Does the addition of a supportive chatbot promote user engagement with a smoking cessation app? An experimental study

OBJECTIVE: The objective of this study was to assess whether a version of the Smoke Free app with a supportive chatbot powered by artificial intelligence (versus a version without the chatbot) led to increased engagement and short-term quit success. METHODS: Daily or non-daily smokers aged ≥18 years who purchased the ‘pro’ version of the app and set a quit date were randomly assigned (unequal allocation) to receive the app with or without the chatbot. The outcomes were engagement (i.e. total number of logins over the study period) and self-reported abstinence at a one-month follow-up. Unadjusted and adjusted negative binomial and logistic regression models were fitted to estimate incidence rate ratios (IRRs) and odds ratios (ORs) for the associations of interest. RESULTS: A total of 57,214 smokers were included (intervention: 9.3% (5339); control: 90.7% (51,875). The app with the chatbot compared with the standard version led to a 101% increase in engagement (IRR(adj) = 2.01, 95% confidence interval (CI) = 1.92–2.11, p < .001). The one-month follow-up rate was 10.6% (intervention: 19.9% (1,061/5,339); control: 9.7% (5,050/51,875). Smokers allocated to the intervention had greater odds of quit success (missing equals smoking: 844/5,339 vs. 3,704/51,875, OR(adj) = 2.38, 95% CI = 2.19–2.58, p < .001; follow-up only: 844/1,061 vs. 3,704/5,050, OR(adj) = 1.36, 95% CI = 1.16–1.61, p < .001). CONCLUSION: The addition of a supportive chatbot to a popular smoking cessation app more than doubled user engagement. In view of very low follow-up rates, there is low quality evidence that the addition also increased self-reported smoking cessation.