A Web-Based Intervention to Increase Smokers' Intentions to Participate in a Cessation Study Offered at the Point of Lung Screening: Factorial Randomized Trial

Jordan M Neil; Yuchiao Chang; Brett Goshe; Nancy Rigotti; Irina Gonzalez; Saif Hawari; Lauren Ballini; Jennifer S Haas; Caylin Marotta; Amy Wint; Kim Harris; Sydney Crute; Efren Flores; Elyse R Park

doi:10.2196/28952

A Web-Based Intervention to Increase Smokers' Intentions to Participate in a Cessation Study Offered at the Point of Lung Screening: Factorial Randomized Trial

JMIR Form Res. 2021 Jun 30;5(6):e28952. doi: 10.2196/28952.

Authors

Jordan M Neil^{1

2

3}, Yuchiao Chang^{2

3

4}, Brett Goshe^{2

5}, Nancy Rigotti^{3

4}, Irina Gonzalez², Saif Hawari², Lauren Ballini⁶, Jennifer S Haas³, Caylin Marotta³, Amy Wint³, Kim Harris³, Sydney Crute³, Efren Flores^{2

7}, Elyse R Park^{2

4

5}

Affiliations

¹ Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States.
² Mongan Institute Health Policy Research Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.
³ Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.
⁴ Tobacco Research and Treatment Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.
⁵ Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.
⁶ Department of Community Health, Tufts University, Medford, MA, United States.
⁷ Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.

PMID: 34255651
PMCID: PMC8280830
DOI: 10.2196/28952

Abstract

Background: Screen ASSIST is a cessation trial offered to current smokers at the point of lung cancer screening. Because of the unique position of promoting a prevention behavior (smoking cessation) within the context of a detection behavior (lung cancer screening), this study employed prospect theory to design and formatively evaluate a targeted recruitment video prior to trial launch.

Objective: The aim of this study was to identify which message frames were most effective at promoting intent to participate in a smoking cessation study.

Methods: Participants were recruited from a proprietary opt-in online panel company and randomized to a 2 (benefits of quitting vs risks of continuing to smoke at the time of lung screening; BvR) × 2 (gains of participating vs losses of not participating in a cessation study; GvL) message design experiment (N=314). The primary outcome was self-assessed intent to participate in a smoking cessation study. Message effectiveness and lung cancer risk perception measures were also collected. Analysis of variance examined the main effect of the 2 message factors and a least absolute shrinkage and selection operator (LASSO) approach identified predictors of intent to participate in a multivariable model. A mediation analysis was conducted to determine the direct and indirect effects of message factors on intent to participate in a cessation study.

Results: A total of 296 participants completed the intervention. There were no significant differences in intent to participate in a smoking cessation study between message frames (P=.12 and P=.61). In the multivariable model, quit importance (P<.001), perceived message relevance (P<.001), and affective risk response (ie, worry about developing lung cancer; P<.001) were significant predictors of intent to participate. The benefits of quitting frame significantly increased affective risk response (Mean_benefits 2.60 vs Mean_risk 2.40; P=.03), which mediated the relationship between message frame and intent to participate (b=0.24; 95% CI 0.01-0.47; P=.03).

Conclusions: This study provides theoretical and practical guidance on how to design and evaluate proactive recruitment messages for a cessation trial. Based on our findings, we conclude that heavy smokers are more responsive to recruitment messages that frame the benefits of quitting as it increased affective risk response, which predicted greater intention to participate in a smoking cessation study.

Keywords: clinical trials recruitment; digital outreach; lung cancer screening; message design experiment; prospect theory; smoking cessation.

©Jordan M Neil, Yuchiao Chang, Brett Goshe, Nancy Rigotti, Irina Gonzalez, Saif Hawari, Lauren Ballini, Jennifer S Haas, Caylin Marotta, Amy Wint, Kim Harris, Sydney Crute, Efren Flores, Elyse R Park. Originally published in JMIR Formative Research (https://formative.jmir.org), 30.06.2021.