Improving Adherence to Web-Based Cessation Programs: A Social Network Approach Amanda L. Graham, PhD Director, Research Development The Steven A. Schroeder Institute for Tobacco Research & Policy Studies Associate Professor (Adjunct) Department of Oncology Georgetown University Medical Center / Lombardi Comprehensive Cancer Center NORTH AMERICAN QUITLINE CONSORTIUM COFFEE BREAK MARCH 8, 2012
Overview 1. Background and results of randomized trial on Internet and telephone treatment for smoking cessation 2. Pilot study of social network approach to improving adherence to web-based cessation treatment 3. Current trial research design and approach 4. Potential implications for research and practice
Internet And Telephone Treatment 2005 participants Recruited online Randomized to real world Internet or phone treatments ~ 70% follow-up rates 3-18 months
30 day abstinence Graham et al. A Randomized Trial of Internet and Telephone Treatment for Smoking Cessation. Arch Intern Med. 2011 Jan 10;171(1):46-53. PMID: 21220660.
Population Impact EFFICACY x REACH = IMPACT (% abstinent) (# using method annually) (total # quitters) None (unaided) 3% 16,000,000 480,000 Rx NRT (1995) 14% 2,500,000 350,000 OTC NRT (1996) 14% 6,300,000 882,000 Internet 17% 10,000,000* 1,700,000 Internet + Telephone 20% 320,000** 64,000 Behavioral counseling 24% 395,000 94,800 Inpatient treatment 32% 500 160 * 9% of Internet users search for cessation assistance = 10,000,000 (Source: Pew Internet) ** US quitlines receive calls from 320,000 smokers annually (Source: NAQC, 2008) Adapted from Shiffman et al. (1998), Annual Review of Public Health.
The Problem of Adherence/Engagement 90+ min 0 min < 90 min
Improving Adherence to Web-Based Cessation Programs: A Social Network Approach R01 CA155489-01A1 July 1, 2011 April 30, 2016
Social Networks & Cessation Table 1. Website utilization patterns among BecomeAnEX.org members by community involvement No Community Community 3+ logins 8% 28% # days website use #interactive tools used 5.0 ± 29.0 22.1 ± 59.1 1.9 ±1.6 3.4 ±2.0
Integrator Pilot Study Identified Integrator from EX community Developed social network (SN) protocol Recruited N=244 new members of EX Randomized to EX alone vs. EX+SN ( Giulia ) 30 day follow-up
Communication Guidelines Number of contacts: Minimum of 3 contacts, ongoing communication with those who respond First contact: Within 24-48 hours of enrollment Post a public message on wall Greeting, welcoming them to the site Encourage to fill out their profile Comment on some aspect of an existing profile
Communication Guidelines Use open-ended questions Share your experience with smoking and quitting Recommend specific tools and features of the website Ask about whether they are planning to use medication, direct them to EX resources, encourage medication adherence; tone = your choice Monitor the participant s profile to determine when they have set a quit date and provide encouragement around the quit date Respond to any forum posts by participants Suggest friends or groups within the community
Integrator Pilot Study Identified Integrator from EX community Developed social network (SN) protocol Recruited N=244 new members of EX Randomized to EX alone vs. EX+SN ( Giulia ) 30 day follow-up
Pilot Study: Results Intervention feasible & well received High ratings on positive adjectives (encouraging, welcoming, supportive) Low ratings on negative adjectives (annoying, intrusive, irrelevant) More satisfied with website Greater perceived helpfulness of website 1.7x more likely to return to the website 3+ times 2.3x more likely to be abstinent at 30 days
Overall Study Aim To improve the effectiveness of web-based cessation treatment BY improving adherence to the practical counseling/behavioral support, social support, and pharmacotherapy components of the website Practical Counseling/ Behavioral Support N=4,000 new members of EX Follow-up at 3- and 9-months Social Support Pharmacotherapy Started recruiting Tuesday!
Research Design Social Network (SN) Integrator Intervention no yes 1month supply NRT no yes EX (control) EX + NRT EX + SN EX + SN +NRT
Web-Based Clinical Trial Management System
Potential Impact on Research and Practice 1. Add to the knowledge base about effectiveness of Internet cessation programs and how to maximize treatment adherence and outcomes 2. Findings may have relevance for web-based behavior change programs in other areas Law of Attrition (Eysenbach) extends beyond cessation 3. Social network approach can be scaled to meet demands of even largest online health communities
END agraham@legacyforhealth.org