The Content, Quality and Usability of Smoking Cessation Treatments on the Internet

Beth Bock
Brown University

Amanda Graham *
Brown University, Psychiatryand Human Behavior

Topic: Psychobehavioral interventions
Track: Research
Type: Oral presentation

     Full text: Not available
     Slides: available to participants
     Last modified: March 15, 2006
     Presentation date: 10/18/2006 9:00 AM in RYH Tudor 7
     (View Schedule)

Abstract
Background: The explosive growth in access to the Internet suggests that the Internet may be a viable channel through which we can reach and treat the large population of smokers who are unlikely to use other modes of intervention.

Objective: To use guidelines from the U.S. Public Health Service (U.S. PHS, 2000) to assess the quality of interventions for smoking cessation that are available on the Internet.

Method: PHS guidelines were codified into two instruments to record intervention content and rate quality of the website intervention contents. Content was divided into eight Key components and quality was rated on coverage of key components, accuracy and website interactivity. Usability guidelines established by the U.S. National Cancer Institute were used to develop a third instrument to assess website usability. Eleven Ph.D. or MD -level specialists in smoking cessation and tobacco research reviewed websites. Reviewers were selected for their clinical or scientific experience, familiarity with the PHS guidelines and current research interests or clinical specialization in tobacco treatment. No reviewer had consulted for or had any financial interest or involvement with any of the websites they were assigned to review.

Results: Of the 202 websites identified in searches 77% did not provide direct intervention on the Internet and were excluded from analyses. Forty-six websites were included in this review. Results of usability assessments showed mixed results. Websites were visually well organized and used consistent graphical design, however, reading difficulty averaged above the 8th grade level. Most websites (87.5%) recommended pharmacotherapy for smoking cessation, 40% assessed nicotine dependence and 43% provided guidelines and instructions for the use of medications. However, over 80% of websites provided no coverage of one or more of the key components of tobacco treatment recommended in the guidelines. Ironically, the areas receiving the least coverage were those most amenable to the interactive capabilities of the Internet, such as providing tailored, personalized advice to quit and arranging follow-up contact.

Conclusions: Smokers seeking quality tobacco dependence treatment on the Internet may have difficulty distinguishing among the numerous websites available. Websites that provide direct treatment often fail to fully implement treatment guidelines and do not take full advantage of the interactive and tailoring capabilities of the Internet. Despite the importance of social support in the process of quitting smoking, few sites used chat rooms, electronic message boards, on-line counselor support (e.g., email) systems or other on-line support groups. The interactivity that can take full advantage of tailoring interventions to the needs of individual smokers is under-utilized despite research supporting its efficacy (Abrams, Mills, & Bulger, 1999). At a minimum, Internet treatment should be responsive to changes in guidelines, current treatment practices, known side effects, available medications and other aspects of smoking cessation treatment that can change over time.

References

Abrams DB, Mills S. & Bulger D. Challenges and future directions for tailored communication research. Annals of Behavioral Medicine 1999;21:299-306.

U.S. Public Health Service (2000). Treating tobacco use and dependence. Clinical Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services. Public Health Service