The Effect of Program Design on Engagement With an Internet-Based Smoking Intervention: Randomized Factorial Trial
Open accessAbstract
BACKGROUND: Participant engagement influences treatment effectiveness, but it is unknown which intervention design features increase treatment engagement for online smoking cessation programs. OBJECTIVE: We explored the effects of 4 design features (ie, factors) on early engagement with an Internet-based, motivational smoking cessation program. METHODS: Smokers (N=1865) were recruited from a large health care organization to participate in an online intervention study, regardless of their interest in quitting smoking. The program was intended to answer smokers' questions about quitting in an effort to motivate and support cessation. Consistent with the screening phase in the multiphase optimization strategy (MOST), we used a 2-level, full-factorial design. Each person was randomized to 1 of 2 levels of each factor, including message tone (prescriptive vs motivational), navigation autonomy (dictated vs not), proactive email reminders (yes vs no), and inclusion of personally tailored testimonials (yes vs no). The effects of each factor level on program engagement during the first 2 months of enrollment were compared, including number of visits to the website resulting in intervention content views (as opposed to supplemental content views), number of intervention content areas viewed, number of intervention content pages viewed, and duration of time spent viewing this content, as applicable to each factor. RESULTS: Adjusting for baseline readiness to quit, persons who received content written in a prescriptive tone made the same number of visits to the website as persons receiving content in a motivational tone, but viewed 1.17 times as many content areas (95% CI 1.08-1.28; P<.001) and 1.15 times as many pages (95% CI 1.04-1.28; P=.009). Time spent viewing materials did not differ among groups (P=.06). Persons required to view content in a dictated order based on their initial readiness to quit made the same number of visits as people able to freely navigate the site, but viewed fewer content areas (ratio of means 0.80, 95% CI 0.74-0.87; P<.001), 1.17 times as many pages (95% CI 1.06-1.31; P=.003), and spent 1.37 times more minutes online (95% CI 1.17-1.59; P<.001). Persons receiving proactive email reminders made 1.20 times as many visits (95% CI 1.09-1.33; P<.001), viewed a similar number of content areas as persons receiving no reminders, viewed 1.58 times as many pages (95% CI 1.48-1.68; P<.001), and spent 1.51 times as many minutes online (95% CI 1.29-1.77; P<.001) as those who did not receive proactive emails. Tailored testimonials did not significantly affect engagement. CONCLUSIONS: Using a prescriptive message tone, dictating content viewing order, and sending reminder emails each resulted in greater program engagement relative to the contrasting level of each experimental factor. The results require replication, but suggest that a more directive interaction style may be preferable for online cessation programs. TRIAL REGISTRATION: clinicaltrials.gov NCT00992264; http://clinicaltrials.gov/ct2/show/NCT00992264 (Archived by WebCite at http://www.webcitation.org/6F7H7lr3P).
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Qualitative insights and questionnaire data can be complemented by proxy measures of engagement based on usage.
“Qualitative insights and questionnaire data can be complemented by proxy measures of engagement based on usage.31”
From Understanding and Promoting Effective Engagement With Digital Behavior Change Interventions (2016) · cites this paper as [31]
Tailoring can improve intervention outcomes and engagement, but the size of this effect differs across studies and settings.
“Tailoring can have a positive impact on intervention outcomes and engagement, but this varies between studies and contexts.31,52”
From Understanding and Promoting Effective Engagement With Digital Behavior Change Interventions (2016) · cites this paper as [31]
Use of reminder emails predicts treatment outcome.
“and use of reminder emails [13].”
From Breaking open the black box: isolating the most potent features of a web and mobile phone-based intervention for depression, anxiety, and stress (2015) · cites this paper as [13]
In an Internet intervention for smoking cessation, users who received email reminders made 1.2 times as many visits, viewed 1.58 times as many pages, and spent 1.51 times as many minutes compared to users who did not receive email reminders.
“In particular, one study showed that users who received email reminders made 1.2 times as many visits, viewed 1.58 times as many pages, and spent 1.51 times as many minutes in an Internet intervention for smoking cessation [13], compared to users who did not receive email reminders.”
From Breaking open the black box: isolating the most potent features of a web and mobile phone-based intervention for depression, anxiety, and stress (2015) · cites this paper as [13]
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- Authors
- McClure, J. B., Shortreed, S. M., Bogart, A., Derry, H., Riggs, K., St John, J., Nair, V., & An, L.
- Affiliations
- Group Health Cooperative (US)
- University of Michigan (US)
- Corresponding author
- McClure, Jennifer B
- Venue
- Journal of Medical Internet Research
- Publisher
- JMIR Publications Inc.
- Published
- 2013-03-25
- Volume
- 15
- Issue
- 3
- Pages
- e69
- ISSN
- 1438-8871 (ISSN-L)
- PMC
- PMC3636802
- OpenAlex
- W2005023254
- Cited by
- 83
- References
- 49
- Citations by year
- 2026: 4 · 2025: 3 · 2024: 2 · 2023: 2 · 2022: 4 · 2021: 13 · 2020: 5 · 2019: 5 · 2018: 6 · 2017: 9 · 2016: 12 · 2015: 10 · 2014: 7 · 2013: 1
- FWCI
- 6.96
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Journal of Medical Internet Research (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- University of Michigan
- National Cancer Institute (R01CA138598)
- Topics
- Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Keywords
- smoking cessation, online intervention, participant engagement, message tone, email reminders, multiphase optimization strategy, health behavior change, workplace health promotion, motivational interviewing, self-efficacy, self-monitoring, goal setting
- MeSH terms
- Adult, Female, Humans, Male, Middle Aged, Research Design, User-Computer Interface, Smoking Cessation, Internet
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