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Blended Smoking Cessation Treatment: Exploring Measurement, Levels, and Predictors of Adherence

BACKGROUND: Blended face-to-face and Web-based treatment is a promising way to deliver cognitive behavioral therapy. Since adherence has been shown to be a measure for treatment’s acceptability and a determinant for treatment’s effectiveness, in this study, we explored adherence to a new blended smo...

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Autores principales: Siemer, Lutz, Brusse-Keizer, Marjolein GJ, Postel, Marloes G, Ben Allouch, Somaya, Patrinopoulos Bougioukas, Angelos, Sanderman, Robbert, Pieterse, Marcel E
Formato: Online Artículo Texto
Lenguaje:English
Publicado: JMIR Publications 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6094087/
https://www.ncbi.nlm.nih.gov/pubmed/30068503
http://dx.doi.org/10.2196/jmir.9969
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author Siemer, Lutz
Brusse-Keizer, Marjolein GJ
Postel, Marloes G
Ben Allouch, Somaya
Patrinopoulos Bougioukas, Angelos
Sanderman, Robbert
Pieterse, Marcel E
author_facet Siemer, Lutz
Brusse-Keizer, Marjolein GJ
Postel, Marloes G
Ben Allouch, Somaya
Patrinopoulos Bougioukas, Angelos
Sanderman, Robbert
Pieterse, Marcel E
author_sort Siemer, Lutz
collection PubMed
description BACKGROUND: Blended face-to-face and Web-based treatment is a promising way to deliver cognitive behavioral therapy. Since adherence has been shown to be a measure for treatment’s acceptability and a determinant for treatment’s effectiveness, in this study, we explored adherence to a new blended smoking cessation treatment (BSCT). OBJECTIVE: The objective of our study was to (1) develop an adequate method to measure adherence to BSCT; (2) define an adequate degree of adherence to be used as a threshold for being adherent; (3) estimate adherence to BSCT; and (4) explore the possible predictors of adherence to BSCT. METHODS: The data of patients (N=75) were analyzed to trace adherence to BSCT delivered at an outpatient smoking cessation clinic. In total, 18 patient activities (eg, using a Web-based smoking diary tool or responding to counselors’ messages) were selected to measure adherence; the degree of adherence per patient was compared with quitting success. The minimum degree of adherence of patients who reported abstinence was examined to define a threshold for the detection of adherent patients. The number of adherent patients was calculated for each of the 18 selected activities; the degree of adherence over the course of the treatment was displayed; and the number of patients who were adherent was analyzed. The relationship between adherence and 33 person-, smoking-, and health-related characteristics was examined. RESULTS: The method for measuring adherence was found to be adequate as adherence to BSCT correlated with self-reported abstinence (P=.03). Patients reporting abstinence adhered to at least 61% of BSCT. Adherence declined over the course of the treatment; the percentage of adherent patients per treatment activity ranged from 82% at the start of the treatment to 11%-19% at the final-third of BSCT; applying a 61% threshold, 18% of the patients were classified as adherent. Marital status and social modeling were the best independent predictors of adherence. Patients having a partner had 11-times higher odds of being adherent (OR [odds ratio]=11.3; CI: 1.33-98.99; P=.03). For social modeling, graded from 0 (=partner and friends are not smoking) to 8 (=both partner and nearly all friends are smoking), each unit increase was associated with 28% lower odds of being adherent (OR=0.72; CI: 0.55-0.94; P=.02). CONCLUSIONS: The current study is the first to explore adherence to a blended face-to-face and Web-based treatment (BSCT) based on a substantial group of patients. It revealed a rather low adherence rate to BSCT. The method for measuring adherence to BSCT could be considered adequate because the expected dose-response relationship between adherence and quitting could be verified. Furthermore, this study revealed that marital status and social modeling were independent predictors of adherence. TRIAL REGISTRATION: Netherlands Trial Registry NTR5113; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=5113 (Archived by WebCite at http://www.webcitation.org/71BAPwER8).
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spelling pubmed-60940872018-08-21 Blended Smoking Cessation Treatment: Exploring Measurement, Levels, and Predictors of Adherence Siemer, Lutz Brusse-Keizer, Marjolein GJ Postel, Marloes G Ben Allouch, Somaya Patrinopoulos Bougioukas, Angelos Sanderman, Robbert Pieterse, Marcel E J Med Internet Res Original Paper BACKGROUND: Blended face-to-face and Web-based treatment is a promising way to deliver cognitive behavioral therapy. Since adherence has been shown to be a measure for treatment’s acceptability and a determinant for treatment’s effectiveness, in this study, we explored adherence to a new blended smoking cessation treatment (BSCT). OBJECTIVE: The objective of our study was to (1) develop an adequate method to measure adherence to BSCT; (2) define an adequate degree of adherence to be used as a threshold for being adherent; (3) estimate adherence to BSCT; and (4) explore the possible predictors of adherence to BSCT. METHODS: The data of patients (N=75) were analyzed to trace adherence to BSCT delivered at an outpatient smoking cessation clinic. In total, 18 patient activities (eg, using a Web-based smoking diary tool or responding to counselors’ messages) were selected to measure adherence; the degree of adherence per patient was compared with quitting success. The minimum degree of adherence of patients who reported abstinence was examined to define a threshold for the detection of adherent patients. The number of adherent patients was calculated for each of the 18 selected activities; the degree of adherence over the course of the treatment was displayed; and the number of patients who were adherent was analyzed. The relationship between adherence and 33 person-, smoking-, and health-related characteristics was examined. RESULTS: The method for measuring adherence was found to be adequate as adherence to BSCT correlated with self-reported abstinence (P=.03). Patients reporting abstinence adhered to at least 61% of BSCT. Adherence declined over the course of the treatment; the percentage of adherent patients per treatment activity ranged from 82% at the start of the treatment to 11%-19% at the final-third of BSCT; applying a 61% threshold, 18% of the patients were classified as adherent. Marital status and social modeling were the best independent predictors of adherence. Patients having a partner had 11-times higher odds of being adherent (OR [odds ratio]=11.3; CI: 1.33-98.99; P=.03). For social modeling, graded from 0 (=partner and friends are not smoking) to 8 (=both partner and nearly all friends are smoking), each unit increase was associated with 28% lower odds of being adherent (OR=0.72; CI: 0.55-0.94; P=.02). CONCLUSIONS: The current study is the first to explore adherence to a blended face-to-face and Web-based treatment (BSCT) based on a substantial group of patients. It revealed a rather low adherence rate to BSCT. The method for measuring adherence to BSCT could be considered adequate because the expected dose-response relationship between adherence and quitting could be verified. Furthermore, this study revealed that marital status and social modeling were independent predictors of adherence. TRIAL REGISTRATION: Netherlands Trial Registry NTR5113; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=5113 (Archived by WebCite at http://www.webcitation.org/71BAPwER8). JMIR Publications 2018-08-01 /pmc/articles/PMC6094087/ /pubmed/30068503 http://dx.doi.org/10.2196/jmir.9969 Text en ©Lutz Siemer, Marjolein GJ Brusse-Keizer, Marloes G Postel, Somaya Ben Allouch, Angelos Patrinopoulos Bougioukas, Robbert Sanderman, Marcel E Pieterse. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 01.08.2018. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on http://www.jmir.org/, as well as this copyright and license information must be included.
spellingShingle Original Paper
Siemer, Lutz
Brusse-Keizer, Marjolein GJ
Postel, Marloes G
Ben Allouch, Somaya
Patrinopoulos Bougioukas, Angelos
Sanderman, Robbert
Pieterse, Marcel E
Blended Smoking Cessation Treatment: Exploring Measurement, Levels, and Predictors of Adherence
title Blended Smoking Cessation Treatment: Exploring Measurement, Levels, and Predictors of Adherence
title_full Blended Smoking Cessation Treatment: Exploring Measurement, Levels, and Predictors of Adherence
title_fullStr Blended Smoking Cessation Treatment: Exploring Measurement, Levels, and Predictors of Adherence
title_full_unstemmed Blended Smoking Cessation Treatment: Exploring Measurement, Levels, and Predictors of Adherence
title_short Blended Smoking Cessation Treatment: Exploring Measurement, Levels, and Predictors of Adherence
title_sort blended smoking cessation treatment: exploring measurement, levels, and predictors of adherence
topic Original Paper
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6094087/
https://www.ncbi.nlm.nih.gov/pubmed/30068503
http://dx.doi.org/10.2196/jmir.9969
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