Context
Despite progress in the past decade, smoking remains common in Samoa, with recent estimates showing approximately one in four adults to be smokers. Interventions that support people to quit smoking may help reduce the high smoking prevalence in the country, and mobile phones may be the ideal mode of delivery due to Samoa’s high rates of mobile phone ownership and its young population. This pilot study examined the effectiveness of the TXTTaoafiTapaa (TxtStopSmoke) program on reducing smoking behaviors among a group of Samoans in 2013.
Intervention
The TXTTaoafiTapaa program was a text messaging-based smoking cessation intervention, culturally adapted for Samoa with the help of the Ministry of Health and the Samoa Cancer Society. The process of creating a smoking cessation program for Samoa began by consulting with local smokers. The program, which was developed in New Zealand, underwent testing on a sample of smokers and ex-smokers in Samoa. The program was then modified to align with Samoa’s culture, language, and lifestyle.
Registered participants first decided on their individual quit days and then received messages from the program motivating them and sharing recommendations to reach their goal. Once they stopped smoking, program messages shifted to helping participants maintain their smoke-free status. Participation was voluntary, and participants could opt out by text. Over the 12-week study, 92 text messages were sent to each participant. In addition to these text messages, the intervention involved a media campaign that broadcasted 30-second clips on national TV and radio about the consequences of smoking. These advertisements were intended to drum up interest in the program and were aired at the same time as study recruitment and enrollment.
Evaluation
Design: The pilot study was conducted in Samoa, and participants were exposed to the intervention for a period of 12 weeks in 2013. Participants were administered face-to-face questionnaires at baseline and at follow-up, right after the program was completed (quasi-experimental design). The questionnaire captured information about participants’ backgrounds, media use, and smoking behaviors. To measure smoking behavior, a version of the Fagerström Test for Nicotine Dependence was used, and participant responses were categorized into low, medium, or high nicotine dependence. Participants also reported whether they stopped smoking and how many times they attempted to quit. Participants were considered to have quit smoking if they reported that they had not smoked a cigarette in the seven days prior to the assessment.
Sample: Inclusion criteria included being at least 16 years old, having a mobile phone, and being a current smoker with a desire to quit. Participants were recruited widely, with advertisements shared in churches, community centers, workplaces, and on Facebook. After two months of recruitment, 100 people provided informed consent and registered for the program. Of those, 72 completed the follow-up assessment and were included in the analysis.
Results
At the follow-up assessment one month after the program ended, about two in five participants reported that they stopped smoking (had not smoked a cigarette in the seven days prior to follow-up assessment). Half of the participants reported that the program helped them try to quit at least once, and 65% reported that it helped them think about quitting smoking.
Limitations: Study limitations that the authors outlined include the technical difficulties that led to many participants not completing the study and the non-randomized design of the pilot.
Conclusion
Despite the limited success of the program in helping users quit smoking, most participants reported that the text program was helpful for promoting thoughts and attempts at quitting. A randomized controlled trial would typically be used to more thoroughly measure efficacy. However, the authors claimed that there was ample evidence of the effectiveness of mobile cessation programs in other settings, and therefore, they aimed to conduct a cost-effectiveness analysis and evaluate the real-world impact of the TXTTaofiTapaa program in Samoa.
