Paper short abstract:

Following a 27-week randomized controlled trial comparing two smoking cessation mobile health interventions, a sequential explanatory mixed methods study was conducted with American Indian (AI) participants to assess their experiences and inform cultural modification of the interventions.

Paper long abstract:

Significance: American Indians (AIs) have some of the highest US smoking rates and disproportionately experience smoking-related cancers and mortality. AIs also have less successful quit attempts compared to other ethnic groups. There is a critical need to address health disparities in smoking-related outcomes among AIs by developing and improving access to effective and culturally relevant smoking cessation interventions.

Method: This study is part of a large (proposed n=450), ongoing 27-week randomized controlled trial that compares two smoking cessation mobile health interventions (NCI QuitGuide vs. Smart-T3). Participants complete baseline surveys, smartphone-based ecological momentary assessments, and receive combination nicotine replacement therapy. A sequential explanatory mixed methods study was conducted with AI participants (n=5), wherein they completed a cultural interview to assess their experiences with the NCI QuitGuide and Smart-T3 apps following the 27-week intervention. Several items from the final survey were analyzed.

Results: Participants were male (80%) and 46 years old (SD=14.2). Participants were somewhat likely to recommend the apps to a friend who smokes and reported their completion rate stayed the same (n=2) or decreased (n=3) during the study. Participants’ ideas for culturally modifying the apps include incorporating video messages from tribal/family members (n=5), additional reminders/cessation tips (n=3), and social support/on-demand live cessation counseling (n=3). Participants identified “technology issues” as barriers to using the apps (n=2).

Conclusions: Mobile health smoking cessation interventions offer promise in reducing tobacco-related health disparities among AI smokers. Findings from this study will inform cultural modification of the study apps for AIs who want to quit smoking.