What Design Features Shape Users’ Choice Of And Sustained Engagement With Smoking Cessation And Alcohol Reduction Apps?

As hundreds of smoking cessation and alcohol reduction apps are currently available on the market, smokers and drinkers looking to cut down or stop must actively select which app to download and try. Less than 10% of users tend to return to their selected health or fitness app 7 days after registration, which suggests that observed levels of app engagement are often too limited to support behavior change. We know very little about the design features that shape smokers’ and drinkers’ choices of commercially available apps, and what features are judged to be important for users to engage with their selected app over a period of time (as opposed to abandoning it after a day or two!).

This study found that adult smokers and drinkers who are based in the United Kingdom (UK) chose apps based on their immediate look and feel (e.g. minimalist design, ease of use), their perceived quality (as judged by other users’ ratings and brand recognition), and titles judged to be realistic and relevant to the user’s own situation.

To engage with their selected app over a period of time, our participants expected that they would need access to features that support their motivation to cut down or stop (e.g. goal setting, self-monitoring, feedback, rewards) and features that make the app seem personally relevant and trustworthy (e.g. tailoring of content, a non-judgmental communication style). They did not expect social features to be engaging in the context of apps for smoking cessation and alcohol reduction because of concerns that other people may react negatively to this (e.g. pity).

Why are these findings important?

Although trusted public health organizations in the UK and the United States have set up online libraries of publicly endorsed health apps (e.g. https://apps.beta.nhs.uk/; https://www.nlm.nih.gov/mobile/)/index.html, smokers and drinkers tend not to rely on this guidance when selecting apps. Instead, one of the most common methods of finding new health apps is to search an online store (e.g. Apple’s iTunes App Store).

The problem is that the majority of the myriad smoking cessation and alcohol reduction apps available on the market are not based on current best evidence and that very few of these apps have been tested in clinical trials. This makes it very difficult for users to identify the apps that are most likely to be effective in helping them to quit smoking or reduce their drinking. To increase the appeal of evidence-based apps, we need to improve their design to match smokers’ and drinkers’ choice heuristics. We, therefore, thought that it would be useful to first gain insight into how smokers and drinkers freely choose apps in an online store.

How was this study conducted?

We recruited 10 adult smokers and 10 adult drinkers living in London (UK) who were interested in quitting or cutting down on drinking using an app. Participants were invited to our lab, where they were first asked to search an online store on their smartphone to identify and explore a smoking cessation or alcohol reduction app of their choice. Whilst completing the task, they were asked to ‘think aloud’, meaning that they were encouraged to verbalize their impressions and thoughts. Participants were then asked to elaborate on these for their selected app through the use of semi-structured interview techniques.

Participants’ verbal reports were audio-recorded and transcribed before being analyzed using thematic analysis. We then re-contacted a subsample of participants and asked them to review the results to ensure that they agreed with the interpretation of their quotes.

As smokers and drinkers in our study selected apps at least partly based on their look and feel, an important implication of our findings is that researchers and healthcare professionals should collaborate with design experts to ensure that evidence-based apps are on a par with other commercially available apps in terms of look and feel. Our results also suggest that the specifics of how to tailor content to best support sustained engagement needs to be explored further.

These findings are described in a study entitled Smokers’ and drinkers’ choice of smartphone applications and expectations of engagement: think aloud and interview study, recently published in the journal BMC Medical Informatics and Decision Making. This work was conducted by Olga Perski, Professor Ann Blandford, Dr. Harveen K. Ubhi, Professor Robert West, and Professor Susan Michie from University College London (UK).