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Effect of a workplace mobile phone-based instant messaging intervention on smoking cessation: a cluster randomised controlled trial.

AIMS
To test the effectiveness of interactive, instant messaging chat-based mobile phone support versus text-based mobile phone support integrated with brief interventions on self-reported smoking abstinence in workplaces.


DESIGN
A two-arm parallel cluster-randomised controlled trial with follow-up to 12 months.


SETTING
75 companies in Hong Kong, China.


PARTICIPANTS
Daily cigarette adult smokers (92.0% male, 90.9% not ready to quit within the next 30 days) from 75 companies (clusters). Interventions Participants were cluster-randomised to receive text-based support (TBS, n=375; 38 clusters) or chat-based support (CBS, n=304; 37 clusters). TBS participants received automated and fix-scheduled text messages on cessation advice and support. CBS participants received fix-scheduled text messages and additional real-time psychosocial and cessation support via instant messaging services (e.g. WhatsApp) by counsellors. Both groups received a 1-hour health talk at baseline and brief telephone counselling at 1 week and 1, 3, 6, and 12 months.


MEASUREMENTS
The primary outcome was self-reported 7-day point-prevalence abstinence at 6 months post-treatment initiation. Secondary outcomes included 7-day point-prevalence abstinence at 12 months, repeated 7-day point-prevalence abstinence, smoking reduction, quit attempts, and intervention engagement, defined as having read text messages and/or engaged in conversation with counsellors.


FINDINGS
By intention-to-treat assuming dropouts were smoking, self-reported abstinence was not significantly different between the CBS and TBS group at 6 months (18.8% versus 21.6%, risk ratio [RR]=0.87, 95% confidence interval [CI]= 0.61, 1.23, retention=71.3%) and 12 months (21.4% versus 24.0%, RR=0.90, 95% CI=0.66, 1.21, retention=70.8%). The repeated 7-day point-prevalence abstinence, smoking reduction, and quit attempts were similar between the groups. The participants who were engaged in the text-based and/or chat-based intervention had greater abstinence (adjusted RR=2.91, 95% CI=1.87, 4.52) at 6 months, compared with unengaged participants.


CONCLUSIONS
Compared with a text messaging mobile phone intervention, a chat-based instant messaging mobile phone intervention did not improve smoking abstinence over 12 months in workplaces. Engagement in text-based or chat-based interventions was associated with higher quit rates compared with nonengagement..