montre à la cigarette c’est qui le boss! using highly tailored text messages to help young adults...

Montre à La Cigarette C’est Qui Le Boss! :P Using Highly Tailored Text Messages to

Help Young Adults Quit Smoking

Rachel Fournier, Catherine Lavoie, Trevor van Mierlo, Peter Selby

Medicine 2.0 CongressSeptember 18, 2011

Before we begin…Rachel Fournier, B.Sc. (Hons) is an employee of Evolution Health Systems Inc.Catherine Lavoie, B.A. is an employee of Canadian Cancer SocietyTrevor van Mierlo, MScCH, is CEO of Evolution Health Systems Inc.Peter Selby, MBBS, CCFP, MHSc, FASAM, has acted as a consultant to Evolution Health Systems Inc.

Canadian Cancer Society – Quebec DivisionThe Canadian Cancer Society (CCS)• National community-based

organization of volunteers (over 25,000)• Mission: eradication of cancer

and enhancement of the quality of life of people living with cancer.

Evolution Health Systems Inc.• Research-based organization founded in 2000• Global presence in US, Canada, UK, Japan and Brazil• 21 peer-reviewed publications, 70+ presentations• Digital Health programs to help people overcome depression, manage anxiety, quit

smoking, achieve a healthy weight, overcome problem drinking, etc.

ContextTobacco is the leading cause of cancer in Canada.•18-24-year olds have highest smoking prevalence in Quebec and Canada

• In Quebec: 30%Text Messaging and mHealth applications can reach Young Adults

Adapting for Young Adults

What is SMAT?

Service deMessagerie texte pourArrêter leTabac(Short Messages Against Tobacco)

• Funded by Health Canada• Phase I : August 4, 2010 – March 31, 2011 (pilot)• Phase II : April 1, 2011 – March 31, 2012

Reaching Young Adults

Messaging emphasis informed by focus group testing• It’s free!• Offered by the Canadian Cancer Society• Words to avoid: help, commitment, coach

Reaching Young Adults

Registration Process1. Smokers complete brief online registration at www.smat.ca

• Short code preferred but far out of budget

2. Receive first text message from SMAT within an hour3. Must text back « ok » to confirm registration

• Users = only those who have confirmed their registration

How Does It Work? A. Proactive messages: text schedule

B. Reactive messages: reply with a keyword

Distraction Envie Pause

Oups Party Stress

Prep. Week Quit Day Week 1 Weeks 2-4 Weeks 5-12

1 / day 2 2 / day 1 / day 2 / wk

The Messages

Proactive messagesAllez hop! Aux poubelles les cendriers, briquets et clopes! Jette-les tous, sans pitié! Mwahaha :P

Reactive messagesTrouve qqc à compter autour de toi : les tuiles au plafond, les autos ds la rue, les gommes en dessous de ta chaise, etc.

• Tone, language and content tested in focus groups and individual interviews

• Young adults want:

• Tips and information on physiological changes due to cessation

Registrations

• 71.69% of participants found SMAT via Facebook• 269 registrations online resulting in 183 users (68%)

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Why didn’t you confirm your registration?n = 38

I changed my mind – I don’t want to quit smoking anymore 21 %

I never received the first text message asking me to text « ok » to confirm my registration 16 %

I forgot to confirm my registration 13 %

I didn’t understand i had to text « ok » to confirm my registration and receive the text messages 11 %

I didn’t understand that SMAT offered support over my cell phone 5 %

I was worried it would cost money 5 %

I texted « ok » but nothing happened 3 %I didn’t like the text message i received from SMAT 3 %I don’t remember 8 %

Other reasons (lost interest, concerned about fraud, gave a residential number, didn’t know how) 13 %

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Average: 27 Median: 26

Evaluation

n = 74

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Keyword Utilization

Reasons for not using keywords

n=30

I didn’t need them 60%I didn’t remember the keywords 23%I thought it would cost money 5%I don’t like to write text messages 4%I didn’t know there were keywords 4%Other reasons 6%

Keyword Utilization

• 1,196 text messages sent by 183 users• Of these, 697 contained a keyword and 398 were conversational

Keyword Number of times sent

Number of users

Average per user

Distraction 229 56 4Envie 124 56 2.2Oups 122 57 2.1Party 100 50 2Stress 85 46 1.8Pause 37 28 1.3

What Did Users Think of the Service?

High Satisfaction Overall• 90% would “definitely” or “probably” recommend to a

friend who was quitting smoking• 86% were satisfied with the service• Most (73%) believed it was useful in their quit attempt• 57% would have liked the service to continue for longer

than 12 weeks

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Great, but did it work?

At three months: • 32% quit smoking• 73% plan on quitting• 58% would use the service again in their next quit attempt

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Relapse

Relapse Triggers n=54

Stressful situation 62%

Alcohol 50%

Being around other smokers 42%

Withdrawl symptoms (cravings, irritibility, anxiety, difficulty concentrating)

35%

Weight gain 3%

Other reasons 11%

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Relapse

What would have prevented relapse? n=54

Using pharmaceutical aids while along with the service 45%

Ability to text chat with a quit specialist 40%

Being buddied up with another quitter 27%

Receiving more text messages 21%

Receiving more follow-up calls from a specialist 13%

Participating in a quit contest 12%

Staying home / going out less / less partying 7%

Not being around smokers 5%

Other reasons 7%

Don’t know 7%

Conclusions

Phase I• Evaluation results are very encouraging :-)• Attrition rate is acceptable :-)• Email follow up rates abysmal :-(• Cessation rate is promising :-)

What’s Next?

Phase II• Register 1,000 users, 60% 18-24• One-on-one text chat with quitline

specialists• Extended messages• Follow-up surveys via text message

and phone only

ttyl!ttyl!

Thank You!

Rachel FournierVice President, Business Development

Email: rfournier@evolutionhs.comToronto: +1-416-644-8476 x222