The development and evaluation of an internet-based smoking cessation intervention (ISCI)

There is a need for effective smoking cessation support that can reach smokers, especially those with economic or other disadvantage, and who do not access face-to-face sessions or telephone support (95% of smokers). There is also a need to develop an improving technology of behaviour change. The internet could meet both those needs. The proposal is to develop an interactive internet-based smoking cessation programme and evaluate its effectiveness, attractiveness and usability in comparison with a simple system that delivers untailored smoking cessation advice. The proposal consists of two phases. The first phase involves using best available evidence and an intensive process of consultation with smokers to design and test a tailored intervention that would be applicable across the UK. The second phase involves a randomised controlled trial comparing this intervention with a simple non-interactive website. The study will assess both effectiveness and the extent to which smokers, especially those from disadvantaged backgrounds, find it attractive and easy to use. If effective, this intervention could form part of the NHS LifeCheck and NHS Health Trainers Programmes. Key novel features for a study of this kind: 1) Use of Health Trainers to recruit disadvantaged smokers; 2) Biochemical verification of self-reported abstinence; 3) Use of LifeGuide to enable highly cost-effective website development and ultimtely help build a technology of behaviour change

Background and aims: There is a need for effective smoking cessation support that can reach large numbers of smokers including the 90% not willing to seek telephone or face-to-face support. There is also a need to develop a system for developing an incremental technology of behaviour change. The internet could meet both those needs. NHS LifeCheck and the NHS Health Trainers programme targeting hard-to-reach individuals have a need for a behaviour change module that focuses on aiding smoking cessation. Internet-based interventions have been found to be effective in aiding smoking cessation, but none thus far have high reach or would be suitable or universally available. The advent of LifeGuide, an innovative platform for developing and evaluating internet-based behaviour change interventions makes it much more cost efficient to develop and evaluate a smoking cessation intervention than would have previously been the case. This proposal is to develop an interactive internet-based smoking cessation programme and evaluate its effectiveness, attractiveness and usability in comparison with a system that delivers non-interactive smoking cessation advice.

Methodology: The project is in two phases: Phase 1 (12 months) involves development and preliminary evaluation of the internet-based intervention. Special emphasis will be placed on maximising user engagement, particularly for smokers in routine and manual occupational groups. Engagement will be assessed using Level 1 criteria recommended by the Science Panel on Interactive Communication and Health. Short-term smoking cessation outcomes will also be assessed. Phase 2 (24 months) is an RCT of the intervention with special focus on recruiting and helping smokers from routine and manual occupational groups. Although a decision on funding this phase is being sought now, a stop-go decision will be made by an independent review panel at the end of Phase 1. The RCT will recruit 4000 smokers using Health Trainers and NHS websites. The interactive intervention will be compared with a simple untailored website. The primary outcome measure will follow the Russell Standard with 6-months of continuous abstinence verified by expired-air carbon monoxide. Attractiveness and measures of user engagement will be important secondary outcome measures. Data analyses will involve mediation analyses using bootstrapping and moderator analyses involving important baseline measures, particularly occupational group. The study will be powered to estimate effect size in routine and manual smokers separately.

Application of the findings: If effective, this system would form a module for the NHS LifeCheck programme and the NHS Health Trainers Programme.