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      Using a Mobile App to Promote Smoking Cessation in Hospitalized Patients

      research-article
      , MD, PhD 1 , , , MPH 2
      (Reviewer), (Reviewer), (Reviewer)
      JMIR mHealth and uHealth
      JMIR Publications Inc.
      mobile apps, patient engagement, hospital, smoking cessation, health literacy

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          Abstract

          Background

          The potential of interactive health education for preventive health applications has been widely demonstrated. However, use of mobile apps to promote smoking cessation in hospitalized patients has not been systematically assessed.

          Objective

          This study was conducted to assess the feasibility of using a mobile app for the hazards of smoking education delivered via touch screen tablets to hospitalized smokers.

          Methods

          Fifty-five consecutive hospitalized smokers were recruited. Patient sociodemographics and smoking history was collected at baseline. The impact of the mobile app was assessed by measuring cognitive and behavioral factors shown to promote smoking cessation before and after the mobile app use including hazards of smoking knowledge score (KS), smoking attitudes, and stages of change.

          Results

          After the mobile app use, mean KS increased from 27(3) to 31(3) ( P<0.0001). Proportion of patients who felt they “cannot quit smoking” reduced from 36% (20/55) to 18% (10/55) ( P<0.03). Overall, 13% (7/55) of patients moved toward a more advanced stage of change with the proportion of patients in the preparation stage increased from 40% (22/55) to 51% (28/55). Multivariate regression analysis demonstrated that knowledge gains and mobile app acceptance did not depend on age, gender, race, computer skills, income, or education level. The main factors affecting knowledge gain were initial knowledge level ( P<0.02), employment status ( P<0.05), and high app acceptance ( P<0.01). Knowledge gain was the main predictor of more favorable attitudes toward the mobile app (odds ratio (OR)=4.8; 95% confidence interval (CI) (1.1, 20.0)). Attitudinal surveys and qualitative interviews identified high acceptance of the mobile app by hospitalized smokers. Over 92% (51/55) of the study participants recommended the app for use by other hospitalized smokers and 98% (54/55) of the patients were willing to use such an app in the future.

          Conclusions

          Our results suggest that a mobile app promoting smoking cessation is well accepted by hospitalized smokers. The app can be used for interactive patient education and counseling during hospital stays. Development and evaluation of mobile apps engaging patients in their care during hospital stays is warranted.

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          Most cited references66

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          A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010

          The Lancet, 380(9859), 2224-2260
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            The process of smoking cessation: an analysis of precontemplation, contemplation, and preparation stages of change.

            Traditionally smoking cessation studies use smoker and nonsmoker categories almost exclusively to represent individuals quitting smoking. This study tested the transtheoretical model of change that posits a series of stages through which smokers move as they successfully change the smoking habit. Subjects in precontemplation (n = 166), contemplation (n = 794), and preparation (n = 506) stages of change were compared on smoking history, 10 processes of change, pretest self-efficacy, and decisional balance, as well as 1-month and 6-month cessation activity. Results strongly support the stages of change model. All groups were similar on smoking history but differed dramatically on current cessation activity. Stage differences predicted attempts to quit smoking and cessation success at 1- and 6-month follow-up. Implications for recruitment, intervention, and research are discussed.
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              Decisional balance measure for assessing and predicting smoking status.

              The Decisional Balance Sheet of Incentives has been proposed by Janis and Mann (1977) as a general schema for representing both the cognitive and motivational aspects of human decision making. In this study, a brief 24-item paper and pencil measure was constructed to study the decision-making process in smoking cessation. Two scales were identified and labeled the Pros of Smoking and the Cons of Smoking. These scales were successful in differentiating between five groups representing stages of change in the quitting process. The two scales were also successful when employed as predictors of smoking status at a 6-month follow-up. The Decisional Balance Scale appears to be a powerful construct of potentially wide application in behavior change.
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                Author and article information

                Contributors
                Journal
                JMIR Mhealth Uhealth
                JMIR Mhealth Uhealth
                JMU
                JMIR mHealth and uHealth
                JMIR Publications Inc. (Toronto, Canada )
                2291-5222
                Apr-Jun 2016
                06 May 2016
                : 4
                : 2
                : e59
                Affiliations
                [1] 1Columbia University Department of Biomedical Informatics New York, NYUnited States
                [2] 2Michael & Susan Dell Center for Healthy Living The University of Texas School of Public Health Austin, TXUnited States
                Author notes
                Corresponding Author: Joseph Finkelstein jf193@ 123456cumc.columbia.edu
                Author information
                http://orcid.org/0000-0002-8084-7441
                http://orcid.org/0000-0003-0609-600X
                Article
                v4i2e59
                10.2196/mhealth.5149
                4875494
                27154792
                0f4c9e7a-476a-4e99-935e-d30ebe8dc909
                ©Joseph Finkelstein, Eun Me Cha. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 06.05.2016.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR mhealth and uhealth, is properly cited. The complete bibliographic information, a link to the original publication on http://mhealth.jmir.org/, as well as this copyright and license information must be included.

                History
                : 20 September 2015
                : 13 October 2015
                : 13 March 2016
                : 30 March 2016
                Categories
                Original Paper
                Original Paper

                mobile apps,patient engagement,hospital,smoking cessation,health literacy

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