Brief, Web-Based Interventions to Motivate Smokers With Schizophrenia: Randomized Controlled Trial (Preprint)
Authors: Brunette Mary F , Ferron Joelle C , McGurk Susan R , Williams Jill M , Harrington Amy , Devitt Timothy , Xie Haiyi 
Published: October 2019

BACKGROUND

In-person motivational interventions increase engagement with evidence-based cessation treatments among smokers with schizophrenia, but access to such interventions can be limited because of workforce shortages and competing demands in mental health clinics. The use of digital technology to deliver interventions can increase access, but cognitive impairments in schizophrenia may impede the use of standard digital interventions. We developed an interactive, multimedia, digital motivational decision support system for smokers with schizophrenia (<i>Let’s Talk About Smoking</i>). We also digitalized a standard educational pamphlet from the National Cancer Institute (<i>NCI Education</i>). Both were tailored to reduce cognitive load during use.

OBJECTIVE

We conducted a randomized trial of <i>Let’s Talk About Smoking</i> versus <i>NCI Education</i> 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 the level of cognitive functioning.

METHODS

Adult smokers with schizophrenia (n=162) were enrolled in the study from 2014 to 2015, randomly assigned to an 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.

RESULTS

Treatment initiation outcomes were not different between intervention conditions (27/84 [32%] for <i>Let’s Talk About Smoking</i> vs 36/78 [46%] for <i>NCI Education</i>; odds ratio [OR] 0.71 [95% CI 0.37-1.33]); 38.9% (63/162) of participants initiated treatment. Older age (OR 1.03 [95% CI 1.00-1.07]; <i>P</i>=.05), higher education (OR 1.21 [95% CI 1.04-1.41]; <i>P</i>=.03), and fewer positive symptoms (OR 0.87 [95% CI 0.80-0.96]; <i>P</i>=.01) predicted cessation treatment initiation, whereas level of cognition did not. The mean satisfaction and usability index score was higher for <i>Let’s Talk About Smoking</i> versus <i>NCI Education</i> (8.9 [SD 1.3] vs 8.3 [SD 2.1]; <i>t</i> <sub>120.7</sub>=2.0; <i>P</i>=.045). Quit attempts (25/84, 30% vs 36/78, 46%; estimate [Est]=−0.093, SE 0.48; <i>P</i>=.85) and abstinence (1/84, 1% vs 6/78, 7%; χ<sup>2</sup><sub>1</sub>=3.4; <i>P</i>=.07) were not significantly different between intervention conditions. Cognitive functioning at baseline (Est=1.47, SE 0.47; <i>P</i>=.002) and use of any behavioral or medication cessation treatment (Est=1.43, SE 0.47; <i>P</i>=.003) predicted quit attempts with self-reported abstinence over the 6-month follow-up.

CONCLUSIONS

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. These findings indicate that additional cessation treatment is needed after brief education or motivational interventions, and that cessation treatment should be adjusted for people with cognitive impairment.

CLINICALTRIAL

ClinicalTrials.gov NCT02086162; https://clinicaltrials.gov/show/NCT02086162