Steps in Tailoring a Text Messaging–Based Smoking Cessation Program for Young Adults

Abstract

Steps to develop or refine text messaging–based interventions are largely missing from the literature. Here, the authors describe steps in refining Stop My Smoking USA, a text messaging–based smoking cessation program for smokers 18–25 years old. Research activities included the following: needs assessment focus groups (n = 35); a content advisory team to affirm message acceptability (n = 10); and two beta tests to confirm technological feasibility (n = 12 and 28, respectively). Various recruitment strategies were tested to identify the optimal methods to reach young adult smokers ready to quit. Each stage of the refinement process yielded new insights, resulting in improved message content and tone, an effective recruitment strategy, and the identification and subsequent resolution of technology challenges. Findings suggest that young adults prefer messages that provide concrete behavioral strategies to overcome cravings, and which are positive in tone. Craigslist was the most efficient recruitment method and yielded a sample that was racially and economically diverse. Despite a successful beta test of initial technological feasibility, extensive problems were subsequently experienced in a beta test of the technological feasibility of the entire program. Iterative program refinement and adaptation on the basis of user input is necessary to ensure salience, while extensive field testing is required to ensure proper functioning of technology-based programs.

Acknowledgments

The authors thank the entire study team from the Center for Innovative Public Health (Internet Solutions for Kids), Michigan State University, and the University of Texas Health Science Center, who contributed to the planning and implementation of the study. The authors also thank Dr. Walter Young for his contributions to the focus group analyses, Laurie Fitzpatrick for assistance with beta testing, and Drs. David Strong and Amanda Graham for their consultation. The authors thank the study participants for their time and willingness to participate in this study. An abbreviated version of this article was presented at the 2011 mHealth Summit in Washington, DC.

Notes

Note. SMS USA = Stop My Smoking USA; Unknown = participants were not asked this question.

Note. This is a selection of the recruitment plan created which targeted more than 60 communities on Craigslist. The city and state are provided for each community selected to have a recruitment advertisement posted. Race and ethnicity data were obtained from the U.S. Census Bureau American Fact Finder website in 2010. A state/city average for targeted communities was then tabulated and compared with the U.S. national average. SMS USA = Stop My Smoking USA.

^a For states where advertisements could only be posted by state rather than specific communities, total state population demographics are reported.

^b Communities where paid advertisements were posted.

Color versions of one or more of the figures in the article can be found online at www.tandfonline.com/uhcm.