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Open Access 01-12-2019 | Research article

WhatsApp embedded in routine service delivery for smoking cessation: effects on abstinence rates in a randomized controlled study

Authors: Seyfi Durmaz, Isil Ergin, Raika Durusoy, Hur Hassoy, Ayhan Caliskan, Pinar Okyay

Published in: BMC Public Health | Issue 1/2019

Abstract

Background

The demand for smoking cessation services has risen in Turkey, as smokers planning to quit reached 35% in 2012. Communication technologies are used globally to support quitters, yet their integration to health services is rare. This study aims to evaluate the effect of support messages through WhatsApp application added to the usual care of a university hospital cessation unit, as compared to usual care alone, on abstinence rates at first month.

Methods

A randomized controlled intervention study was conducted with 132 patients applying to Ege University Hospital’s Department of Public Health Smoking Cessation Clinic, between March and July 2017. Intervention content was prepared and 60 WhatsApp messages about having a plan of action and preventing relapse were developed through expert panels. These messages lasted for 3 months and follow-ups continued for 6 months. The primary outcome was abstinence rate at 1st month post target quit day. As secondary outcomes; the continuous abstinence rates at 3rd and 6th months, number of follow-ups, change in weight and continuity of medication were evaluated. Intention-to-treat analysis was used.

Results

Abstinence rate at 1st month was 65.9% in the intervention group and 40.9% in the control group (p = 0.007); 50.0 and 30.7% at 3rd month and 40.9 and 22.7% at 6th month, consecutively (both p < 0.05). Being in the intervention group increased abstinence rate by 3.50 (OR, 95% CI = 1.30–9.44) times in the 1st month. When controlled for all other factors in the multivariate logistic regression, the intervention was the only variable significantly associated with abstinence. For secondary outcomes, the intervention increased abstinence rate by 2.50 (OR, 95% CI = 1.08–6.40) times in the 3rd and 2.31 (OR, 95% CI = 1.03–5.16) times in the 6th month. In the intervention group, the number of follow-ups and face-to-face follow-ups were higher at 1st and 3rd months and continuity of medication was longer at 3rd month.

Conclusions

WhatsApp support embedded in cessation service delivery increases the abstinence rate and has favorable effects on follow-up.

Trial registration

This trial is retrospectively registered online at ClinicalTrials.gov with the identifier NCT03714971.

Available only for authorised users

American Cancer Society, Vital Strategies. Tobacco Atlas. Turkey; 2019. tobaccoatlas.org/country/turkey accessed 10 Feb 2019

Turkish Statistical Institute. The percentage of individuals' status of smoking tobacco products by sex and age group (2010-2016). 2016. http://www.tuik.gov.tr/PreIstatistikTablo.do?istab_id=2393. Accessed 25 Dec 2017.

Turkish Statistical Institute. Global adult tobacco survey. TSI Bulletin. 2012. http://www.tuik.gov.tr/PreHaberBultenleri.do?id=13142. Accessed 25 Dec 2017.

Turkish Ministry of Health, Health Promotion General Directorate. Smoke-free Turkey. 2016. http://www.sggm.saglik.gov.tr/TR,3881/turkiyenin-dumansiz-hava-sahasi-dunyaya-resmen-ornek-oldu.html. Accessed 22 Aug 2017.

Turkish Ministry of Health. Tobacco control in Turkey 2016. http://havanikoru.org.tr/surec. Accessed 8 Sep 2017. Accessed 27 Dec 2017.

Fiore MC, Jaén CR, Baker TB, et al. Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline. Rockville: U.S. Department of Health and Human Services. Public Health Service; 2008.

Stead LF, Hartmann-Boyce J, Perera R, Lancaster T. Telephone counselling for smoking cessation. Cochrane Database Syst Rev. 2013;12(8):CD002850.

Hall SM, Tunstall CD, Vila KL, Duffy J. Weight gain prevention and smoking cessation: cautionary findings. Am J Public Health. 1992;82:799–803.CrossRef

Danielsson T, Rossner S, Westin A. Open randomised trial of very low energy diet together with nicotine gum for stopping smoking in women who gained weight in previous attempts to quit. BMJ. 1999;319:490–4.CrossRef

10.

McDonough M. Update on medicines for smoking cessation. Aust Prescr. 2015;38(4):106–11.CrossRef

11.

Kemp S. Three billion people now use social media - we are social. https://wearesocial.com/blog/2017/08/three-billion-people-now-use-social-media. Accessed 11 Sept 2017.

12.

Statista. WhatsApp: number of users 2013–2017 | Statista. 2017. https://www.statista.com/statistics/260819/number-of-monthly-active-whatsapp-users. Accessed 11 Sept 2017.

13.

Statista. WhatsApp: mobile usage penetration by country | Statista. 2017. https://www.statista.com/statistics/291540/mobile-internet-user-whatsapp. Accessed 12 Sept 2017.

14.

Trujillo Gómez JM, Díaz-Gete L, Martín-Cantera C, Fábregas Escurriola M, Lozano Moreno M, et al. Intervention for smokers through new communication technologies: what perceptions do patients and healthcare professionals have? A qualitative study. PLoS One. 2015;10(9):e0137415. https://doi.org/10.1371/journal.pone.0137415.CrossRefPubMedPubMedCentral

15.

Cheung Y, Chan C, Lai C, Chan V, Wang M, Li W, et al. Using WhatsApp and Facebook online social groups for smoking relapse prevention for recent quitters: a pilot pragmatic cluster randomized controlled trial. J Med Internet Res. 2015;17(10):e238. https://doi.org/10.2196/jmir.4829.CrossRefPubMedPubMedCentral

16.

Andreeva T, Petrenko T, Kharchenko N, Zakhozha V. 7th European tobacco or health conference book of abstracts. In: Tailoring smoking cessation services to smokers perceived needs in Ukraine; 2017. p. 71.

17.

Whittaker R, McRobbie H, Bullen C, Rodgers A, Gu Y. Mobile phone-based interventions for smoking cessation. Cochrane Database of Systematic Reviews. 2016;(Issue 4):CD006611. https://doi.org/10.1002/14651858.CD006611.pub4.

18.

Alanzi T, Bah S, Alzahrani S, Alshammari S, Almunsef F. Evaluation of a mobile social networking application for improving diabetes type 2 knowledge: an intervention study using WhatsApp. J Comp Eff Res. 2018;7(9):891–9.CrossRef

19.

Muniasamy M, Hashim HM, Lim C, Junazli NB, Choo SL, Low KY. Would you like a free mammogram? Effectiveness of utilizing WhatsApp as a social marketing tool in improving uptake for a free mammography Service in Kuala Lumpur Malaysia. J Glob Oncol. 2018;(4_suppl_2):54s–s. https://doi.org/10.1200/jgo.18.29100.

20.

Baskerville NB, Azagba S, Norman C, McKeown K, Brown KS. Effect of a digital social media campaign on young adult smoking cessation. Nicotine Tob Res. 2016 Mar;18(3):351–60. https://doi.org/10.1093/ntr/ntv119.CrossRefPubMed

21.

Graham AL, Carpenter KM, Cha S, Cole S, Jacobs MA, Raskob M, Cole-Lewis H. Systematic review and meta-analysis of internet interventions for smoking cessation among adults. Subst Abus Rehabil. 2016;7:55–69. https://doi.org/10.2147/SAR.S101660.CrossRef

22.

Ünal M. Smoking cessation counseling in the hospitals: problems and solutions. Konuralp Tıp Derg. 2017;9(2):94–9. https://doi.org/10.18521/ktd.315188.CrossRef

23.

Dumville JC, Hahn S, Miles JNV, Torgerson DJ. The use of unequal randomisation ratios in clinical trials: a review. Contemp Clin Trials. 2006;27(1):1–12. https://doi.org/10.1016/j.cct.2005.08.003.CrossRefPubMed

24.

Mars M, Escott R. WhatsApp in clinical practice: a literature review. Stud Health Technol Inform. 2016;(231):82–90. https://doi.org/10.3233/978-1-61499-712-2-82.

25.

Fleiss JL. Statistical methods for rates and proportions. 2nd Ed. New York: John Wiley; 1981. Print.

26.

West R, Hajek P, Stead L, Stapleton J. Outcome criteria in smoking cessation trials : proposal for a common standard. Soc Stud Addict. 2005;100:299–303. https://doi.org/10.1111/j.1360-0443.2005.00995.x.CrossRef

27.

Uysal MA, Kadakal F, Karsidag C, Bayram NG, Uysal O, et al. Fagerstrom Test for Nicotine Dependence: Reliability in a Turkish Sample and Factor Analysis. Tuberkuloz ve Toraks. 2004;52(2):115–21.PubMed

28.

Aydemir O, Güvenir T, Küey L, Kültür S. Reliability and validity of the Turkish version of hospital anxiety and depression scale. Türk Psikiatri Derneği. 1997;8(4):280–7.

29.

North American Quitline Consortium. Measuring quit rates / NAQC issue paper. 2009. https://www.pdastats.com/PublicFiles/Naqc_Issuepaper_Measuringquitrates.pdf.

30.

Çelik İ, Yüce D, Hayran M, Erman M, Kılıçkap S, et al. Nationwide smoking cessation treatment support program – Turkey project. Health Policy. 2015;119(1):50–6. https://doi.org/10.1016/j.healthpol.2014.11.017.CrossRefPubMed

31.

Pekel Ö. One year rate of smoking cessation in Balçova center and effect of nicotine dependence on relaps rate. Izmir: Dokuz Eylül University; 2012.

32.

Carlson LE, Goodey E, Bennett MH, Taenzer P, Koopmans J. The addition of social support to a community-based large-group behavioral smoking cessation intervention: improved cessation rates and gender differences. Addict Behav. 2002;27(4):547–59. https://doi.org/10.1016/S0306-4603(01)00192-7.CrossRefPubMed

33.

Westmaas JL, Wild TC, Ferrence R. Effects of gender in social control of smoking cessation. Health Psychol. 2002;21(4):368–76. https://doi.org/10.1037/0278-6133.21.4.368.CrossRefPubMed

34.

Wilkinson R, Marmot M. Social determinants of health: the solid facts. Copenhagen: World Health Organization; 2003.

35.

Benach J, Muntaner C, Santana V. Employment conditions and health inequalities, final report to the WHO commission on social determinants of health (CSDH); 2007.

36.

Turner J, McNeill A, Coleman T, Bee JL, Agboola S. Feasibility of offering nicotine replacement therapy as a relapse prevention treatment in routine smoking cessation services. BMC Health Serv Res. 2013;13(1):38. https://doi.org/10.1186/1472-6963-13-38.CrossRefPubMedPubMedCentral

37.

Andreeva TI, Zakhozha V, Kharchenko N, Petrenko T. Smokers' past experience and intentions in selecting cessation aids: implications of social learning theory. Tob Prev Cessat. 2017;3(May Supplement):64. https://doi.org/10.18332/tpc/70597.CrossRef

38.

Argüder E, Karalezli A, Hezer H, Kılıç H, Er M, et al. Factors affecting the success of smoking cessation. Türk Toraks Derg. 2013;(14):81–7. https://doi.org/10.5152/ttd.2013.18.

39.

Ayesta FJ, Martin F, Otero M. No differences among sexes in smoking cessation in the patients treated in an specialized unit. Tob Prev Cessat. 2017;3(May Supplement):59. https://doi.org/10.18332/tpc/71199.CrossRef

40.

Fidan F, Pala E, Ünlü M, Sezer M, Kara Z. Factors affecting smoking cessation and success rates of the treatment methods used. Kocatepe Tip Derg. 2005;6(3):27–34.

41.

Ayesta FJ, Martin F, Veiga S. Influence of having a psychiatric diagnosis on smoking cessation. Tob Prev Cessat. 2017;3(May Supplement):73. https://doi.org/10.18332/tpc/71198.CrossRef

42.

Bravin JI, Bunge EL, Evare B, Wickham RE, Perez-Stable EJ, et al. Socioeconomic predictors of smoking cessation in a worldwide online smoking cessation trial. Internet Interv. 2015;2(4):410–8. https://doi.org/10.1016/j.invent.2015.10.001.CrossRef

43.

Muñoz RF, Chen K, Bunge EL, Bravin JI, Shaughnessy EA, et al. Reaching Spanish-speaking smokers online: a 10-year worldwide research program. Rev Panam Salud Publica. 2014;35(5–6):407–14.PubMedPubMedCentral

44.

Filozof C, Fernandez Pinilla MC, Fernandez-Cruz A. Smoking cessation and weight gain. Obes Rev. 2004;5(2):95–103. https://doi.org/10.1111/j.1467-789X.2004.00131.x.CrossRefPubMed

45.

Yılmaz A, Turan A. General characteristic of smoking cessation patients and factors effecting treatment success. İzmir Göğüs Hastanesi Dergisi. 2015;29(3):145–9.

46.

Kökten R. Evaluation for the study of quitting smoking clinic of Trakya University Medical Faculty. Edirne: Trakya University; 2008.

47.

Kiter G, Başer S, Akdağ B, Eki̇nci̇ A, Ünal N, et al. The characteristics of smoking habit among patients evaluated at our outpatient clinic. Tuberc Thorax. 2008;56(1):30–6.

48.

Raherison C, Marjary A, Valpromy B, Prevot S, Fossoux H, Taytard A. Evaluation of smoking cessation success in adults. Respir Med. 2005;99(10):1303–10.CrossRef

49.

Koyun, A. The effect of stage of change model based education given for smoking cessation to adult women. Ankara: Hacettepe University The Institute of Health Science, Program of Obstetric and Women’s Health Nursing, Doctorate Thesis; 2013.

50.

Agresti A. An introduction to categorical data analysis. 2nd ed. Florida: Wiley-Interscience; 2007.CrossRef

Title: WhatsApp embedded in routine service delivery for smoking cessation: effects on abstinence rates in a randomized controlled study
Authors: Seyfi Durmaz
Isil Ergin
Raika Durusoy
Hur Hassoy
Ayhan Caliskan
Pinar Okyay
Publication date: 01-12-2019
Publisher: BioMed Central
Published in: BMC Public Health / Issue 1/2019
Electronic ISSN: 1471-2458
DOI: https://doi.org/10.1186/s12889-019-6727-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

WhatsApp embedded in routine service delivery for smoking cessation: effects on abstinence rates in a randomized controlled study

Abstract

Background

Methods

Results

Conclusions

Trial registration

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Trial registration

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