%0 Journal Article
%T Engagement With a Mobile Chat-Based Intervention for Smoking Cessation: A Secondary Analysis of a Randomized Clinical Trial.
%A Li Y
%A Luk TT
%A Cheung YTD
%A Zhao S
%A Zeng Y
%A Tong HSC
%A Lai VWY
%A Wang MP
%J JAMA Netw Open
%V 7
%N 6
%D 2024 Jun 3
%M 38922618
%F 13.353
%R 10.1001/jamanetworkopen.2024.17796
%X <B>UNASSIGNED: </B>Determining how individuals engage with digital health interventions over time is crucial to understand and optimize intervention outcomes.<BR><B>UNASSIGNED: </B>To identify the engagement trajectories with a mobile chat-based smoking cessation intervention and examine its association with biochemically validated abstinence.<BR><B>UNASSIGNED: </B>A secondary analysis of a pragmatic, cluster randomized clinical trial conducted in Hong Kong with 6-month follow-up. From June 18 to September 30, 2017, 624 adult daily smokers were recruited from 34 community sites randomized to the intervention group. Data were analyzed from March 6 to October 30, 2023.<BR><B>UNASSIGNED: </B>Chat-based cessation support delivered by a live counselor via a mobile instant messaging app for 3 months from baseline.<BR><B>UNASSIGNED: </B>Group-based trajectory modeling was used to identify engagement trajectories using the participants' weekly responses to the messages from the counselor over the 3-month intervention period. The outcome measures were biochemically validated tobacco abstinence at 3-month (end of treatment) and 6-month follow-ups. Covariates included sex, age, educational level, nicotine dependence, past quit attempt, and intention to quit at baseline.<BR><B>UNASSIGNED: </B>Of 624 participants included in the analysis, 479 were male (76.8%), and the mean (SD) age was 42.1 (16.2) years. Four distinct engagement trajectories were identified: low engagement group (447 [71.6%]), where participants maintained very low engagement throughout; rapid-declining group (86 [13.8%]), where participants began with moderate engagement and rapidly decreased to a low level; gradual-declining group (58 [9.3%]), where participants had high initial engagement and gradually decreased to a moderate level; and high engagement group (58 [5.3%]), where participants maintained high engagement throughout. Compared with the low engagement group, the 6-month validated abstinence rates were significantly higher in the rapid-declining group (adjusted relative risk [ARR], 3.30; 95% CI, 1.39-7.81), gradual-declining group (ARR, 5.17; 95% CI, 2.21-12.11), and high engagement group (ARR, 4.98; 95% CI, 1.82-13.60). The corresponding ARRs (95% CI) of 3-month validated abstinence were 4.03 (95% CI, 1.53-10.59), 5.25 (95% CI, 1.98-13.88), and 9.23 (95% CI, 3.29-25.86).<BR><B>UNASSIGNED: </B>The findings of this study suggest that higher levels of engagement with the chat-based smoking cessation intervention were associated with greater biochemically validated tobacco abstinence. Improving engagement with digital interventions may increase intervention benefits.<BR><B>UNASSIGNED: </B>ClinicalTrials.gov Identifier: NCT03182790.