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Optimal content of smoking cessation websites

This study explores the optimal content for smoking cessation websites, including interactive features such as FAQs, personal stories, discussion groups, quizzes, and computer-tailored counseling. It also discusses the importance of research and evaluation in improving website effectiveness and offers suggestions for different formats and personalized follow-up strategies.

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Optimal content of smoking cessation websites

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  1. Optimal content of smoking cessation websites Jean-François E T T E R PhD, lecturer Institute of social and preventive medicine University of Geneva - Switzerland Jean-Francois.Etter@imsp.unige.ch January 2004 stop-tabac.ch

  2. Website content: not interactive PULL • library, PDFs • fact sheets • addresses: clinics, help / support • links • news PUSH • general e-mails • general SMS

  3. Website content: interactive PULL • FAQ • personal stories • discussion groups, bulletin boards, chat rooms • quiz, tests: dependence, withdrawal, $ spent on cig • computer-tailored counseling, expert-systems • decision aid, action plan • one-to-one counseling by e-mail PUSH • tailored e-mails + SMS (stage, dependence, age, ...)

  4. Interactivity: research, evaluation • Use research + evaluation to improve websites • Surveys: needs assessment • Satisfaction / opinion surveys • Track individual visitors (pages seen , N visits) • Quantitative surveys • Large samples, rapid data collection • Cohort studies with multiple follow-ups • Collect saliva (cotinine, DNA)

  5. Number of sessions (face-to-face) Fiore et al. Clinical practice guideline, USDHHS 2000

  6. Follow-up • Data storage, incl. e-mail addresses- data protecion laws • Comparison with answers given on last session- progress reports • Personalized follow-up (e.g. more intensive just after the quit date) • Discussion forums = several sessions- people come back to read answers to their messages

  7. Number of formats (face-to-face) Formats: e.g. Self-help materials, telephone, groups... Fiore et al. Clinical practice guideline, USDHHS 2000

  8. Formats • Static or interactive web pages • Personal pages (access code) • Discussion forums, chat rooms • Personal stories • E-mail:- bulk- computer-tailored, individualized- one-to-one • SMS • Telephone • Snail mail (tailored letters, booklets)

  9. Most popular pages: Stop-tabac.ch • Personal stories, testimonies • Discussion forums, chat rooms • Tests => feedback (Fagerström, withdrawal, money spent on cigarettes, BMI, COPD) • Library (PDFs, stage-matched booklets) • Info on NRT + Zyban • Interactive, computer-tailored counseling service

  10. Statistics, Stop-tabac.ch Data for July 2003 only = 19'000 visits

  11. Survey of webmasters • December 2003 • E-mail to ~30 webmasters of smoking cessation websites • E-mail to Globalink + SRNT listserve • "What are the most frequently visited pages / services / features of your website" • 6 answers (20%)

  12. Most popular features / pages (n=6) • Not interactive- Library of documents, basic info (3 x)- "Best tools" to quit (1x)- Directory of smoking cessation programs (1x)- Links (1x)- Video game to download (1x) • Interactive:- E-mail coaching, e-mail list (2x)- Message board (1x)- Quiz (1x)- Quit date wizard, self assessments (1x)

  13. Distribution of smokers by "stageof change", Geneva 1996 Etter et al. Preventive Medicine 1997 26(4), 580-585

  14. Distribution of smokers by "stageof change", U.S.A 1999 Current Population Survey Wewers et al. Preventive Medicine 2003, 36, 710-20

  15. Smokers and EX-smokers by "stage", stop-tabac.ch, Jan. 2004 Unpublished data

  16. Develop different pages / services to suit the needs of different groups

  17. Computer-tailored counseling Assessment (questionnaire)  Data processing  Data storage Individual counseling letter  Follow-up e-mail Personal page accessedwith code  Invitation to2nd assessment progress report

  18. Behavior theory • Transtheoretical model of change • Ajzen+Fishbein: Theory of planned behavior • Bandura: Social learning theory (self-efficacy) • Health Belief Model • Protection Motivation Theory • PRECEDE / PROCEED model • Addiction and withdrawal (DSM-IV, ICD-10)

  19. Tailoring variables • Age, sex, have children, country of residence • Smoking status (daily, occasional, ex-smoker) • Ex-smokers: - quit date- withdrawal symptoms - use of medications (NRT, zyban)- self-perceived risk of relapse- self-efficacy (relapse situations)

  20. Tailoring variables: smokers • Smokers: - motivation to quit- previous quit attempts (date, duration)- dependence level- intention to use treatments + medications- perceived risk / benefits of smoking / quitting - set a quit date- other smokers at home

  21. Tailoring variables: smokers • Use of self-change strategies- getting support from others- processing information - taking control of automatisms- avoiding smoking cues + situations- coping with craving and withdrawal symptoms • Self-efficacy (smoking situations) • => use validated questionnaires (Etter et al. Addictive Behaviors 2000;25:523-38)

  22. STOP-TABAC: randomized trial • On paper, by "snail mail", NOT on the internet • Computer-tailored counseling letters • Stage-matched booklets • French-speaking Switzerland , in 1999 • 2'934 smokers (no ex-smoker) • 1.5 letters over 6 months, on average • Follow-up after 7 months • Response rate 86%

  23. STOP-TABAC: randomized trial • Abstinence, 7 months after entry in the programme = no puff of tobacco in the past 4 weeks • Quit = 1 / 28 • p<0.001 • Archives Intern Med 2001;161:2596

  24. Impact = efficacy * participation Stop-Tabac.ch = • > 100'000 counseling reports produced • December 2003 = 50'000 visitors / month • > 1,000,000 visitors since 1997 • Weekly news sent to 10'000 people • 6 languages: French, German, Italian, Danish, English, Chinese • In French, 1st in Google, Yahoo, Altavista

  25. Social support: USDHHS guideline • Discussion forums • Chat rooms • From a counselor, individually- e-mail- telephone (help line)=> costly

  26. Discussion forums and chats: social support on the internet • Users control the content themsleves- warn us if intruders • Discussion forums:- 5 x stages of change- medications- weight gain • Increase the number of sessions- come back to look at answers to their messages- come back to chat with friends

  27. Evaluation of smoking cessation websites Aims of evaluations: • Improve quality • Minimize harm • Promote innovation • Assess effectiveness • Increase confidence among - users- funding agencies • Improve competitivity (>200 websites) • Increase the number of visitors

  28. Evaluation of smoking cessation websites • Needs of users, preferred services / pages • Satisfaction, opinions of users • Which information / service is - best suited to each category (current / former smoker, age, sex, country, dependence, motivation)- most effective • Outcome: RCTs- smoking cessation- compliance, use of treatments- effect of interactive features, chat, discuss. forums- incremental effect of follow-up

  29. Conclusions • Computer-tailored (on paper) = effective • On the internet: no RCT published • Not enough research published • Interactivity = not used enough by websites • Let users participate and contribute to the content • Learner centered vs. teacher centered • Perspectives:- combine with medications (use + compliance)- translation

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