Use of Mobile Health Tools to Facilitate Tobacco Treatment Among Older, Underserved Adults: A Community-Based Approach to Intervention Refinement

Abstract

RATIONALE: Given the disproportionate impact of tobacco and the COVID-19 pandemic on older, medically underserved adults, it is important to identify efficient uses of mobile health (mHealth) tools for tobacco treatment and barriers to their uptake. We sought to (1) identify the barriers and facilitators of delivering tobacco treatment via mHealth and (2) engage stakeholders in designing an mHealth tobacco treatment tool for use among older, underserved adults. METHODS: We conducted semi-structured telephone interviews in English or Spanish with individuals who were 55- 80 years old, smoked tobacco daily, and self-identified as Black, Hispanic/Latinx, living in a rural area, or of low income or formal educational attainment from the University of Pennsylvania and the Latino Connection's COVID-19 mobile response unit. We inductively developed a codebook based on emerging themes from the interviews. Four trained project staff coded all interviews and conducted thematic analysis. Twenty percent of interviews were coded by at least two staff to ensure reliability. To support a multi-center, pragmatic RCT seeking to enroll 3,200 underserved, older adults who smoke tobacco, we engaged a stakeholder advisory committee (SAC) consisting of community organizations, policy experts, patients, clinicians, and payers to co-design and refine mHealth tobacco treatment interventions, informed by these findings. RESULTS: Between September 2020 and September 2021, we conducted interviews with 39 individuals. Participants described challenges with unfamiliar technology and discomfort with using mobile applications beyond texting and Facebook as barriers to mHealth use. Respondents identified tutorial videos, instruction manuals, and direct guidance from a support person as potential facilitators of mHealth use. Most respondents believed mHealth tools would facilitate tobacco cessation only among individuals committed to quitting tobacco. SAC members co-designed mHealth interventions to be used in the RCT through joint work sessions. The SAC shaped their design and content to be maximally relevant to the target population (e.g., incorporating examples of mHealth use from realworld situations). Our resulting mHealth interventions are delivered via 2-way automated text messaging. We provide instructional videos, including SAC-guided scripts and graphic design, and featuring an SAC member as the narrator (Figure). We provide a mailed informational packet to supplement the mHealth tool and established a hotline available in English or Spanish to provide guidance from support staff. CONCLUSIONS: Older, underserved adults who smoke tobacco may benefit from mHealth tools, particularly during the COVID-19 pandemic. Careful attention to reducing barriers to use and incorporating stakeholder guidance is critical in their development. (Figure Presented).