WhatsApp Embedded in Routine Service Delivery for Smoking Cessation

NCT03714971 | Completed

• 1 other identifier: 16-12.1/11
• Study Type: interventional
• Target: 127
• Locations: 1 country
• Sites: 1

Brief Summary

Background: Recently, the use of communication technologies and social media applications has become increasingly widespread to strengthen efforts for smoking cessation. The purpose of this study is; to assess the effect on success rate of the WhatsApp application which is embedded in the smoking cessation policlinic service delivery. Materials and Methods: A randomized controlled intervention study was conducted with 132 volunteers who were followed up at the EUTF Smoking Cessation Policlinic between March-July 2017. The intervention content based on transtheoretic model was prepared and 60 WhatsApp messages were delivered to participants for 3 months of follow up. For data collection, initial interview form and follow up form consisting sociodemographic characteristics, smoking status, medical condition and treatment, were used. The success rate at first and third months were assessed by the point-prevalence regarding the previous week. Intention-to-treat analysis was used. For secondary outcomes; number of follow-ups, change in weight and continuity of medication were evaluated. Findings: Success rate in the first month was 65.9% for intervention group and 40.9% in the control group; for the third month it was 50.0% in the intervention group and 30.7% in the control group. Being in the intervention group increased the success rate by 3,50 (1,30-9,44) times in the first month and 2,50 (1,08-6,40) times in the third month. The intervention was the only parameter effective in the two follow-up periods; the difference in success rate caused by gender, marital status and work-related social class has been eliminated after adjustment for the intervention.

Conditions

Smoking Cessation

Keywords

Whatsapp; smoking cessation; cessation service

Outcome Measures

Primary Outcomes (1)

• Quitting success rates at the end of the 1st, 3rd and 6th month

  Quitting success rates at the end of the 1st, 3rd and 6th month of follow-up in the intervention and control groups. Quitting success rate at 1st month was calculated with point prevalence. History of cessation was based on self report and those who declared not smoked even a single puff on a cigarette at all in the past two weeks were considered as "successful" in the quitting attempt (19). The success rate at 3rd month was calculated with point prevalence. In this point, not smoking at all in total in the past ten weeks was considered "successful" in the quitting attempt. The success rate at 6th month was calculated with point prevalence. In this point, not smoking at all in total in the past 24 weeks was considered "successful" in the quitting attempt. A decrease in success rates at six months is expected in comparison with 3 months as the intervention lasts for 3 months.

  6 months

Secondary Outcomes (3)

• The total number of follow-ups

  3 months

• The continuity to drug,

  3 months

• Self reported difference in weight in kilograms since the first contact

  3 months

Study Arms (2)

Receiving WhatsApp messages

EXPERIMENTAL

Among patients applying to the smoking cessation outpatient clinic between March and October 2017, \>18-year old volunteers who smoked at least one cigarette/day, using WhatsApp at least on four days of the week, accepting the 3-month follow-up were included In receiving WhatsApp messages group.

Behavioral: WhatsApp embedded in smoking cessation service

Not receiving WhatsApp messages

NO INTERVENTION

In "not receiving WhatsApp messages" group; Stratification and randomization were both used to randomly allocate participants to both arms of the study. The intervention and control groups were first stratified according to physician and then gender, and later allocated in a simple random manner. Randomization was conducted using a computer spreadsheet. Allocation according to gender was conducted regarding the 2:3 female to male ratio in the routine cessation services and stratification according to physician aimed to have a balanced distribution among the different physicians working in the same cessation unit. As the target number of participants was small, further stratification was not applied. Simple random sampling was then used to allocate participants to each group.

Interventions

WhatsApp embedded in smoking cessation service BEHAVIORAL

The routine service delivery was ongoing as the intervention was conducted. In addition to the routine procedures in service delivery described above, WhatsApp messages were sent according to the plan.

Receiving WhatsApp messages

Eligibility Criteria

• Age: 18 Years - 65 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Among patients applying to the smoking cessation outpatient clinic between March and October 2017,
• \>18-year old volunteers who smoked at least one cigarette/day,
• using WhatsApp at least on four days of the week,
• accepting the 3-month follow-up were included in the study.

You may not qualify if:

• people who were not 'ready to quit' according to the TTM stages of change evaluation
• who had already quit before applying to the clinic were excluded.
• If two or more patients were living in the same house or had applied to the clinic together, only the first of these was included and the rest were excluded from the study, as they could show the arriving messages to their friend/ partner/ relative.

Sponsors & Collaborators

• Ege University: lead

Study Sites (1)

Ege University Faculty of Medicine Public Health Departmant

Izmir, 35100, Turkey (Türkiye)

Location

Related Publications (8)

• Filozof C, Fernandez Pinilla MC, Fernandez-Cruz A. Smoking cessation and weight gain. Obes Rev. 2004 May;5(2):95-103. doi: 10.1111/j.1467-789X.2004.00131.x.

  PMID: 15086863 BACKGROUND

• Munoz RF, Chen K, Bunge EL, Bravin JI, Shaughnessy EA, Perez-Stable EJ. Reaching Spanish-speaking smokers online: a 10-year worldwide research program. Rev Panam Salud Publica. 2014 May-Jun;35(5-6):407-14.

  PMID: 25211569 BACKGROUND

• Prochaska JO, Velicer WF. The transtheoretical model of health behavior change. Am J Health Promot. 1997 Sep-Oct;12(1):38-48. doi: 10.4278/0890-1171-12.1.38.

  PMID: 10170434 BACKGROUND

• Cheung YT, Chan CH, Lai CK, Chan WF, Wang MP, Li HC, Chan SS, Lam TH. Using WhatsApp and Facebook Online Social Groups for Smoking Relapse Prevention for Recent Quitters: A Pilot Pragmatic Cluster Randomized Controlled Trial. J Med Internet Res. 2015 Oct 22;17(10):e238. doi: 10.2196/jmir.4829.

  PMID: 26494159 BACKGROUND

• Whittaker R, McRobbie H, Bullen C, Rodgers A, Gu Y. Mobile phone-based interventions for smoking cessation. Cochrane Database Syst Rev. 2016 Apr 10;4(4):CD006611. doi: 10.1002/14651858.CD006611.pub4.

  PMID: 27060875 BACKGROUND

• Carlson LE, Goodey E, Bennett MH, Taenzer P, Koopmans J. The addition of social support to a community-based large-group behavioral smoking cessation intervention: improved cessation rates and gender differences. Addict Behav. 2002 Jul-Aug;27(4):547-59. doi: 10.1016/s0306-4603(01)00192-7.

  PMID: 12188591 BACKGROUND

• Turner J, McNeill A, Coleman T, Bee JL, Agboola S. Feasibility of offering nicotine replacement therapy as a relapse prevention treatment in routine smoking cessation services. BMC Health Serv Res. 2013 Feb 1;13:38. doi: 10.1186/1472-6963-13-38.

  PMID: 23375024 BACKGROUND

• Durmaz S, Ergin I, Durusoy R, Hassoy H, Caliskan A, Okyay P. WhatsApp embedded in routine service delivery for smoking cessation: effects on abstinence rates in a randomized controlled study. BMC Public Health. 2019 Apr 8;19(1):387. doi: 10.1186/s12889-019-6727-z.

  PMID: 30961557 DERIVED

Related Links

• WHO report on the global tobacco epidemic, 2017: monitoring tobacco use and prevention policies
• Türkiye Health Survey, 2016
• WhatsApp: number of users 2013-2017

MeSH Terms

Conditions

Smoking Cessation

Condition Hierarchy (Ancestors)

Health Behavior; Behavior

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: DOUBLE
• Who Masked: PARTICIPANT, CARE PROVIDER
• Masking Details: The study was designed as a single-blind study. The physicians (except the first author) were blind to the allocation to intervention or control groups and they conducted their routine smoking cessation counseling work. As long as the patient did not comment on the messages, the physicians were blind throughout the follow ups as well. After the first routine counseling, participants were informed by the first author about the study, thus they were not blind to the intervention. The analysis of the study was conducted by the first author who was not blind to the intervention/ control status of the participants. The first author could not be blind as he was to send out the WhatssApp messages. However, contact numbers of the participants were labeled with numbers (I-01 to I-44) to secure anonymity and to prevent any bias.
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: PhD MD, research asistant

Model Details: The study was designed as a RCT including two parallel arms: an intervention group receiving messages through WhatsApp Messenger operating on smart phones and a control group not receiving these messages, with an allocation ratio of 1:2. Both groups received the standard outpatient care of the clinic including a 45-60 minutes face-to-face individual counseling at first contact ending with the decision of treatment and quit date, and a support booklet on quitting and subsequent follow-ups by the same clinician at 1st, 2nd, 4th weeks and 3rd month after quit date, either face-to-face at the clinic or by telephone if the patient does not come to the clinic for follow-up. The study was carried out in the smoking cessation clinic of Ege University Medical School's Public Health Department.

Study Record Dates

• First Submitted: September 4, 2018
• First Posted: October 22, 2018
• Study Start: March 1, 2017
• Primary Completion: June 1, 2017
• Study Completion: October 1, 2017
• Last Updated: September 17, 2026

Record last verified: 2026-09

Data Sharing

• IPD Sharing: Will not share

Locations

TU (1)