A Mobile Computer-Assisted Education System to Promote Smoking Cessation In Patients with Severe Mental Illness

Theoretical Background and research questions/hypothesis:  Tobacco smoking is the leading preventable cause of death in the United States. Smoking is highly prevalent in patients with severe mental illness (SMI) however computer-mediated health communication interventions to promote smoking cessation in this population have not been studied systematically. Mobile communication technology has the advantage of being interactive and potentially can be tailored to patients’ preferred learning styles and disease experience however it was not systematically assessed in patients with SMI. This study was conducted to assess the feasibility of and knowledge gains from using a mobile multimedia education system in smokers with SMI.  

Methods:  A previously developed curriculum about the hazards of smoking was adapted for use in the computer-assisted education (CO-ED) system. Brief educational statements about the effects of smoking and the advantages of quitting are presented, each followed by a multiple choice question about the material. When the correct answer is chosen users are congratulated and directed to the next educational statement. When the question is answered incorrectly users are given an opportunity to review the material and then reattempt the question.  For this pilot study patients at two large urban psychiatric rehabilitation centers were screened for smoking status and a sample of smokers was then approached for permission to participate. Participants completed a set of questionnaires with questions about demographics, prior experience with mobile devices, and knowledge about the effects of smoking before and after using the system. A research assistant provided the patient with a touch-screen tablet PC and trained them how to use the self-paced CO-ED module. Patients spent up to 45 minutes using the system.  

Results:  A convenience sample of 11 smokers with SMI used CO-ED. The mean age was 47.7 years, 54.5% were women. The subjects smoked on average 13.0 ± 5.0 cigarettes per day for 19.4 ± 14.2 years. Though about 70% of the participants never used the computer or had only basic skills, 81.8% of the patients reported that the mobile touch-screen was not complicated at all and 81.8% did not have any difficulty moving from one screen to another. Over 72% responded that they gained very significant and considerable amount of new information. Pre/post comparison demonstrated statistically significant improvement in the Knowledge Score with average increase in 3.5 ± 3.9 points (p=0.006). Before using the system, 27.3%, 27.3%, and 45.5% of the participants responded that they are thinking about quitting smoking within the next 30 days, with the next 6 months, and not thinking about quitting respectively. After using the system, 36.4% were ready to quit within the next 30 days, 36.4% within the next 6 month, and 27.3% still not thinking of quitting.    

Conclusions:  The mobile touch-screen system is a feasible and effective way to educate patients with SMI about the hazards of smoking. This system may also be effective in other chronic conditions where patients with SMI can benefit from self-management of their illnesses.

Implications for research and/or practice:Further research is needed regarding the cost-effectiveness and long-term effects of this patient education method in psychiatric rehabilitation setting.