Exploring perspectives on digital smoking cessation just-in-time adaptive interventions: A focus group study with adult smokers and smoking cessation professionals

Technology-mediated just-in-time adaptive interventions (JITAIs), which provide users with real-time, tailored behavioural support, are a promising innovation for smoking cessation. However, a greater understanding of stakeholder, including user, perspectives on JITAIs is needed. Focus groups with UK-based adult smokers (three groups; N = 19) and smoking cessation professionals (one group; N = 5) were conducted January-June 2024. Topic guides addressed the integration of a JITAI into users' lives, preferred content and features, and data and privacy. Transcripts were analysed using inductive and deductive Framework Analysis; deductive codes were derived from the Theoretical Domains Framework and the Technology Acceptance Model. Four co-equal major themes, "Smoking Cessation Process", "JITAI Characteristics", "Perceived Value of the JITAI", and "Relationship with the JITAI", and 16 subordinate themes were identified. The smoking cessation process was described as a challenging and idiosyncratic, non-linear journey during which a JITAI should provide consistent support. Preferences for specific JITAI characteristics varied. However, participants consistently expressed that a JITAI should be highly personalised and offer both immediate, interruptive support and ambient, in-depth content. The perceived usefulness and ease of use of a JITAI were described as central to its perceived value. Participants stressed that a JITAI would need to be convenient enough to easily integrate into users' daily lives, yet disruptive enough to facilitate behaviour change. Smokers expressed that they would want their relationship with a JITAI to feel supportive and non-judgmental. They also felt a JITAI should promote their autonomy. Smoking cessation professionals stressed the importance of privacy and data protection, whereas smokers appeared more ambivalent and had mixed opinions about this topic. JITAIs need to balance aspects of competing demands in their design, such as optimising for both convenience and sufficient disruption, promoting autonomy, and integrating interruptive and ambient content while also meeting stakeholder needs and expectations in terms of privacy.