SmokeFree Baby is a five-module, theory-based mobile application to promote smoking abstinence in pregnant smokers.
SmokeFree Baby developed from multiple behavior change frameworks: The Behavior Change Wheel, Multiphase Optimization Strategy, and guidance from the Medical Research Council in the United Kingdom. The app features 5 distinct core modules that address positive identity change (Identity), consequences of smoking and benefits of quitting (Health Information), sources of support (Face-to-Face Support), stress management techniques (Stress Management), and behavioral techniques for smoking cessation (Behavioral Substitution). Users complete the 5 modules at a self-set pace. SmokeFree Baby asks participants to report whether they smoked in the past day upon their first log-in each day. SmokeFree Baby is internationally available on the Apple and Google Play app stores.
Link to commercial site here.
Cognitive Behavioral Skills Training
Young Adults (18-30)
Usability testing of a smoking cessation smartphone application (‘SmokeFree Baby’): A think-aloud study with pregnant smokers
Wu J, Tombor I, Shahab L, West R. Digital Health. 2017. 3. doi: 10.1177/2055207617704273
Summary: Researchers recruited 10 pregnant adult women who smoked at least weekly via charities, clinics, web forums, and community websites, to evaluate usability of SmokeFree Baby. Participants used the full app for about 30 minutes and described their thoughts to researchers. Participants appreciated the app’s aesthetic appeal, blue theme color, intuitive navigation, and interactive intervention components, both online and offline (e.g. helpline phone numbers). Participants appreciated that intervention content featured information relevant to tobacco-use during pregnancy while focusing on the ultimate objective: child protection. Participants highlighted features that allowed them to document progress (e.g. video diary) and receive professional advice (e.g. videos from smoking cessation advisors). Participants found the app’s featured ex-smoker relatable, but recommended researchers include multiple pregnant ex-smokers, to expose users to diverse perspectives and life experiences. Visual presentation of smoke-free days and social support features (e.g. a loved one’s voice memo) motivated participants to remain abstinent, while display of monetary savings from abstinence received mixed feedback. Some participants felt the content for coping with cravings and diversion would be impractical at times of temptation and insufficient for sustained abstinence. Participants felt a larger font size, a more varied (or customizable) color palette, and highlighting useful intervention components would improve design. Participants also suggested frequent intervention content updates, more concise content segments, and user-tailored intervention content to promote engagement.
Take Away: Participant feedback about the design, navigation, and content of SmokeFree Baby was positive overall, but included suggestions for accessibility and user engagement improvements.
Randomized factorial experiment of components of the SmokeFree Baby smartphone application to aid smoking cessation in pregnancy
Tombor I, Beard E, Brown J, et al. Translational Behavioral Medicine. 2019 Jul 16. doi: 10.1093/tbm/iby073
Summary: Researchers recruited 565 pregnant women through referral from tobacco-cessation advisors, print and web-based advertisements, and a study website, to participate in a factorial design study to evaluate SmokeFree Baby. Researchers developed each module to include a concise, advisory (minimal) version and an interactive (full) version. Researchers randomized participants who downloaded SmokeFree Baby into one of 32 experimental groups, which represented all possible combinations of the minimal and full module versions. The app measured participant duration and frequency of SmokeFree Baby use. Daily in-app assessments of smoking abstinence measured number of participant-reported smoke-free days for up to 1 month from the participant’s chosen quit date. Participants logged in an average of 2.9 times and engaged with the app intervention for an average of 4.5 days, both indicators of low participant engagement. Participants who received the full Health Information module engaged with SmokeFree Baby for significantly longer, and participants who interacted with both the full Face-to-Face Support module and the full Behavioral Substitution module also exhibited a longer duration of engagement relative to other modules combinations. While none of the individual 5 modules yielded a significant main effect on smoking abstinence, the interaction between the full Identity module and full Behavioral Substitution module did have a significant effect on both participants’ frequency of app engagement and number of smoke-free days.
Take Away: Full versions of specific modules, either individually (e.g. Health Information) or in combination (e.g. Face-to-Face Support and Behavioral Substitution, Identity and Behavioral Substitution) may promote engagement with SmokeFree Baby and smoking abstinence.