Delivering tailored smoking cessation support by SMS text- message Felix Naughton General Practice and Primary Care Research Unit University of Cambridge Research team Stephen Sutton A Toby Prevost Hazel Gilbert James Jamison Sue Boase Melanie Sloan Susan Smith James Brimicombe

Computer-tailoring – use of a computer program to individualise feedback according to user characteristics Increasing the personal relevance of feedback increases attention, use/consumption and adoption of message Petty & Cacioppo (1986); Skinner et al (1999); Sutton et al (2007) What is tailoring?

MiQuit development work 2005/6 2006/7 2007/ MRC framework phase Phase 0 Phase 1 Phase 2 Theoretical and Intervention targets, Feasibility and evidence generation modelling and barriers acceptability Interview study (qualitative) Pre-test study (qualitative) Systematic review Intervention development

MiQuit development work 2005/6 2006/7 2007/ MRC framework phase Phase 0 Phase 1 Phase 2 Theoretical and Intervention targets, Feasibility and evidence generation modelling and barriers acceptability Interview study (qualitative) Pre-test study (qualitative) Systematic review Intervention development

Acceptability and feasibility RCT - MiQuit Pregnant smokers were randomised to: Tailored support - MiQuit (n=102) Tailored self-help leaflet 12 week programme of tailored ‘push’ text-messages Tailored to 26 characteristics Target theory-based cognitive determinants of smoking behaviour Provide general support and encouragement Instant support ‘pull’ text-message facility HELP – if they are struggling not to smoke SLIP – if they have smoked and regretted it Control group – non-tailored self-help leaflet (n=105)

Feasibility 94% of treatment participants received both intervention components 57% of sample on average replied to assessment text-messages 9% requested an instant support text-messages (mean messages requested = 1.3) Acceptability 24% of treatment participants felt text-messages were annoying to some degree 9% opted to discontinue text-messages (but mostly for reasons other than annoyance) Effectiveness estimate Cotinine validated abstinence at 3-months follow-up: treatment 12.5%, control 7.8%, (OR = 1.68, 95% CI 0.66 – 4.31) Increased self-efficacy, harm beliefs and determination to quit in treatment arm Naughton et al – in preparation MiQuit findings

Text-messaging/mobile phones can deliver tailored support in real-time but currently not using real-time data User initiated support is rarely used and not done so strategically Limitations of current system

Using mobile sensing to tailor behavioural support Passive Proximity support triggers (GPS, Wi-fi etc.) User/system specified high-risk locations e.g. friends house, pub, work Interaction with time of day, situation, behaviour change progress Situation/state triggers (audio, EmotionSense, physiological etc.) Specific situations e.g. with others, alone, moving Detection of emotional states related to relapse risk e.g. anger Active Tailoring user initiated support according to situation/location

Future work Could also help researchers and users learn about triggers of relapse Tailoring behavioural support using mobile sensing would work well for other behaviours e.g. physical activity Key points Need to establish acceptability of tailoring support to real-time information Important that interventions are systematically developed and evaluated

Thank you Felix Naughton General Practice and Primary Care Research Unit University of Cambridge Research team Stephen Sutton A Toby Prevost Hazel Gilbert James Jamison Sue Boase Melanie Sloan Susan Smith James Brimicombe

Have you set a quit date yet Julie? Setting a date can help you to plan your quit & Although you found your longest previous quit hard work Julia, you managed to stay quit for over a month. You can do it again - High motivation to quit - Previously quit for over a month - Previous quit was difficult - Reason for quitting - Current smoking rate Motivational text ‘mm’ – sent day 12 MiQuit

Have you set a quit date yet Julie? Setting a date can help you to plan your quit & If you are feeling low on motivation Julia, remind yourself how much money you will save by quitting - A rate of 5-a-day equals £40 a month and £500 a year - Low motivation to quit - Previously quit for less than a month - Difficulty of previous quit - Reason for quitting = money - Current smoking rate 4-5 a day Motivational text ‘mm’ – sent day 12 MiQuit