A smoker’s choice? Identifying the most autonomy-supportive message frame in an online computer-tailored smoking cessation intervention

Figures & data

Figure 1. Hypothetical model.

Note. Simplified version of the hypothetical model used in the present study.

Figure 2. Flow chart of participant progress.

Table 1. Example of smoking cessation advice.

Condition	Autonomy-supportive language	Controlling language
No choice	Nice to hear that you wouldn’t feel lonelier when you quit smoking. As other smokers, you are not sure whether you wouldn’t feel sad. Many smokers think that smoking would help them against feelings of loneliness, anger, and sadness. Often, people feel bored and don’t feel like doing anything when being sad. What could you do when you feel sad or lonely? We would like to offer you some tips. You could watch TV, read a book, call (a) friend(s), go outside or repair something. You could as well plan something nice, such as going to the cinema or the spa. Maybe it would help you to talk about your feelings with someone or write them down. Further, you may try to not think about the fact that you miss smoking. Maybe you like to distract yourself and think about the nice things in life, so the negative thoughts and feelings will fade away.	You don’t think that you wouldn’t feel lonelier when you quit smoking. However, you are not sure whether you wouldn’t feel sad. According to experts, many smokers think that smoking would help them against feelings of loneliness, anger, and sadness. Experts say that many people feel bored and don’t feel like doing anything when being sad. This is why you must watch TV, read a book, call (a) friend(s), go outside or repair something. You must look for distraction when feeling sad or lonely and plan something nice, such as going to the cinema or the spa. Also, you must share your feelings with someone or write them down. Don’t think about it that you miss smoking. You have to think of the nice things in life, then the negative things will fade away.
Choice	Nice to hear that you wouldn’t feel lonelier when you quit smoking. As other smokers, you are not sure whether you wouldn’t feel sad. Many smokers think that smoking would help them against feelings of loneliness, anger, and sadness. Often, people feel bored and don’t feel like doing anything when being sad. Below, you can choose whether you would like to receive some tips over how to prevent yourself from negative thoughts and feelings. Choice question: Do you want to receive these tips? Answered “yes”: What could you do when you feel sad or lonely? We would like to offer you some tips. You could watch TV, read a book, call (a) friend(s), go outside or repair something. You could as well plan something nice, such as going to the cinema or the spa. Maybe it would help you to talk about your feelings with someone or write them down. Further, you may try to not think about the fact that you miss smoking. Maybe you like to distract yourself and think about the nice things, in life, so the negative thoughts and feelings will fade away.	You don’t think that you wouldn’t feel lonelier when you quit smoking. However, you are not sure whether you wouldn’t feel sad. According to experts, many smokers think that smoking would help them against feelings of loneliness, anger, and sadness. Experts say that many people feel bored and don’t feel like doing anything when being sad. Below, you can choose whether you would like to receive some tips over how to prevent yourself from negative thoughts and feelings. Choice question: Do you want to receive these tips? Answered “yes”: You must watch TV, read a book, call (a) friend(s), go outside or repair something. You must look for distraction when feeling sad or lonely and plan something nice, such as going to the cinema or the spa. Also, you must share your feelings with someone or write them down. Don’t think about it that you miss smoking. You have to think of the nice things in life, then the negative things will fade away.

Note. If respondents answered “no” to the choice question, the intervention continued without the provision of the tips.

Figure 3. Hypothesized structural model with significant paths.

Note. Results are presented as standardized total effects. For clarity, items of latent variables (ellipse) are not presented. Observed variables are presented as rectangles. Cog = cognitive advantages of smoking cessation. Phy = physical advantages of smoking cessation. Con = disadvantages of smoking cessation. Dotted lines represent non-significant paths. Straight lines represent significant paths (p < .05).

Table 2. Comparison of participants who completed the study with those who dropped out.

	Participants at T2		Participants in experimental conditions^5		Dropout
	n	%	n	%	n	%
n	798		626		213
Demographics
Sex (females)	351	44	259	41.4	101	47.4
Age (years), M (SD)	49.2 (14.1)		49.3 (14.4)		48.2 (14.8)
Educational level
High	246	30.8	200	31.9	66	31
Middle	427	53.5	323	51.6	111	52.1
Low	124	15.5	102	16.3	33	15.5
Other/missing	1	0.1	1	0.2	3	1.4
Living arrangement
With partner	282	35.3	221	35.3	63	29.6
With partner and child(ren)	228	28.6	174	27.8	48	22.5
With child(ren)	50	6.3	35	5.6	15	7
Alone	218	27.3	178	28.4	80	37.6
Other/missing	20	2.5	18	2.9	7	3.3
Number of daily smoked:
Cigarettes, M (SD)	9.7 (9.1)		9.4 (9.1)		9.9 (8.9)
Shags, M (SD)	5.7 (8.5)		5.9 (8.4)		5 (8.4)
Cigars, M (SD)	0.3 (1.6)		0.3 (1.6)		0.4 (2.6)
Cigarillos, M (SD)	0.3 (2.4)		0.3 (2)		0.2 (1.3)
Pipes, M (SD)	0.1 (0.9)		0.1 (0.9)		0 (0.5)
Earlier quit attempts, M	5.4 (40.1)		4.2 (21.9)		3.7 (5.8)
Existence of (chronic) disease
Heart disease	99	12.4	82	13.1	27	12.7
COPD	150	18.8	121	19.3	33	15.5
Diabetes	69	8.6	59	9.4	22	10.3
Cancer	66	8.3	54	8.6	17	8

Note. M = Mean; Standard deviations are presented in parentheses.

Table 3. Fit indices of the measurement model.

Models	No interaction	Only 2-way interaction	All interactions
Fit indices
CMIN (df)	3300,313 (1455)***	4112,866 (1893)***	4529,789 (2128)***
CFI	.92	.94	.95
RMSEA [CI]	.045 [.043, .047]	.043 [.042, .045]	.042 [.041, .044]

Note. CMIN = Chi-square. Df = degrees of freedom. CFI = comparative fit index; RMSEA = root mean square error of approximation. CI = 90% Confidence interval.

*** p < .001.

Table 4. Means of perceived autonomy-support and need for autonomy per experimental condition (n = 626).^a

Dependent variable	Perceived autonomy-support	Need for autonomy
Condition (n)	M (SD)	M (SD)
Autonomy-supportive language * choice (n = 167)	3.37 (.83)	3.95 (.83)
Autonomy-supportive language * no choice (n = 160)	3.48 (.82)	3.92 (.74)
Controlling language * choice (n = 147)	3.45 (.73)	3.89 (.73)
Controlling language * no choice (n = 152)	3.54 (.74)	3.89 (.74)
Overall M (SD)	3.46 (.78)	3.87 (.76)

Note. n = Number of respondents. M = Mean. SD = Standard Deviation.

^a A total of n = 172 participants were enrolled in the control condition, who were not considered for analysis.

Appendix I. Indirect & direct effects.

Independent variable	Dependent variable
	3	4	5	6	7	8	9	10
1 Need for autonomy
Indirect effect	–	0.06	0.07	−0.03	0.04	−0.06	0.03	0.19
Direct effect	0.23*	–	–	–	–	–	–	–
2 Perceived autonomy-support
Indirect effect	–	0.18*	0.23	−0.10	0.13	−0.18	0.11	0.63
Direct effect	0.74*	–	–	–	–	–	–	–
3 Self-determined motivation
Indirect effect	–	–	–	–	–	–	–	0.11*
Direct effect	–	0.25*	0.32*	−0.14*	0.17*	−0.25*	0.15*	0.74*
4 Attitudes physical
Indirect effect	–	–	–	–	–	–	–	–
Direct effect	–	–	–	–	–	–	–	0.05
5 Attitudes cognitive
Indirect effect	–	–	–	–	–	–	–	–
Direct effect	–	–	–	–	–	–	–	0.04
6 Attitudes disadvantages
Indirect effect	–	–	–	–	–	–	–	–
Direct effect	–	–	–	–	–	–	–	–0.29
7 Social Support
Indirect effect	–	–	–	–	–	–	–	–
Direct effect	–	–	–	–	–	–	–	0.09*
8 Social Norms
Indirect effect	–	–	–	–	–	–	–	–
Direct effect	–	–	–	–	–	–	–	0.01
9 Self-efficacy
Indirect effect	–	–	–	–	–	–	–	–
Direct effect	–	–	–	–	–	–	–	0.13*
10 Intention
Indirect effect	–	–	–	–	–	–	–	–
Direct effect	–	–	–	–	–	–	–	–

Note. Unstandardized effects are presented. * = significant at p < .05.

Data availability statement

The data that support the findings of this study are available from the corresponding author, MA, upon reasonable request.