Chinese residents between 18 and 65 years of age who owned a smart phone and were current smokers with a willingness to quit via online advertising.Respondents were prescreened for eligibility by web portal and,if appropriate,contacted by telephone to provide informed consent,confirm eligibility,and directed to be randomized into the App group and the control group with the proportion of 1:1.Participants in the App group will be sent the App by Weichat/QQ/email,while the control group will receive the general health science magazines by post.We completed study assessments via telephone surveys at baseline and after 6 weeks.Data of engagement with the smart-phone app were collected automatically in Google Analytics.Outcomes measured were indicators of engagement with the smart-phone app(number of app opens),the satisfaction evaluation and the cessation outcomes of 7-day self-reported abstinence from smoking,as well as the attempted smoking cessation rate.The results of intentional analysis and completion of experimental analysis were obtained.The non-conditional logistic regression model was adopted for multi-factor influence analysis of smoking cessation rate and attempted smoking cessation rate.The description of all count data in the study was expressed in terms of frequency and percentage or medium(P25,P75).Measured data were described by mean and standard deviation.Pearson’s chi-square and Fisher’s exact probability method were used for comparing the differences of the count data.Differences in measurement data were compared using two independent samples t-test,a= 0.05,all statistic analysis is two-sided test.Results:402 subjects participated and completely randomized at a ratio of 1:1,201 individuals in each group.A total of 402 people completed the baseline survey and 103 individuals in the intervention group received the App and installed it,including 44 people who continued to use it for 1 week or more.In the intervention group,103 individuals finished the follow-up surveys,the rate of lost follow-up was 48.8%.155 individuals in the control group finished the follow-up surveys,including 55 individuals who received the magazine and the loss rate was 22.9%.Comparing the social demographics and smoking-related variables of the lost participates,there were no significantly differences between the two groups.The intent-to-treat analysis results showed that 7-day self-reported abstinence from smoking of the App group was 10.0%,and the control group was 7.0%,there was no significant difference between the two groups.The Per-Protocol analysis results showed that the 7-day self-reported abstinence from smoking of the App group and the control group were 25.0%and 9.2%respectively,and the difference was statistically significant.The intent-to-treat analysis results showed that quit attempt rate was 44.8%,and the control group was 35.3%,the difference was not statistically significant.The Per-Protocol analysis results showed that quit attempt rate of the App and the control group were 90.9%,46.4%respectively,the difference was statistically significant.In order to exclude the influence of other confounding factors on the significance of the difference between the rate of quitting attempt rate and abstinence from smoking among those who actually used the software in the intervention group and the blank control group.The multi-factor influence analysis of 7-day self-reported abstinence from smoking and quit attempt rate were performed to the Per-Protocol analysis(PP2).The results showed that,after excluding age,education,marital status,smoking age,and other factors,the use of Chinese version of QuitGuide still was the protective factor for the quit attempt rate(OR=0.09,95%CI:0.03～0.26)and abstinence from smoking(OR=0.28,95%CI:0.11～0.73).49 out of 201 participants in the App group were identified on Google Analytics,The analysis results showed that the medium of times for each participant using the App was 146(96,282)times during the 6-week intervention period.The most used function was the "set up the plan for quitting",and the medium of times were 32(24,49)for per person.The second one was "message reminder",and the medium of times were 31(21,54)per person.31%of the users thought that the App was helpful,49%thought it was general helpful,and 20%thought it didn’t help them to quit;3%of users were very satisfied with the App,31%were satisfied,and 47%were generally satisfied,and 18%were not satisfied.Conclusion:This research was the first RCT of evaluation the App for smoking cessation in China.The results showed that the continuous use of the Chinese version of QuitGuide for one week or more can promote smokers with quit attempts and raise the smoking cessation rate significantly.The quit attempt rate was 90.9%and the 7-day self-reported abstinence from smoking rate is 25%.And the Chinese version of QuitGuide was acceptable in China.