Introduction
Methods
Step 1. Identify target behaviours
Step 2. Identify the theoretical base
Step 3. Review relevant scientific literature
Step 4. Conduct exploratory work and need assessment
Step 5. Select mode of delivery
Step 6. Select intervention components
Step 7. Specify the intervention content by BCTs
Step 8. Translate the intervention content into app features
Step 9. Design a prototype intervention
Step 10. Pilot the app
Results
Registration and general app features
Features | Key targets | Proposed process of change a
| Intervention functions b
| BCTs c
| Sample text |
---|---|---|---|---|---|
Goal setting | • Set a behaviour change goal: stopping smoking or cutting down • Prompt participants to affirm commitment to their selected goal • Review goal and advise participants to consider modifying it if needed | • Psychological capability: self-regulation • Reflective motivation: intentions; goals | Enablement Persuasion | 1.1 Goal setting (behaviour) 1.5 Review behaviour goal 1.6 Discrepancy between current behaviour and goal 1.9 Commitment | “As you are progressing very well here, it’s a good time to revisit your initial goal and think about stopping smoking completely. You can do this!” |
Feedback and monitoring | • Prompt participants to record how many cigarettes they smoke each day • Provide feedback on performance of the selected behaviour • Praise participants for progress in changing the behaviour • Prompt self-praise and self-reward • Boost motivation and self-confidence • Advise participants to think about previous successes with quitting | • Psychological capability: self-regulation • Environmental opportunity: resources • Automatic motivation: habit formation; reinforcement • Reflective motivation: self-confidence | Enablement Persuasion | 2.2 Feedback on behaviour 2.3 Self-monitoring of behaviour 10.4 Social reward 10.7 Self-incentive 10.9 Self-reward 15.1 Verbal persuasion about capability 15.3 Focus on past success | “You have reached your one-week milestone. Sounds like a great achievement! Why do not you think about a reward for yourself if you stick to your smokefree goal for the next 7 days?” |
Features available pre-quit | • Provide information about the app, the research team, nicotine addiction and withdrawal symptoms • Prompt participants to think about why they want to quit smoking • Prompt planning of performing the behaviour | • Psychological capability: knowledge; planning • Automatic motivation: desires | Education Persuasion | 1.4 Action planning 3.1 Social support (unspecified) 5.3 Information about the social and environmental consequences 11.1 Pharmacological support 12.1 Restructuring the physical environment 12.2 Restructuring the social environment 12.3 Avoidance/reducing exposure to cues for the behaviour | “SmokeFree Baby has been developed by a research team at University College London who specialize in smoking cessation.” |
Savings calculator | • Monitor and provide feedback on how much money participants have saved | • Automatic motivation: reinforcement | Persuasion | 2.7 Feedback on outcome of behaviour | “Saved so far up to £10. That’s enough to buy a baby bottle.” |
‘Medicine’ | • Provide information about smoking cessation medications | • Psychological capability: knowledge | Education | 11.1 Pharmacological support | “It is best to combine mouth spray with […] nicotine patches.” |
‘Support’ | • Advise on eliciting social support | • Social opportunity: social influence | Enablement | 1.4 Action planning 3.1 Social support (unspecified) | “Think about the people closest to you who you can rely on when you need support. Add their phone numbers here and call them if you feel that the urge to smoke is getting overwhelming.” |
‘Memos’ | • Advise on eliciting social support • Prompt participants to reaffirm their commitment with the behaviour change | • Social opportunity: social influence • Reflective motivation: intentions; goals | Enablement Persuasion | 3.1 Social support (unspecified) 1.9 Commitment | “Help maintain your motivation to stop smoking or cut down by recording supportive video messages from your friends and family. You can also record your personal commitment to the goal you set for yourself.” |
‘Social’ | • Provide information about cues and social situations that can trigger urges to smoke • Provide tips to avoid environmental and social cues of smoking • Advise on eliciting social support | • Psychological capability: knowledge; self-regulation; planning • Social opportunity: social influence; social cues • Environmental opportunity: environmental cues • Reflective motivation: beliefs about consequences | Education Persuasion Environmental restructuring | 1.4 Action planning 3.1 Social support (unspecified) 3.2 Social support (practical) 3.3 Social support (emotional) 4.2 Information about antecedents 5.3 Information about the social and environmental consequences 6.3 Information about others’ approval 12.1 Restructuring the physical environment 12.2 Restructuring the social environment 12.3 Avoidance/reducing exposure to cues for the behaviour 15.2 Mental rehearsal of successful performance 16.2. Imaginary reward 16.3. Vicarious consequences | “Imagine that you are out with friends and you are the only one who does not smoke. Prepare in advance what you are going to do when they go to have a cigarette. For example you can browse the internet on your phone to kill time.” |
Core intervention modules
Modules | Key targets | Proposed process of change a
| Intervention functions b
| BCTs c
| Sample text |
---|---|---|---|---|---|
‘Identity’ | |||||
Control | • Foster identity change | • Reflective motivation: identity | Persuasion | 13.5 Identity associated with changed behaviour | “Building up a new identity as someone for whom smoking is not an option any more is an important part of leaving smoking behind for good.” |
Full | • Foster identity change • Prompt positive self-labels, self-images and self-thoughts • Increase salience of identities that do not promote smoking • Prompt identification with positive role models for cessation • Facilitate bonding with the baby | • Reflective motivation: identity; self-esteem; beliefs about consequences • Automatic motivation: desires • Social opportunity: social influence; modelling | Persuasion Modelling | 13.5 Identity associated with changed behaviour 13.4 Valued self-identity 13.3 Incompatible beliefs 13.2 Framing/reframing 13.1 Identification of self as a role model 3.1 Social support (unspecified) 9.3 Comparative imagining of future outcomes 15.4 Self talk | “You might feel that smoking has always been a part of who you are, and stopping smoking would mean that you lose something of yourself. Think about what you can gain by making ‘not smoking’ an essential part of your identity. Make a list of all the things about yourself that will not change even if you become a non-smoker.” |
‘Stress relief’ | |||||
Control | • Provide information about smoking and stress • Advise on using stress management techniques | • Psychological capability: knowledge; self-regulation | Education | 11.2 Reduce negative emotions 12.6 Body changes | “Bear in mind that smoking does not reduce stress, it simply relieves your withdrawal symptoms.” |
Full | • Provide information about smoking and stress • Advise on using stress management techniques • Provide training to perform a brief breathing exercise • Prompt planning to cope with stress without smoking | • Psychological capability: knowledge; self-regulation; skills; memory processes; planning • Reflective motivation: beliefs about consequences | Education Training Enablement | 11.2 Reduce negative emotions 12.6 Body changes 1.2 Problem solving 1.4 Action planning 8.3 Habit formation 11.3 Conserving mental resources | “Here are 3 top tips to reduce your stress without smoking. Try them out the next time you begin to feel stressed.” |
‘Health effects’ | |||||
Control | • Provide information about the health effects of smoking and benefits of cessation | • Psychological capability: knowledge • Automatic motivation: desires | Education Persuasion | 5.1 Information about health consequences | “By stopping smoking completely during pregnancy […] your baby is less likely to be born too early with a low birth weight.” |
Full | • Provide information about the health effects of smoking and benefits of cessation • Address misconceptions about the effects of smoking | • Psychological capability: knowledge • Automatic motivation: desires • Reflective motivation: beliefs about consequences | Education Persuasion | 5.1 Information about health consequences 5.3 Information about social and environmental consequences 5.6 Information about emotional consequences | “Delivering a baby with a low birth weight is the main pregnancy complication known to be linked with both active and passive smoking. The less you smoke, the greater your chances of having a normal birth are.” |
‘Face-to-face’ | |||||
Control | • Provide information about sources of support and how to access them | • Psychological capability: knowledge | Education | 3.1 Social support (unspecified) | “One of the most effective ways of stopping smoking is by getting support from an expert stop smoking advisor.” |
Full | • Provide information about sources of support and how to access them • Provide ready access to support in the localities • Address misconceptions about face-to-face support • Advise on making an appointment | • Psychological capability: knowledge • Environmental opportunity: access to support • Social opportunity: social influence | Education Persuasion Enablement | 3.1 Social support (unspecified) 3.2 Social support (practical) | “It’s never too late to change your mind about getting face-to-face support from a stop smoking advisor. Even if you decided not to get support at first, you can always ask your GP or midwife for a referral to your local stop smoking clinic, or contact them yourself.” |
‘Behaviour’ | |||||
Control | • Provide information about sources of urges to smoke • Promote behavioural substitution | • Psychological capability: knowledge; self-regulation | Education | 4.2 Information about antecedents 8.2 Behaviour substitution 12.4 Distraction | “Have a think about what you can do instead of smoking. One option might be to play a game on your phone.” |
Full | • Provide information about sources of urges to smoke • Promote behavioural substitution • Provide distraction • Prompt planning to cope with urges to smoke | • Psychological capability: knowledge; self-regulation; planning; memory processes • Environmental opportunity: resources • Automatic motivation: habit formation | Education Training Enablement | 4.2 Information about antecedents 8.2 Behaviour substitution 12.4 Distraction 1.2 Problem solving 1.4 Action planning 8.3 Habit formation | “Decorate your baby’s room. Search on the internet for ideas then try to do little bits and pieces every time you think about smoking” |