A mHealth Intervention to Prevent Smoking Relapse After Pregnancy

RESPREMO

This project aims to develop an adapted and enhanced mHealth couple intervention to prevent postpartum smoking relapse. The main goal of this project is to develop, implement, and disseminate effective and sustainable interventions to prevent and reduce smoking in families over their reproductive life span. So, the purpose of this project is to adapt, enhance, and test the implementation feasibility and efficacy of an evidence-based pregnancy and postnatal smoking relapse pilot mHealth intervention. The scientific relevance of this research project is given by: 1) testing a cultural-adapted version of the iCoach mobile application for the prevention of smoking uptake after birth. 2) The cultural adaptation will be obtained based on the existing literature regarding the adaptation of preventive interventions for substance use. 3) The iCoach app intervention is enhanced with SMS-delivered content addressing the dyadic efficacy for smoking cessation aiming to improve both partners’ skills to work together as a team to prevent smoking uptake after birth.

Maternal smoking is one of the most modifiable factors clearly linked to adverse effects for the fetus and the baby. A significant problem, and the focus of this project, is that up to 70% of women who quit resume smoking after birth, with the majority relapsing in the first 3 months postpartum. The birth and the postpartum period represent windows of opportunity to prevent smoking relapse in mothers who quit smoking before or during pregnancy.

Mobile phones offer a virtually unused opportunity to deliver customizable tobacco cessation interventions, particularly relevant in low and middle-income countries characterized by underfunded and understaffed health systems.

The long-term goal of my research program is to develop, implement, and disseminate effective and sustainable interventions to prevent and reduce smoking in families over their reproductive life span. This project will adapt, enhance, and test the implementation feasibility and efficacy of an evidence-based pregnancy and postnatal smoking relapse pilot mHealth intervention. This mHealth intervention targeting couples is enhanced with SMS-delivered MAPS-based content.

Objectives

The aim of this project is to adapt, enhance, and test the implementation feasibility and efficacy of an evidence-based pregnancy and postnatal smoking relapse pilot mHealth intervention. The project will generate data on a clinical sample of women enrolled in a pilot randomized controlled trial, to examine the implementation feasibility and initial efficacy of a mHealth intervention in reducing maternal smoking relapse.

The specific objectives of the project are:

  1. To develop an adapted and enhanced mHealth couple intervention to prevent postpartum smoking relapse based on the iCoach mobile application enhanced with SMS-delivered MAPS (Motivation and Problem Solving)-based content
  2. To conduct a pilot-test-scale randomized controlled trial (RCT) of the intervention
  3. To examine in the pilot the implementation feasibility and initial efficacy in reducing maternal smoking relapse, with secondary hypotheses regarding spousal cessation and reduction

Starting / Ending Date

August 2017 – December 2019

Project Coordinator

Babeș-Bolyai University from Cluj-Napoca / Michigan State University – Romania/ US

Funding

Funder: Executive Unit for financing education Higher, Research Development and innovation (UEFISCDI)
Grant Number: PN-III-P4-ID-PCE-2016-0632
Total Amount: 849.087 RON

Staff from Department of Public Health

Assistant Professor

Research Technician, Local Project Director

Associated Researcher

Research Assistant

Project Partners

Our study is implemented with the support of the two largest, state-owned clinical settings in Cluj-Napoca, Romania.

The clinical partners of the project are:

County Emergency Clinical Hospital Cluj-Napoca, Gynecology Clinic I

County Emergency Clinical Hospital Cluj-Napoca, Gynecology Clinic II

Project Outputs

Scientific Conferences

  1. Conference: SRNT Europe 19th Annual Conference (12-14 September 2019, Oslo, Norway) Presentation title: Development of the Stay Quit Together mHealth intervention
  2. Conference: SRNT 25th Annual Meeting (20-23 February 2019, San Francisco, USA) Presentation title: Preliminary feasibility and acceptability of Stay Quit Together-a smoking relapse prevention intervention
  3. Conference: 3rd International Conference of the European Network for Smoking and Tobacco Prevention (14-16 June 2018, Madrid, Spain) Presentation title: Risk factors for postnatal smoking relapse among Romanian women
  4. Conference: SRNT Europe 19th Annual Conference (12-14 September 2019, Oslo, Norway) Presentation title: Stay quit together – follow-up feasibility and biochemical verification in a postnatal smoking relapse prevention intervention
  5. Conference: SRNT Europe 18th Annual Conference (6-8 September 2018, Munich, Germany) Presentation title: Use of a visually-built platform to deliver mHealth interventions: A case study on the use of the Textit platform to deliver SMSs to prevent smoking relapse after birth

Scientific Reports

2017 – In the first six months of the project (July-December 2017), the research team developed and pretested the mHealth intervention. More specifically, the study team signed collaboration agreements with the two clinics included in the study, translated the content of the iCoach application in Romanian, and developed the text messages repository and the instruments necessary to pretest these (standard operating procedure manual, semi-structured interview guides, eligibility registry). The quantifiable results of the project for the year of 2017 consist of the partnerships established with the clinics included in the study, the content of the iCoach application translated in Romanian, the text messages repository, the semi-structured interview guide used to pretest the intervention, the database containing qualitative information on the intervention pretesting, and the dissemination of the project through its website and by participating in two scientific conferences. All the contract objectives of the project for 2011 were met. A summary of the report can be found here. Download here.

2018 – In the second year of the project (January-December 2018), the research team has finalized Phase II of the project, namely the implementation and evaluation of the mHealth intervention for the prevention of smoking relapse in the postpartum period, through a randomized controlled study. Specifically, the research team developed the research instruments used for the randomized clinical trial (the questionnaires, the standard operating procedures manual and the informative brochure), started the enrollment of the participants in the randomized clinical trial and initiated the delivery of the intervention. Moreover, the research team developed two databases, one that started to be filled in with the data collected from the participants before the delivery of the intervention and one that is going to be filled in with the data collected from the participants six months after the delivery of the intervention. The project dissemination was completed through the maintenance and periodical update of the project website in Romanian and in English, through three presentations held at two scientific manifestations, through one scientific manuscript that was sent for publication to an ISI indexed scientific journal and through a conference proceedings paper that was published in the proceedings of an ISI-indexed conference. All the contract objectives of the project for 2018 were met. A summary of the report can be found here.

2019 – During January-December 2019, the research team has finalized Phase III of the project, namely the implementation and evaluation of the mHealth intervention for the prevention of smoking relapse in the postpartum period, through a randomized controlled trial. Specifically, the research team finalized the enrollment of the participants in the randomized clinical trial, the delivery and the evaluation of the intervention. Moreover, the research team developed two databases, one containing the data collected from the participants before the delivery of the intervention and one containing the data collected from the participants six months after the delivery of the intervention. The intervention showed implementation feasibility and evidence of initial efficacy in preventing maternal smoking relapse after birth. The project dissemination was completed through the maintenance and periodical update of the project website in Romanian and in English, through three presentations held at two scientific manifestations, through one scientific manuscript that was sent for publication to an ISI indexed scientific journal and through a press release. All the project’s objectives were met. The report can be downloaded here.

Scientific Publications

Hostina, A, Chereches, RM (2018). The use of mHealth technology in smoking cessation interventions for pregnant women: the emerging field of eHealth and mHealth in Romania. Transylvanian International Conference in Public Administration Conference proceedings, 220-227. Accession number: WOS:000442554700016