Currently submitted to: JMIR Mental Health
Date Submitted: Oct 21, 2019
(currently open for review)
Randomized trial of brief, web-based interventions to motivate smokers with schizophrenia
In-person motivational interventions increase engagement with evidence-based cessation treatments among smokers with schizophrenia, but access to such interventions can be limited due to workforce shortages and competing demands in mental health clinics. Use of digital technology to deliver interventions can increase access, but cognitive impairments in schizophrenia may impede use of standard digital interventions. We developed an interactive, multimedia, digital motivational decision support system for smokers with schizophrenia (Let’s Talk About Smoking). We also digitalized a standard educational pamphlet from the National Cancer Institute (NCI Education). Both were tailored to reduce cognitive load during use.
We conducted a randomized trial of Let's Talk About Smoking vs. NCI Education to test whether the interactive motivational intervention was more effective and more appealing than the static educational intervention for increasing use of smoking cessation treatment, quit attempts and abstinence among smokers with schizophrenia, accounting for level of cognitive functioning.
Adult smokers with schizophrenia (n=162) were enrolled in 2014-2015, randomly assigned to intervention condition, and assessed in person at 3- and 6-month follow-ups. Interventions were delivered on a laptop computer in a single session. All participants had access to standard, community-delivered cessation treatments during follow-up. Multivariate models were used to evaluate outcomes.
All participants completed their assigned intervention. Treatment initiation outcomes were not different between intervention conditions (32.1% Let’s Talk About Smoking vs. 46.2% NCI Education; OR = 0.71 [0.37-1.33]); 38.9% of all participants initiated treatment. Older age (OR=1.03 [1.00-1.07], P=.05), higher education (OR=1.21 [1.04-1.41], P=.03), and fewer positive symptoms (OR=.87 [0.80-0.96], P=.01) predicted cessation treatment initiation, whereas level of cognition did not, suggesting that tailoring the digital interventions to reduce cognitive load was effective. The mean satisfaction/usability index score was higher for Let’s Talk About Smoking vs. NCI Education (8.9±1.3 vs. 8.3±2.1, df= 120.7, t= 2.0, P=.045). Quit attempts and abstinence were not different between intervention conditions Cognitive functioning at baseline (Est=1.47, SE=0.47, P=.002) and use of any behavioral or medication cessation treatment (Est=1.43, SE=.47, P=.003) predicted quit attempts with self-reported abstinence over the 6-months follow-up, indicating that smokers with schizophrenia required additional treatment after brief education or motivational interventions, and that treatment should be adjusted for people with cognitive impairment.
The interactive, multimedia intervention was not more effective than the static, text-based intervention among smokers with schizophrenia. Both tailored digital interventions resulted in levels of treatment engagement and quit attempts that were similar to findings from previous studies of in-person interventions, confirming the potential role of digital interventions to educate and motivate smokers with schizophrenia to use cessation treatment and to quit smoking. The interactive, multimedia intervention was rated as more appealing, suggesting the potential for better uptake of interactive, multi-media interventions in non-research environments. Clinical Trial: ClinicalTrials.gov NCT02086162
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