SQ4U — A computer tailored smoking relapse prevention program incorporating planning strategy assignments and multiple feedback time points after the quit-attempt: Development and design protocol

Abstract

Background

The SQ4U (Stay Quit for You)-study aims to test the efficacy of two computer tailored smoking relapse prevention programs which incorporate planning strategy assignments and provide tailored feedback at multiple time points after the quit-attempt. The programs differ in the support provided after the quit-attempt. This paper aims to describe the development and design of SQ4U.

Methods/design

SQ4U-respondents were daily smokers in the 18–65 years age group, who were motivated to quit smoking and willing to make a quit-attempt within 1 month of registration. The study is a randomized controlled trial with three conditions: 1. Control group, 2. Action planning (AP) program, 3. Action planning plus (AP+) program. Respondents in the control group only filled out questionnaires. The AP program consisted of computer tailored baseline feedback based on the I-Change Model and six planning strategy assignments. The AP+ program provided the same program elements as the AP program, but was extended with tailored feedback at eleven time points after the quit-attempt. The feedback targeted (recovery) self-efficacy, planning and negative affect. There were two follow-up measurements at 6 and 12 months after baseline. User experiences and the efficacy of the programs in fostering seven-day point prevalence and continued abstinence were examined using a process evaluation and logistic regression analyses.

Discussion

The present paper outlines the development and design of the SQ4U-study. This study has the potential to provide a new effective computer tailored smoking relapse prevention program as well as insight into effective smoking relapse prevention strategies.

Introduction

Smoking relapse is an evident problem in the process of smoking cessation. A systematic review shows relapse rates of 49–76% in the first week and 80–90% in the first three months after the quit-attempt [1].

Several factors are associated with smoking relapse. The Relapse Prevention (RP) Model [2], [3] accentuates the role of covert (e.g. lifestyle imbalances and cravings) and immediate (e.g. high-risk situations) factors in the process of relapse. A range of empirical studies demonstrated the role of self-efficacy and identified a low level of self-efficacy as a reliable predictor of smoking relapse [4], [5], [6], [7], [8], [9], [10]. Furthermore, studies identified associations between smoking relapse and negative outcome expectancies of smoking [5], [10], lack of social support [11], [12], physical dependence [13], [14], [15], high craving levels [7], [16], [17], negative affect and stress [18], [19], [20], [21], [22]. A number of relapse prevention programs incorporating strategies to change these factors have been developed and tested. Many of these programs prevent relapse by utilizing behavioral approaches, mainly skill trainings aimed at identifying and coping with high-risk situations [23]. Other programs use pharmacological therapy. Yet, two literature reviews concluded that the efficacy of current smoking relapse prevention programs remains limited [23], [24].

The alarming relapse rates combined with the lack of effective prevention programs suggest the need for new approaches. We conducted the SQ4U-study and developed and tested a new relapse prevention approach consisting of three main elements.

First, planning strategies – which consist of preparatory planning and coping planning according to the Integrated Change Model – have recently shown their importance in fostering smoking cessation [25] and smoking abstinence [26], [27], [28], [29]. However, little attention has been given to the possible efficacy of combining these planning strategies in smoking relapse prevention programs. We incorporated preparatory and coping planning strategy assignments. The second element is the delivery mode of the prevention program. This needs to be modified for the needs of the quitter. Computer tailoring is a very personalized approach and computer feedback is assessment-based, focuses on the respondent and only addresses aspects that are relevant to the respondent [30], [31]. Moreover this strategy has been shown to meet the needs and interests of the respondent, to be more likely to be read and remembered and to have a high reach with relatively low costs [32], [33], [34], [35]. Computer tailored programs have shown to be promising tools in the field of smoking cessation [33], [36], [37], [38], [39]. Third, providing tailored feedback at multiple time points has shown to be more effective than a single tailoring point [40], [41], [42]. Yet, as far as we know, no specific computer tailored smoking relapse prevention program incorporating planning strategy assignments and multiple feedback points has been developed and/or tested.

The SQ4U-study aims to fulfill these needs by developing and testing the efficacy of two computer tailored smoking relapse prevention programs incorporating planning strategy assignments and providing tailored feedback at multiple time points after the quit-attempt. The programs differ in the support provided after the quit-attempt.

This paper describes the development of the SQ4U-program, the program elements and the design of the SQ4U-study.