Feasibility and Acceptability of a Text Messaging Intervention to Increase Smoking Cessation in Vietnam 

BACKGROUND: 
Smoking rates in Vietnam are among the highest in the world. Promoting cessation is the key to reversing current global trends in tobacco -related mortality over the next few decades. Yet, there is a lack of smoking cessation interventions that demonstrate efficacy in low middle-income countries (LMICs) like Vietnam. To increase cessation rates, innovative interventions are needed that are easily accessible, adapted to the local context and culture, and have the potential to reach large numbers of smokers. Low cost mobile technology that uses text messaging or short message systems (SMS) to deliver behavioral health interventions meet these criteria and represent an underutilized public health opportunity with high potential for reaching large numbers of smokers. SMS is particularly well suited to address behaviors like smoking. SMS interventions are able to tailor interactions to individuals ‟needs and preferences and to interact with individuals with much greater frequency and in the context of the behavior. In addition, a recent study suggests that SMS interventions, which deliver assistance proactively, may be more effective than smartphone smoking cessation applications which require smokers to engage in the intervention on their own.

There is growing support for the efficacy of text-based smoking cessation interventions but these studies have largely taken place in Western countries. The remarkable growth in mobile phone use LMICs presents an opportunity to expand this research in LMICs like Vietnam where smoking rates remain high. There are 134 million active mobile phone subscriptions in Vietnam, 80% of households own at least one mobile phone and 93% of urban adults have a mobile phone. In 2010, 84 percent of mobile phone subscribers used SMS.

A 2012 Cochrane Review found a benefit for text message-based smoking cessation interventions on long- term cessation outcomes, but these studies have largely taken place in Western countries. We are aware of only one pilot study using text messaging in a LMIC and none in Vietnam.  Moreover, there is a lack of research examining methods for adapting effective text message interventions to address sociocultural differences and differences in linguistic and communication styles and preferences. 

In collaboration with New York University, ISMS implement the project “Feasibility and Acceptability of a Text Messaging Intervention to Increase Smoking Cessation in Vietnam” funded by NCI/NIH USA.
This proposal will begin to fill significant gaps in research on smoking cessation interventions in LMICs, and specifically in South East Asian Countries (SEACs), where smoking rates remain high.

GOALS

The purpose of this study is to develop and then test the feasibility, acceptability, and preliminary effect of a bidirectional text message smoking cessation intervention among Vietnamese smokers in Hanoi, Vietnam. The specific aims are: 
1) To develop a smoking cessation text message library among Vietnamese smokers;
2) To evaluate message preferences, and the feasibility and acceptability of the bidirectional text message smoking cessation intervention; and 
3) To assess the preliminary effect of a bidirectional mobile phone text message intervention on biochemically validated smoking abstinence.

STUDY DESIGN 
For AIM 1, we will recruit 50 current smokers to develop a smoking cessation SMS library. We will conduct focus groups and surveys to assess message preferences and to determine what elements of the texts used in prior interventions should be retained and modified. 

For AIM 2, we will recruit 40 current smokers to participate in a single arm pre-test of the intervention to evaluate message preferences in real time using brief text message surveys, and assess the feasibility and acceptability of the bidirectional SMS smoking cessation intervention. We will also conduct baseline and 4-week surveys to assess the feasibility and acceptability of the intervention, and participants’ satisfaction with the intervention. After the pre-test, we will randomly select 10 participants from the 40 subjects to conduct semi-structured interviews to fully understand the acceptability of the intervention and elicit suggestions for further adaptation. Findings from the pre-test intervention will be used to refine the SMS intervention.
For AIM 3, we will recruit 100 current smokers and conduct a pilot RCT to examine the preliminary effect of bidirectional SMS smoking cessation intervention. We will randomize subjects into one of the two groups (intervention vs. control), and compare the carbon monoxide (CO) validated 7-day point prevalence smoking abstinence rates at 3-month follow-up between intervention group (SMS smoking cessation treatment) and control group (assessment texts only). We will administer surveys at baseline, 4-week and 3-month follow-up, and assess daily cigarette consumption using text message surveys. After the intervention, we will randomly select 10 participants from the intervention group to attend semi-structured interviews to obtain more in-depth understanding about the usefulness, usability, and acceptability of the intervention. Findings from the pilot RCT will be used to derive an estimate of the effect size, power, and sample size for a full-scale efficacy trial.

Study setting and Time: 
Study sites: Me Tri ward and Tay Mo Ward, South Tu Liem District, HaNoi
Time: 08/2017 - 06/2019
Funding source and Partners:
Funded by by National Cancer Institute of the National Institutes of Health (5R21 CA225852)
Implementers: Institute of Social and Medical Studies, New York University, Hanoi Medical University, South Tu Liem District Health Center