Supportive Accountability and Mobile App Use in a Tobacco Control Intervention Targeting Low-Income Minority Mothers Who Smoke: Observational Study

BACKGROUND: Smartphone mobile apps are frequently used in standalone or multimodal smoking cessation interventions. However, factors that impede or improve app usage are poorly understood. OBJECTIVE: This study used the supportive accountability model to investigate factors that influence app usage in the context of a trial designed to reduce maternal smoking in low-income and predominantly minority communities. METHODS: We conducted a secondary analysis of data (N=181) from a randomized controlled trial that included a smoking cessation app (QuitPal-m). Supportive accountability was measured by the number of times a participant was advised by their cessation counselor to use QuitPal-m. Participants reported app use helpfulness and barriers. Investigators tracked reported phone and technical problems that impeded app use. RESULTS: Most participants rated the app as very helpful (103/155, 66.5%), but daily use declined rapidly over time. App use was positively related to the level of perceived app helpfulness (P=.02) and education (P=.002) and inversely related to perceived barriers (P=.003), phone technical problems (P<.001), and cigarettes smoked per day at the end of treatment (P<.001). Participants used the app a greater proportion of the days following app advice than those preceding app advice (0.45 versus 0.34; P<.001). The positive relation between counselor app advice and app usage 24 hours after receiving advice was stronger among smokers with no plan to quit than in those planning to quit (P=.03), independent of education and phone or app problems. CONCLUSIONS: Findings show the utility of supportive accountability for increasing smoking cessation app use in a predominantly low-income, minority population, particularly if quit motivation is low. Results also highlight the importance of addressing personal and phone/technical barriers in addition to adding supportive accountability. TRIAL REGISTRATION: ClinicalTrials.gov NCT02602288; https://clinicaltrials.gov/ct2/show/NCT02602288