Exploring perspectives on digital smoking cessation just-in-time adaptive interventions: A focus group study with adult smokers and smoking cessation professionals
Authors: Leppin Corinna , Okpako Tosan , Garnett Claire , Perski Olga , Brown Jamie 
Published: November 2024

Technology-mediated just-in-time adaptive interventions (JITAIs), which provide users with real-time, tailored behavioural support, are a promising innovation for smoking cessation. However, a greater understanding of stakeholder, including user, perspectives on JITAIs is needed.

Focus groups with UK-based adult smokers (three groups; N=19) and smoking cessation professionals (one group; N=5) were conducted January-June 2024. Topic guides addressed the integration of a JITAI into users’ lives and care provision, preferred content and features, and data and privacy. Transcripts and observational notes were analysed using Framework Analysis, guided by the Theoretical Domains Framework and the Technology Acceptance Model.

Four major themes, “Smoking Cessation Process”, “JITAI Characteristics”, “Perceived Value of the JITAI”, and “Relationship with the JITAI”, and 16 subordinate themes were identified. The smoking cessation process was described as a challenging and idiosyncratic, non-linear journey during which a JITAI should provide consistent support. Preferences for specific JITAI characteristics varied. However, participants consistently expressed that a JITAI should be highly personalised and offer both immediate, interruptive support and ambient, in-depth content. The perceived usefulness and ease of use of a JITAI were described as central to its perceived value. Participants stressed that a JITAI would need to be convenient enough to easily integrate into its users’ daily lives, yet disruptive enough to facilitate behaviour change. Overall, smokers expressed that they would want their relationship with a JITAI to feel supportive and non-judgmental. They also felt a JITAI should promote, rather than infringe on, their autonomy. Smoking cessation professionals stressed the importance of privacy and data protection, whereas smokers appeared more ambivalent and had mixed opinions about this topic.

JITAIs will need to balance aspects such as convenience and disruption and interruptive and ambient content while also addressing concerns related to privacy and autonomy to meet stakeholders’ needs and preferences.

Author Summary

Just-in-time adaptive interventions (JITAIs) are new digital tools that can provide personalised, real-time support for people trying to change their behaviour. To help us understand how a JITAI could help people stop smoking, we conducted focus group discussions with adult smokers and smoking cessation professionals. We explored how a JITAI could fit into the daily lives and care of people trying to quit smoking, what it should do, and how concerned people were about data collection and privacy.

Our findings indicate that a JITAI needs to strike a balance between being easy to use and providing enough disruption to help smokers change their behaviour. People in our focus groups felt that a JITAI should be flexible and personalised. They wanted it to act like a supportive friend, without being controlling. They also thought it should include both immediate, on-the-spot assistance and more detailed, reflective content. Privacy was an important concern for some, particularly for professionals, although some smokers were less concerned about this issue.

Overall, our findings suggest that JITAIs need to be thoughtfully designed to respect user preferences, offer flexible and varied forms of support, and address privacy concerns to support people trying to quit smoking.