A Multi-Methods Exploration of Expectations and Preferences for Digital Cessation Treatment Among Older Adults Who Smoke Cigarettes (Preprint)

Abstract

To address enduring age-related tobacco disparities, there is critical need to promote the utilization of cessation treatment among older adults (65+ years). Digital health platforms offer opportunities for wide dissemination of evidence-based behavioral cessation support. However, existing digital cessation treatments are not tailored to unique aging-related needs and preferences, resulting in low uptake. Detailed information is needed about how to best adapt these treatments for this age group.

To collect detailed, hypothesis-generating information about the expectations and preferences for cessation digital treatment among older adults who smoke cigarettes.

Semi-structured interviews were conducted with adults 65+ years currently smoking or who had recently quit. Interviews included open-ended questions regarding prior experiences with digital health platforms and expectations and preferences for cessation treatment via various modalities (application [app]-delivered, texting-based, counseling via videoconferencing). Interviews also elicited questions regarding digital modalities that integrated social components (app-delivered social forums, group videoconferencing counseling). Using an iterative, team-based approach, thematic analysis identified meaningful themes. Interviews were supplemented with quantitative measures assessing sociodemographics, digital literacy, and physical health symptoms.

Participants (N=20; 60% men; 75% White; 20% Black/African American, 5% Asian) were currently smoking cigarettes (N=17), with (N=3) recently quit. Technology use for non-cessation reasons was common and digital literacy varied widely (Mobile Device Proficiency Questionnaire scores 16-80 out of possible 16-80). Three participants had used a digital cessation treatment. Expected benefits (across all modalities) included accessibility and convenience. Participants preferred treatments to be personalized and deliver content/strategies beyond standard education. Most were unfamiliar with apps for cessation but found them appealing given potential for offering a novel quitting strategy (85% interested). App ease of use (e.g., easy navigation) was preferred. Half would try a texting-based intervention, with many preferring texting with a cessation counselor rather than automated messaging. Most (85%) would use videoconferencing and expected this modality to deliver better quality counseling than via telephone. Expected videoconferencing challenges included looking presentable onscreen, technological difficulties, and privacy/security. Videoconferencing was regarded as the most personalized digital treatment yet benefits unique to app-delivered and texting-based treatments included anonymity and access to treatment 24/7. Participants expected integrating social components into digital treatment to be useful for quit success and social connection yet were concerned about possible interpersonal challenges.

Because a long history of quit attempts and familiarity with standard quitting advice is common among older adults who smoke cigarettes, digital platforms might offer appealing and novel strategies for cessation that are accessible and convenient. Overall, this population was open to trying digital cessation treatments and would prefer that these platforms prioritize ease of use and personalized content. Findings challenge the bias that older adults are uninterested or unwilling to engage with digital treatments for behavioral health.

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