Adaptation and Testing of a Novel Text-based Tobacco Cessation and Education Intervention in Kenyan Emergency Department Patients

Aim 1. To assess tobacco use and willingness to engage with mHealth for tobacco cessation targeting Kenyan ED patients.

Aim 2. To adapt the Text2Quit mHealth tool for use in the Kenya context using a participatory approach.

Aim 3. To pilot test Text2Quit-Kenya and assess its acceptability, feasibility, and efficacy.

The focus of this registration is Aim 3.

• Text2Quit-Kenya (Other): A text message-based mHealth tool addressing tobacco cessation. The program is organized around automated, bidirectional text messages timed for a user's quit date. Messages based on social cognitive theory prompt users to track smoking, report on cravings and on smoking status.

Primary outcomes

• Text2Quit Survey to assess efficacy [Baseline and 1 Month post intervention]: Efficacy will be assessed by self-report binary quantitative outcome of tobacco use in past 7 days
• Exhaled Carbon Monoxide testing to assess efficacy [Baseline, Month 1 and Month 6]: Efficacy will be assessed by repeat exhaled Carbon Monoxide testing. Will be assessed using both a binary assessment with a cutoff of 10% and a continuous assessment of percent point prevalence

Secondary outcomes

• Percent enrollment [Baseline]: Percent enrollment per arm using Reach RE-AIM Framework
• Adoption assessed using Adoption RE-AIM Framework [up to Month 6]: This is a qualitative outcome. The measure will be assessed using a semi-structured interview guide informed by the RE-AIM Adoption framework. Interview transcripts will undergo thematic analysis to identify themes related to intervention adoption, future use, and perceived fit within the target community.
• Facililtators -Implementation [up to Month 6]: Facililtators assessed using semi-structured qualitative interviews guided by the RE-AIM Implementation framework, with thematic analysis used to identify themes.
• Barriers-Implementation [up to Month 6]: Barriers assessed using semi-structured qualitative interviews guided by the RE-AIM Implementation framework, with thematic analysis used to identify themes.
• Frequency of message delivery [up to Month 6]: Frequency of message delivery using Implementation RE-AIM Framework
• Frequency of message read [Baseline, Month 1 and Month 6]: Frequency of message read using Implementation RE-AIM Framework
• Frequency of response [up to Month 6]: Absolute and proportion of response to interactive messages using Implementation RE-AIM Framework
• Maintenance assessed using RE-AIM Framework [Month 6]: Assesses the long-term sustainability of an intervention by measuring two key levels: individual long-term effects and setting-level institutionalization.
• Cost [Month 6]: Number of texts sent x cost per text to obtain individual user cost using Implementation RE-AIM Framework
• Tobacco Policies Knowledge [Baseline and Month 1]: Change in knowledge on tobacco policies using qualitative measure based on Efficacy RE-AIM Framework
• Tobacco Harms Knowledge [Baseline and Month 1]: Change in knowledge on tobacco harms of use using qualitative measure based on Efficacy RE-AIM Framework. Mean count of correct responses to the tobacco harms knowledge items, with scores ranging from 0 to 5 (higher scores indicate greater knowledge).
• Tobacco Use Frequency [Baseline and Month 1]: Frequency of tobacco use using Efficacy RE-AIM Framework
• Mean Tobacco Cessation Attempts [Baseline and Month 1]: Mean number of tobacco cessation attempts using Efficacy RE-AIM Framework
• Absolute Number Tobacco Cessation Attempts [Baseline and Month 1]: Absolute number of tobacco cessation attempts using Efficacy RE-AIM Framework

Sex: All, ages: 18 Years to any

Inclusion Criteria:

* Current tobacco users (self-identified smokers).
* Presenting to the Emergency Department (ED) at Kenyatta National Hospital (KNH).
* Own a mobile phone capable of receiving text messages.
* Willing to quit tobacco use.
* Able and willing to provide informed consent.

Exclusion Criteria:

* Individuals unwilling or unable to provide consent.
* Non-tobacco users.
* Those without access to a mobile phone.
* Patients who are critically ill or otherwise unable to participate (practically excluded at triage).

• Christine Ngaruiya, MD MSC DTMH, Principal investigator, Stanford School of Medicine

NIH grants: R21DA052790