Measurement of Dose and Response for Smoking Behavior Change Interventions in the Digital Age: A Systematic Review (Preprint)
Authors: Ichimiya Megumi , Gerard Raquel , Mills Sarah , Brodsky Alexa , Evans W Douglas 
Published: April 2022

BACKGROUND

There is little consensus regarding effective interventions for diverse populations. This is due to the difficulty of quantifying digital health interventions that use various media and content, and the lack of consensus on how to evaluate and report dose and outcomes. One of the most rapidly changing areas is digital smoking behavior change intervention and reviewing the contents and outcomes of digital interventions and consistency of reporting leads to informing future research.

OBJECTIVE

This paper aims to 1) systematically review the current practice of digital smoking behavior change interventions, and 2) evaluate the consistency in measuring and reporting intervention contents, channels, and dose and response outcomes in this field.

METHODS

PubMed, Embase, Scopus, Psych INFO, and PAIS were used to search literature. General search and journal-based search were combined to find literature that was directly related to the scope of the study. All records were imported to COVIDENCE, a screening tool designed for systematic reviews, and duplicates were removed. Titles and abstracts were screened by four trained reviewers to determine eligible full-text literature. The data synthesis scheme was designed under the concept that exposure to digital interventions can be divided into 1) intended doses that were planned by the intervention, and 2) enacted doses that were completed by participants. The intended dose consisted of frequency and lengths of interventions, and the enacted dose was assessed as engagement. Response measures were assessed for behaviors, intentions, and psychosocial outcomes. Measurement of dose-response relationship was reviewed for all literature.

RESULTS

A total of 2,916 articles were identified through a database search. Title and abstract review yielded 324 articles for possible eligibility, and 19 articles on digital smoking behavior change interventions were ultimately included for data extraction and synthesis. The analysis revealed the lack of prevention studies (0%, 0/19) and dose-response studies (16%, 3/19) in this field. 6 studies (32%, 6/19) reported multiple behavioral measures and 5 studies (23%, 5/19) reported multiple psychosocial measures as outcomes. As dose measures, 7 studies (37%, 7/19) used frequency of exposure, and 4 studies (21%, 4/19) mentioned the length of exposure to the intervention. The assessment of clarity of reporting revealed that duration of intervention and data collection tend to be reported vaguely in literature.

CONCLUSIONS

This review revealed the lack of studies that assess targeted behavioral outcomes. Data synthesis showed that both measurement and reporting were not consistent across studies, illustrating current challenges in this field. Although most studies paid attention to reporting outcomes, measurement of exposure including intended and enacted doses was unclear in a large proportion of studies. Clear and consistent reporting of both outcomes and exposures is needed to develop further evidence in digital smoking behavior change intervention research.

CLINICALTRIAL

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