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Tailored Web-Based Smoking Interventions and Reduced Attrition: Systematic Review and Meta-Analysis

BACKGROUND: The increasing number of internet users presents an opportunity to deliver health interventions to large populations. Despite their potential, many web-based interventions, including those for smoking cessation, face high rates of attrition. Further consideration of how intervention feat...

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Autores principales: Shah, Amika, Chaiton, Michael, Baliunas, Dolly, Schwartz, Robert
Formato: Online Artículo Texto
Lenguaje:English
Publicado: JMIR Publications 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7605982/
https://www.ncbi.nlm.nih.gov/pubmed/33074158
http://dx.doi.org/10.2196/16255
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author Shah, Amika
Chaiton, Michael
Baliunas, Dolly
Schwartz, Robert
author_facet Shah, Amika
Chaiton, Michael
Baliunas, Dolly
Schwartz, Robert
author_sort Shah, Amika
collection PubMed
description BACKGROUND: The increasing number of internet users presents an opportunity to deliver health interventions to large populations. Despite their potential, many web-based interventions, including those for smoking cessation, face high rates of attrition. Further consideration of how intervention features impact attrition is needed. OBJECTIVE: The aim of this systematic review is to investigate whether tailored web-based smoking cessation interventions for smokers are associated with reduced rates of attrition compared with active or passive untailored web-based interventions. The outcomes of interest were dropout attrition at 1-, 3-, 6-, and 12-month follow-ups. METHODS: Literature searches were conducted in May 2018 and updated in May 2020 on MEDLINE (Medical Literature Analysis and Retrieval System Online), PsycINFO (Psychological Information), EMBASE (Excerpta Medica dataBASE), CINAHL (Cumulated Index to Nursing and Allied Health Literature), Scopus, and the Cochrane Tobacco Addiction Group Specialized Register with the following search terms: smoking cessation, tailored, or web- or internet-based. Included studies were published in English before or in May 2020 using a randomized controlled trial design. Studies were restricted to those with web-based delivery, a tailored intervention group, an untailored control group, and a reported outcome of smoking cessation. Studies were assessed for methodological quality using the Cochrane Risk of Bias tool. Two reviewers independently extracted the study characteristics and the number of participants lost to follow-up for each treatment group. RESULTS: A total of 13 studies were included in the systematic review, of which 11 (85%) were included in the meta-analysis. Tailoring had no statistically significant effect on dropout attrition at 1-month (risk ratio [RR]=1.02, 95% CI 0.95-1.09; P=.58; I(2)=78%), 3-month (RR=0.99, 95% CI 0.95-1.04; P=.80; I(2)=73%), 6-month (RR=1.00, 95% CI 0.95-1.05; P=.90; I(2)=43%), or 12-month (RR=0.97, 95% CI 0.92-1.02; P=.26; I(2)=28%) follow-ups. Subgroup analyses suggested that there was a statistically significant effect of tailoring between the active and passive subgroups at 1-month (P=.03), 3-month (P<.001), and 6-month (P=.02) follow-ups but not at 12-month follow-up (P=.25). CONCLUSIONS: The results suggest that tailoring of web-based smoking cessation interventions may not be associated with reduced rates of dropout attrition at 1-, 3-, 6-, or 12-month follow-ups. Significant differences between studies that include untailored active and passive control groups suggest that the role of tailoring may be more prominent when studies include a passive control group. These findings may be because of variability in the presence of additional features, the definition of smokers used, and the duration of smoking abstinence measured. Future studies should incorporate active web-based controls, compare the impact of different tailoring strategies, and include populations outside of the Western countries.
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spelling pubmed-76059822020-11-16 Tailored Web-Based Smoking Interventions and Reduced Attrition: Systematic Review and Meta-Analysis Shah, Amika Chaiton, Michael Baliunas, Dolly Schwartz, Robert J Med Internet Res Review BACKGROUND: The increasing number of internet users presents an opportunity to deliver health interventions to large populations. Despite their potential, many web-based interventions, including those for smoking cessation, face high rates of attrition. Further consideration of how intervention features impact attrition is needed. OBJECTIVE: The aim of this systematic review is to investigate whether tailored web-based smoking cessation interventions for smokers are associated with reduced rates of attrition compared with active or passive untailored web-based interventions. The outcomes of interest were dropout attrition at 1-, 3-, 6-, and 12-month follow-ups. METHODS: Literature searches were conducted in May 2018 and updated in May 2020 on MEDLINE (Medical Literature Analysis and Retrieval System Online), PsycINFO (Psychological Information), EMBASE (Excerpta Medica dataBASE), CINAHL (Cumulated Index to Nursing and Allied Health Literature), Scopus, and the Cochrane Tobacco Addiction Group Specialized Register with the following search terms: smoking cessation, tailored, or web- or internet-based. Included studies were published in English before or in May 2020 using a randomized controlled trial design. Studies were restricted to those with web-based delivery, a tailored intervention group, an untailored control group, and a reported outcome of smoking cessation. Studies were assessed for methodological quality using the Cochrane Risk of Bias tool. Two reviewers independently extracted the study characteristics and the number of participants lost to follow-up for each treatment group. RESULTS: A total of 13 studies were included in the systematic review, of which 11 (85%) were included in the meta-analysis. Tailoring had no statistically significant effect on dropout attrition at 1-month (risk ratio [RR]=1.02, 95% CI 0.95-1.09; P=.58; I(2)=78%), 3-month (RR=0.99, 95% CI 0.95-1.04; P=.80; I(2)=73%), 6-month (RR=1.00, 95% CI 0.95-1.05; P=.90; I(2)=43%), or 12-month (RR=0.97, 95% CI 0.92-1.02; P=.26; I(2)=28%) follow-ups. Subgroup analyses suggested that there was a statistically significant effect of tailoring between the active and passive subgroups at 1-month (P=.03), 3-month (P<.001), and 6-month (P=.02) follow-ups but not at 12-month follow-up (P=.25). CONCLUSIONS: The results suggest that tailoring of web-based smoking cessation interventions may not be associated with reduced rates of dropout attrition at 1-, 3-, 6-, or 12-month follow-ups. Significant differences between studies that include untailored active and passive control groups suggest that the role of tailoring may be more prominent when studies include a passive control group. These findings may be because of variability in the presence of additional features, the definition of smokers used, and the duration of smoking abstinence measured. Future studies should incorporate active web-based controls, compare the impact of different tailoring strategies, and include populations outside of the Western countries. JMIR Publications 2020-10-19 /pmc/articles/PMC7605982/ /pubmed/33074158 http://dx.doi.org/10.2196/16255 Text en ©Amika Shah, Michael Chaiton, Dolly Baliunas, Robert Schwartz. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 19.10.2020. 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 Review
Shah, Amika
Chaiton, Michael
Baliunas, Dolly
Schwartz, Robert
Tailored Web-Based Smoking Interventions and Reduced Attrition: Systematic Review and Meta-Analysis
title Tailored Web-Based Smoking Interventions and Reduced Attrition: Systematic Review and Meta-Analysis
title_full Tailored Web-Based Smoking Interventions and Reduced Attrition: Systematic Review and Meta-Analysis
title_fullStr Tailored Web-Based Smoking Interventions and Reduced Attrition: Systematic Review and Meta-Analysis
title_full_unstemmed Tailored Web-Based Smoking Interventions and Reduced Attrition: Systematic Review and Meta-Analysis
title_short Tailored Web-Based Smoking Interventions and Reduced Attrition: Systematic Review and Meta-Analysis
title_sort tailored web-based smoking interventions and reduced attrition: systematic review and meta-analysis
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7605982/
https://www.ncbi.nlm.nih.gov/pubmed/33074158
http://dx.doi.org/10.2196/16255
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