Project Overview +

About 80% or more of smokers are not sufficiently motivated and ready to quit smoking, even though they may want to quit someday. Interventions are critically needed which can reach these people, enhance their motivation for quitting, promote uptake of existing empirically-validated treatments, and ultimately enhance abstinence rates on a population level. 

The current study tests the effectiveness of four potentially important tailoring factors (decisional framework, self-efficacy, navigation autonomy, and proactive outreach) to increase motivation to quit.

Related Media +

Related Media:

Aims +

Aim 1. Conduct a screening experiment to identify which of the proposed psychosocial and presentation factors are effective at enhancing motivation to quit smoking, driving smokers to utilize subsequent cessation treatment, and promoting abstinence among smokers not ready to quit at baseline.

Aim 2. Examine how individual differences mediate or moderate the effectiveness of each tailoring factor.

Aim 3. Finally, consistent with the multiphase optimization strategy (MOST), the findings from this research will be used to inform planning for the next sequential phase of systematic investigation.

Participants +

Participants in this study are recruited from a large, regional U.S. health plan. We will recruit 1840 smokers who are not actively trying to quit smoking.

Intervention +

Potentially eligible smokers are identified using the health plan's automated records (e.g., based on age, smoking status) and mailed a study invitation letter by GH staff. We also provide a $2 pre-incentive payment with each invitation, to encourage smokers to visit the website and learn more about the program.

Each participant receives access to a personally-tailored, online intervention program following completion of a baseline assessment. The program is designed to enhance motivation for quitting by increasing positive outcome expectations for quitting, increasing self-efficacy for seeking treatment and quitting, and reducing perceived barriers to behavior change.

Content includes material addressing the risks (e.g., withdrawal, cravings, etc.) and benefits of quitting smoking (e.g., health, financial, social, etc.), perceived barriers to treatment, perceived barriers to quitting (e.g., stress relief, weight concerns, enjoyment), strategies for reducing smoking, how and where to seek treatment, how to quit, what treatments are shown to be effective, and how to remain abstinent once quit. The basic program structure includes didactic components, narrative testimonials, and interactive exercises for all participants.

The study tests the effectiveness of 5 potentially important factors for an online motivational cessation program using an initial screening experiment. In addition to the personalized base content, each person will be assigned to one of 16 possible combinations of the experimental factors. For each factor, we explore two contrasting levels to determine which is associated with more positive intervention outcomes.

- Decisional Framework: Prescriptive vs. Non-directive

The prescriptive arm includes messages emphasizing the need to quit. The non-directive arm emphasizes choice in the quitting process and embody principles of motivational interviewing (e.g., recognizing ambivalence, collaboration, evocation of intrinsic motivation, recognizing autonomy, etc.)

- Navigation: Dictated vs. Non-dictated

Presentation order is either dictated based on stage of change (which can be re-assessed to update content as appropriate) or participants have access to all content at once and freedom to access all content at will.

- Self-efficacy: Low tailored vs High tailored

Messages designed to enhance self-efficacy for seeking treatment, quitting smoking, and remaining abstinent are either low tailored using personal details such as race, gender, age, smoking history, and other characteristics which give a personalized look and feel or highly tailored to include this personalization plus messages tailored to address participants' specific concerns about quitting and perceived treatment barriers.

- Proactive outreach: None vs. Email

Participants receive no emails or receive weekly proactive emails. Email content includes tips for quitting, information regarding quitting resources, supportive messages, and a link to the study website to encourage return visits.