Quit Sense: a ‘Context Aware’ Smoking Cessation App

Struggling Smokers: The idea for the Quit Sense app came from talking to smokers who were struggling to quit smoking. They wanted help to stop them reaching for a cigarette when they had a craving to smoke.

Cravings can happen at any time, most often due to where a person is (e.g. at work) or what they are doing (e.g. socialising). We have learnt that smokers are not very good at seeking support during a craving or when in a situation where cravings are likely. The most used smoking cessation medications don’t seem to help in these situations either and while there are effective behavioural strategies smokers can use themselves to help manage or avoid cravings these are not generally used very much.

So how can we help smokers in situations when they get cravings to smoke? It is impractical to have a person following them around suggesting behavioural strategies whenever they might need them. As most people own smartphones, we decided to use the in-built sensors in smartphones to work out where someone is, what they are doing and whether they are likely to experience a craving to smoke.

With involvement from several members of the public, we created Quit Sense, an app that learns about a person’s smoking habits so it can deliver ‘in the moment’ support to help them avoid or manage cravings to smoke.

Quit Sense is a truly interdisciplinary project, where psychologists and computer scientists have worked with members of the public to create what we believe is the world’s first context aware smoking cessation app.

Quit Sense is a type of intervention known as a Just-In-Time Adaptive Intervention (JITAI). These are interventions which adapt the timing and content of the behavioural support they deliver according to incoming data, usually from sensors in the smartphone such as location sensors (e.g. GPS), accelerometers or even the microphone.

Supported by a Medical Research Council (MRC) grant, we developed, refined and acceptability tested Quit Sense (formally known as Q Sense). Quit Sense is informed by learning theory and identifies high-risk situations using a learning tool and location sensor to provide support to help smokers manage cues to smoke from their environment as they arise.

Two pilot studies have shown that Quit Sense can provide ‘in the moment’ support to smokers, including delivering behavioural strategies to help avoid or manage cravings, and that this is engaged with and is acceptable. We are now starting the next phase of evaluation funded by the National Institute for Health Research (NIHR) Public Health Research scheme: a feasibility randomised controlled trial (RCT).

This RCT will help us design a larger study by informing us about recruitment approaches and cost, study measurement, how many people will install and use Quit Sense, what participants thought about Quit Sense and an indication as to whether it is likely to help smokers to stop and how it might do this (e.g. by boosting confidence). Participants (N=160) will be smokers, from a range of socioeconomic groups, who want to quit smoking and will be randomly allocated to either a ‘usual care’ (access to the NHS SmokeFree resources) or ‘usual care’ plus access to the Quit Sense app.

Delivering an automated, online randomised controlled trial

Another cutting-edge aspect of our project is undertaking an automated evaluation trial. Firstly, we will recruit participants using adverts in Google Search and on social media. Interested individuals clicking on the advert will be taken to our study website to learn more about the study and if interested to take part will provide online informed consent. They will then be invited to complete baseline measures after which the website will randomise them into one of the two groups. Those randomised to receive Quit Sense will get a text message and/or email with a link for downloading the app from the app store.

Follow up measures at six-weeks and six-months will also be invited through text messages and/or emails and completed on the study website. Telephone calls will be used for participants who do not complete the measures online in response to the automated prompts to ensure we follow up as many participants as possible.

The project is led by Dr Felix Naughton and is supported by a team of experts, including:

Prof. Gary Barton (UEA), Prof. Tim Coleman (Nottingham), Dr David Crane (23 ltd), Dr Felix Greaves (Public Health England), Prof. Cecilia Mascolo (Cambridge), Dr Caitlin Notley (UEA), Prof. Toby Prevost (Imperial), Prof. Stephen Sutton (Cambridge) and Dan Tarrant-Willis (Patient and Public Involvement).

Delivery of the trial will be supported by the Norwich Clinical Trials Unit and and Dr Aimie Hope.

This trial will produce essential data to inform a definitive trial of Quit Sense which, if effective, could be offered to smokers outside the NHS to help address a key support gap. Quit Sense is highly scalable, could be combined with most other types of cessation support and could be highly cost-effective.

Naughton F, Hopewell S, Lathia N, Schalbroeck R, Brown C, Mascolo C, et al. A Context-Sensing Mobile 

Phone App (Q Sense) for Smoking Cessation: A Mixed-Methods Study. JMIR mHealth and uHealth. 

2016;4(3):e106. 