Text2Quit: an analysis of participant engagement in the mobile smoking cessation program

ABSTRACT

Background: Text2Quit, an interactive text-messaging program aimed at smoking cessation, has been shown to increase quit rates, but engagement has not been thoroughly explored. Understanding the program features associated with engagement and behavior change is integral for effective program design. Objectives: This study explored participants’ interaction with the Text2Quit text-messaging program and associations between engagement and smoking cessation. Methods: The study included the 262 participants who received the Text2Quit intervention. Self-reported engagement measures, primarily usage of Text2Quit keywords and survey responses, were collected through computer records of participant use. Demographic variables and self-reported smoking abstinence were recorded in surveys at baseline and 6-month assessment. Results: The majority of participants (73%) maintained their subscription during the 6-month intervention. On average, participants received 210.51 text messages, 23.75 emails, and logged into the web portal 1.94 times. Being female was predictive of engagement with the program (β = 15.39). Program engagement, measured by the keyword PLEDGE (p = .002) and the Smokefree Status at 7 Days survey (p < .001) were associated with 6-month abstinence; use of keywords SMOKED (p < .001), RELAPSE (p = .007), and STOP (p = .023) were inversely related to abstinence. While abstainers (N = 83, 31%) stayed enrolled longer and engaged with the program more frequently, program “dose” was not predictive of smoking cessation. Conclusions: Using interactive tools such as pledges and reporting on smoking status were predictive of cessation. Further study of program features is required to understand how to optimally design text messaging programs.

KEYWORDS:

• Text messaging
• smoking cessation
• engagement
• mHealth

Acknowledgments

Dr. Abroms would like to thank the research staff at The George Washington University for their dedication to the study, including Leah Leavitt, Jennifer Schindler-Ruwisch, MPH, Judy Mendel, MPH, Amanda Davis, MPH, and Meenakshi Ahuja, MPH.

Funding

Research reported in this publication was supported by grant number 5K07 CA124579-02 and the American Recovery and Reinvestment Act supplement to Dr. Lorien C. Abroms, from the National Cancer Institute of the NIH. Support also came from an award from the Department of Prevention and Community Health at the George Washington University Milken Institute School of Public Health to Dr. Lorien C. Abroms.

Declarations of interest

The George Washington University/Dr. Lorien C. Abroms has licensed the Text2Quit program to Voxiva, Inc.; Dr. Lorien C. Abroms has stock options in Voxiva, Inc. The remaining authors report no declarations of interest.

Additional information

Funding

Research reported in this publication was supported by grant number 5K07 CA124579-02 and the American Recovery and Reinvestment Act supplement to Dr. Lorien C. Abroms, from the National Cancer Institute of the NIH. Support also came from an award from the Department of Prevention and Community Health at the George Washington University Milken Institute School of Public Health to Dr. Lorien C. Abroms.