Online intervention engagement predicts smoking cessation
Highlights
► Posting online messages and donating money indicate intervention engagement. ► Online behaviors may stimulate motivation and volition. ► Being involved in virtual activities contributes to smoking abstinence.
Introduction
The success of a smoking cessation program depends on many factors that include characteristics of the treatment as well as characteristics of the participants. On the treatment side, differences have been found depending on whether the treatment is based on medical therapy, psychotherapy, bibliotherapy, internet use, or personal consultation, among others (Wu et al., 2006). On the participant side, motivational and volitional factors have been frequently studied. For example, individual differences in perceived self-efficacy, outcome expectancies, intention, and planning have been found to be predictive of a reduction in smoking (Schwarzer, and Luszczynska, 2008). Although a research focus on individual differences has brought about a rich body of evidence, further improvements could be made by shifting the focus toward behavioral process variables. Then, the question is “what they do” instead of “who they are.” Participants are usually motivated to quit; otherwise, they would not participate in such programs. On the other hand, the intention to quit is not a sufficient prerequisite for quitting as most participants fail to quit for good. Thus, the volitional or self-regulatory process that lies between intention formation and abstinence deserves more attention. Preparatory acts can be specified as putative mediators that may help bridge the intention–abstinence gap.
The present study examines such behaviors that are involved in the quitting process. The context of an online smoking cessation program allows access to behavioral data that are otherwise less accessible to the researcher. Two meta-analyses have found that online treatment groups are more successful than passive control groups or minimal-intervention groups (Myung et al., 2009, Shahab and McEwen, 2009). A third meta-analysis (Haug, and Schaub, 2011) has confirmed the results of the previous two, based on 14 randomized controlled trials that were published in the middle of 2010. There is no doubt that web-based smoking cessation programs can be effective, but their active ingredients are less well studied (An et al., 2008, Etter, 2006, Strecher, 2007, van Osch et al., 2008).
The present article investigates intervention engagement, represented by three behavioral acts that are recorded while participants proceed through the web-based course. First, after one smoke-free day, participants can post their own bulletin board entry, which becomes visible to the online community. Second, they may volunteer to offer a donation. Third, they can post any number of messages, for example, in the chat room, which is connected to the social network of fellow quitters. We assume that such online activities would help to sustain motivation and volition (Richert et al., 2011), and we examine whether this makes a difference in the behavior change process.
Whereas previous studies have focused on individual differences of smokers as predictors of quitting (“who they are”), the present study focuses on self-regulatory actions (“what they really do”). The purpose is to predict abstinence maintenance in a large sample of internet users who may become involved in numerous social activities within the virtual community. There are three putative predictors of maintenance: posting on a bulletin board after the first smoke-free day, offering a donation, and posting messages throughout the course. It is hypothesized that these activities reflect intervention engagement that leads to improved behavioral maintenance as documented by self-reported abstinence rates for particular time periods (1 day, 2 days, 1 week, 2 weeks, 3 weeks, 4 weeks, 8 weeks, and 10 weeks).
Section snippets
Procedures
A web portal (www.stop-simply.de) to promote smoking cessation was set up to collect data. It was a theory-based research and development project, inspired by the Health Action Process Approach (Schwarzer and Luszczynska, 2008). The portal was publicly announced by media interviews with the second author, resulting in the recruitment of 13,191 German-speaking internet users who signed up with a username and password. They signed an informed consent form and responded to an online questionnaire
Results
Fig. 1 displays the numbers of participants who logged in at multiple points in time to report their current abstinence. Out of 13,174 participants, a subset of 3733 persons reported at least one smoke-free day (28%), and 1078 persons later reported a 10-week abstinence (8%).
Out of the 3733 participants who reported at least one smoke-free day, 826 posted their success in a bulletin board entry. Doing so was associated with a smaller decline in maintenance rates. Fig. 2 displays the survival
Discussion
Within the self-regulatory process of behavior change, an active involvement of participants is needed to attain success. The present study examined three behavioral predictors of abstinence within a web-based smoking cessation program: disclosing one's initial success in an entry on the bulletin board, offering a donation, and actively posting multiple messages to the virtual community during the course of quitting. It was found that all three behaviors were associated with improved abstinence
Conflict of interest statement
The authors declared that there are no conflicts of interest.
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