Mobile phone text messaging and app‐based interventions for smoking cessation

Robyn Whittaker; Hayden McRobbie; Chris Bullen; Anthony Rodgers; Yulong Gu; Rosie Dobson

doi:10.1002/14651858.CD006611.pub5

Intervenciones basadas en mensajes de texto y aplicaciones de teléfonos móviles para el abandono del hábito de fumar

Appendices

Appendix 1. Tobacco Addiction Group Specialised Register search strategy

Searched in Cochrane Register of Studies

#1 Cellular Phone:MH
#2 Cell Phones:MH
#3 MeSH DESCRIPTOR Cellular Phone
#4 MESH DESCRIPTOR Cell Phones
#5 MeSH DESCRIPTOR Text Messaging
#6 (mobile NEAR2 (phone* OR telephon*)):TI,AB,MH,EMT,XKY,KY,KW
#7 (cell* NEAR2 (phone* OR telephon*)):TI,AB,MH,EMT,XKY,KY,KW
#8 smartphone*:TI,AB,MH,EMT,XKY,KY,KW
#9 text messag*:TI,AB,MH,EMT,XKY,KY,KW
#10 (txt OR pxt OR mms OR sms):TI,AB,MH,EMT,XKY,KY,KW
#11 #1 OR #2 OR #3 OR #4 OR #5 OR #6 OR #7 OR #8 OR #9 OR #10

Figure 1

Study flow diagram for this update

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Figure 2

'Risk of bias' summary: review authors' judgements about each 'Risk of bias' item for each included study

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Figure 3

Funnel plot of comparison 1. Text messaging versus minimal smoking cessation support, outcome: 1.1 long‐term abstinence (all randomised))

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Analysis 1.1

Comparison 1 Text messaging versus minimal smoking cessation support, Outcome 1 Long‐term abstinence (all randomised)).

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Analysis 1.2

Comparison 1 Text messaging versus minimal smoking cessation support, Outcome 2 Long‐term abstinence (complete case).

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Analysis 2.1

Comparison 2 Text messaging versus other smoking cessation intervention, Outcome 1 Long‐term abstinence (all randomised).

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Analysis 2.2

Comparison 2 Text messaging versus other smoking cessation intervention, Outcome 2 Long‐term abstinence (complete case).

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Analysis 3.1

Comparison 3 Text messaging + other smoking cessation support versus other smoking cessation support alone, Outcome 1 Long‐term abstinence (all randomised).

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Analysis 3.2

Comparison 3 Text messaging + other smoking cessation support versus other smoking cessation support alone, Outcome 2 Long‐term abstinence (complete case).

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Analysis 4.1

Comparison 4 High‐frequency versus low‐frequency text messaging, Outcome 1 Long‐term abstinence (all randomised).

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Analysis 4.2

Comparison 4 High‐frequency versus low‐frequency text messaging, Outcome 2 Long‐term abstinence (complete case).

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Analysis 5.1

Comparison 5 Smartphone app versus lower‐intensity smoking cessation support, Outcome 1 Long‐term abstinence (all randomised).

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Analysis 5.2

Comparison 5 Smartphone app versus lower‐intensity smoking cessation support, Outcome 2 Long‐term abstinence (complete case).

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Analysis 6.1

Comparison 6 CO monitoring + contingency management versus smoking cessation support, Outcome 1 Long‐term abstinence (all randomised).

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Analysis 6.2

Comparison 6 CO monitoring + contingency management versus smoking cessation support, Outcome 2 Long‐term abstinence (complete case).

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Analysis 7.1

Comparison 7 Smartphone app + text messaging versus web‐based intervention, Outcome 1 Long‐term abstinence (all randomised).

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Analysis 7.2

Comparison 7 Smartphone app + text messaging versus web‐based intervention, Outcome 2 Long‐term abstinence (complete case).

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Summary of findings for the main comparison. Text messaging compared to minimal support for smoking cessation

Text messaging compared to minimal support for smoking cessation
Patient or population: people who smoke Setting: community Intervention: text messaging Comparison: minimal smoking cessation support
Outcomes	*Anticipated absolute effects^ (95% CI)**		Relative effect (95% CI)	№ of participants (studies)	Certainty of the evidence (GRADE)	Comments
	Risk with minimal SC support	Risk with text messaging
Long‐term abstinence (all randomised) Measured with self‐report and biochemical validation at 6 to 12 months	Study population		RR 1.54 (1.19 to 2.00)	14,133 (13 RCTs)	⊕⊕⊕⊝ Moderate^a
	6 per 100	9 per 100 (7 to 11)
*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; RCT: randomised controlled trial; RR: risk ratio; SC: smoking cessation
GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect.
^aDowngraded one level due to inconsistency: substantial unexplained heterogeneity (I² = 71%).

Summary of findings for the main comparison. Text messaging compared to minimal support for smoking cessation

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Summary of findings 2. Text messaging in addition to other smoking cessation support

Text messaging in addition to other smoking cessation support compared to other smoking cessation support alone for smoking cessation
Patient or population: people who smoke Setting: community Intervention: text messaging + other smoking cessation support Comparison: other smoking cessation support alone
Outcomes	*Anticipated absolute effects^ (95% CI)**		Relative effect (95% CI)	№ of participants (studies)	Certainty of the evidence (GRADE)	Comments
	Risk with other SC support alone	Risk with text messaging + other SC support
Long‐term abstinence (all randomised) Measured as self‐reported and biochemical validation at 6 to 12 months	Study population		RR 1.59 (1.09 to 2.33)	997 (4 RCTs)	⊕⊕⊕⊝ Moderate^a
	8 per 100	12 per 100 (9 to 18)
*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; RCT: randomised controlled trial; RR: risk ratio; SC: smoking cessation
GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect.
^aDowngraded one level due to imprecision: fewer than 300 events overall.

Summary of findings 2. Text messaging in addition to other smoking cessation support

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Summary of findings 3. Smartphone app compared to lower‐intensity support for smoking cessation

Smartphone app compared to lower‐intensity support for smoking cessation
Patient or population: people who smoke Setting: community Intervention: smartphone app Comparison: lower‐intensity smoking cessation support
Outcomes	*Anticipated absolute effects^ (95% CI)**		Relative effect (95% CI)	№ of participants (studies)	Certainty of the evidence (GRADE)	Comments
	Risk with lower intensity SC support	Risk with Smartphone app
Long‐term abstinence (all randomised) Measured with self‐report and biochemical validation at 6 months	Study population		RR 1.00 (0.66 to 1.52)	3079 (5 RCTs)	⊕⊝⊝⊝ Very low^a,b
	8 per 100	8 per 100 (5 to 12)
*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; RCT: randomised controlled trial; RR: risk ratio; SC: smoking cessation
GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect.
^aDowngraded one level due to inconsistency: considerable unexplained statistical heterogeneity (I² = 59%). ^bDowngraded two levels due to imprecision: confidence intervals encompass both clinically significant harm and clinically significant benefit.

Summary of findings 3. Smartphone app compared to lower‐intensity support for smoking cessation

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Comparison 1. Text messaging versus minimal smoking cessation support

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Long‐term abstinence (all randomised)) Show forest plot	13	14133	Risk Ratio (M‐H, Random, 95% CI)	1.54 [1.19, 2.00]

2 Long‐term abstinence (complete case) Show forest plot	13	11969	Risk Ratio (M‐H, Random, 95% CI)	1.56 [1.21, 2.02]

Comparison 1. Text messaging versus minimal smoking cessation support

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Comparison 2. Text messaging versus other smoking cessation intervention

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Long‐term abstinence (all randomised) Show forest plot	2	2238	Risk Ratio (M‐H, Random, 95% CI)	0.92 [0.61, 1.40]

2 Long‐term abstinence (complete case) Show forest plot	2	1813	Risk Ratio (M‐H, Random, 95% CI)	0.93 [0.63, 1.36]

Comparison 2. Text messaging versus other smoking cessation intervention

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Comparison 3. Text messaging + other smoking cessation support versus other smoking cessation support alone

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Long‐term abstinence (all randomised) Show forest plot	4	997	Risk Ratio (M‐H, Random, 95% CI)	1.59 [1.09, 2.33]

2 Long‐term abstinence (complete case) Show forest plot	4	796	Risk Ratio (M‐H, Random, 95% CI)	1.63 [1.12, 2.37]

Comparison 3. Text messaging + other smoking cessation support versus other smoking cessation support alone

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Comparison 4. High‐frequency versus low‐frequency text messaging

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Long‐term abstinence (all randomised) Show forest plot	3	12985	Risk Ratio (M‐H, Random, 95% CI)	1.00 [0.95, 1.06]

2 Long‐term abstinence (complete case) Show forest plot	3	6798	Risk Ratio (M‐H, Random, 95% CI)	1.04 [1.00, 1.09]

Comparison 4. High‐frequency versus low‐frequency text messaging

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Comparison 5. Smartphone app versus lower‐intensity smoking cessation support

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Long‐term abstinence (all randomised) Show forest plot	5	3079	Risk Ratio (M‐H, Random, 95% CI)	1.00 [0.66, 1.52]

1.1 Comparison: minimal non‐app SC support	2	1645	Risk Ratio (M‐H, Random, 95% CI)	0.82 [0.56, 1.18]
1.2 Comparator: less intensive smartphone app	3	1434	Risk Ratio (M‐H, Random, 95% CI)	1.12 [0.60, 2.09]
2 Long‐term abstinence (complete case) Show forest plot	5	1774	Risk Ratio (M‐H, Random, 95% CI)	1.06 [0.72, 1.54]

2.1 Comparison: minimal non‐app SC support	2	771	Risk Ratio (M‐H, Random, 95% CI)	0.87 [0.62, 1.23]
2.2 Comparator: less intensive smartphone app	3	1003	Risk Ratio (M‐H, Random, 95% CI)	1.18 [0.67, 2.09]

Comparison 5. Smartphone app versus lower‐intensity smoking cessation support

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Comparison 6. CO monitoring + contingency management versus smoking cessation support

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Long‐term abstinence (all randomised) Show forest plot	2		Risk Ratio (M‐H, Random, 95% CI)	Totals not selected

1.1 Comparison: counselling, nicotine replacement therapy and monitoring only app	1		Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
1.2 Comparison: counselling and nicotine replacement therapy	1		Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
2 Long‐term abstinence (complete case) Show forest plot	2		Risk Ratio (M‐H, Random, 95% CI)	Totals not selected

2.1 Comparison: counselling, nicotine replacement therapy and monitoring only app	1		Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
2.2 Comparison: counselling and nicotine replacement therapy	1		Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]

Comparison 6. CO monitoring + contingency management versus smoking cessation support

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Comparison 7. Smartphone app + text messaging versus web‐based intervention

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Long‐term abstinence (all randomised) Show forest plot	1		Risk Ratio (M‐H, Random, 95% CI)	Totals not selected

2 Long‐term abstinence (complete case) Show forest plot	1		Risk Ratio (M‐H, Random, 95% CI)	Totals not selected

Comparison 7. Smartphone app + text messaging versus web‐based intervention

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Intervenciones basadas en mensajes de texto y aplicaciones de teléfonos móviles para el abandono del hábito de fumar

Appendices

Appendix 1. Tobacco Addiction Group Specialised Register search strategy

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Appendices

Appendix 1. Tobacco Addiction Group Specialised Register search strategy

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