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My Mobile Advice Program (MyMAP)

About

Smoking is a leading cause of death in the US, killing more than 440,000 people a year. While effective treatments exist, their impact is significantly reduced by poor treatment adherence, particularly to pharmacotherapy. One way to improve the effectiveness of existing pharmacotherapy and to help more people stop smoking is to enhance treatment adherence.

The current study develops and pilot tests a prototype My Mobile Advice Program (MyMAP). MyMAP is designed to a) provide real-time, algorithm-driven, personalized guidance to smokers' regarding how to manage common, non-serious, bothersome medication side-effects and nicotine withdrawal symptoms, b) provide patients with timely, individually-tailored, supportive encouragement to enhance their motivation for quitting and promote better adherence to their prescribed treatment regimen; c) alert providers to potentially serious adverse events or persistent bothersome symptoms that warrant timely medical intervention; and d) provide patients and providers 24/7 access to relevant educational and behavioral self-help information that can either be viewed online (via computer or smart phone) or printed for reference.

Through this comprehensive web-based intervention, we hypothesize that MyMAP will promote treatment adherence, thereby ultimately improving cessation rates and treatment cost-effectiveness. Given the popularity, high frequency of bothersome, non-serious medication side-effects, and increased monitoring demands for varenicline use, the pilot prototype is designed to support varenicline pharmacotherapy, but if the proposed intervention strategy proves promising, MyMAP will be expanded to support nicotine replacement and bupropion use in the future.

Aims

  1. Create a working prototype of the MyMAP program for use with varenicline, based on the design and content already created through iterative preliminary developmental work and with input from smokers and clinical experts in medicine, pharmacy, psychiatry, and clinical psychology.
  2. Conduct a randomized pilot test to inform the acceptability, feasibility, and potential impact of MyMAP based on self-report (quantitative and qualitative) data from participants and study clinicians, automated pharmacy records, and automated tracking of MyMAP use. If the program is found to be feasible and acceptable from the perspective of smokers and clinicians, we will use the estimated effects on adherence and cessation outcomes from the pilot to inform the sample size for a future RCT.
  3. Interview relevant clinicians (physicians, nurses, quitline counselors) about their willingness to use MyMAP, if it were available, and assess their reactions to the program’s design and functionality.
  4. As warranted based on the results, we will refine the MyMAP design with input from an expert clinical advisory panel and plan for a randomized trial to evaluate program effectiveness and cost-effectiveness.

Participants

Adult smokers (n=70) who are members of Group Health, a large not-for-profit health plan in the Pacific Northwest will test the intervention. Also, approximately 50 clinicians who represent potential future MyMAP users will be interviewed.

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