Mobile Health Technology for Personalized Tobacco Cessation Support Among Cancer Survivors and Caregivers in Laos: A Pilot Trial

PURPOSE In Laos, tobacco smoking prevalence among cancer patients is high: 60% in men and 15% in women. However, there are no institutional or national tobacco treatment programs for cancer patients or their caregivers. To address this pressing need, we developed an mHealth-based, fully-automated, interactive intervention to help these populations quit smoking. This pilot randomized controlled trial aims to evaluate the feasibility and preliminary efficacy of our mHealth intervention. METHODS Thirty cancer survivors and 50 independent caregivers were recruited from Lao National Cancer Center and Setthathirath Hospital in Vientiane Capital. Participants were randomized to Standard Care (SC, n=40) or Automated Intervention (AI, n=40). SC consisted of brief advice to quit, a 2-week supply of nicotine patches, and self-help materials. AI consisted of the SC components plus a smartphone-based fully-automated treatment program that involved interactive, tailored, proactive content (∼3 messages per day plus some images/videos) for a 3-month period. RESULTS Most participants belonged to Lao ethnicity (98.7%), 8.8% were female, and 57.5% lived in non-urban areas. There was a loss to follow-up at 3 months due to the death of a cancer patient. AI was acceptable: 61.5% of AI participants agreed that the Insight app was easy to use, 61.5% agreed that the message content was easy to understand, and 64.1% felt comfortable with opening the messages in public places. Regarding the preliminary efficacy, changes in self-efficacy to avoid smoking in various social situation (measured on a 5-point Likert scale) from baseline to the 3-month follow-up was 2.41 for AI and -0.04 for SC (paired t-test, P=0.516). Biochemically verified 7-day point prevalence abstinence at 3 months were 74% for AI and 40% for SC (relative risk, 1.85 [95% confidence interval, 1.21–2.83]). CONCLUSION Our mHealth-based AI for smoking cessation is acceptable and potentially efficacious among cancer survivors and caregivers in Laos. The observed quit rates for both groups at 3 months were considerably higher than rates in our previous studies in other Lao or Cambodian general patient populations, suggesting that cancer patients and caregivers, who are facing a real consequence of smoking (i.e., cancer), may be more determined to quit smoking.