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Development and application of the BREATHE framework for systematic content and quality evaluation of tobacco
Varkey Nadakkavukaran Santhosh1, Rhea Vas2, Shruthi Bannur3
1Independent Public Health Researcher, Uttar Pradesh, India.
Introduction:
Smartphone applications offer innovative and accessible digital interventions to support tobacco cessation across diverse healthcare settings, especially in a country like India. This study aimed to evaluate the quality, evidence base, and rigor of tobacco cessation applications available on Indian mobile application stores using the novel BREATHE Framework.
Methods:
The BREATHE Framework (Benchmark Rating and Evaluation Analysis of Tobacco-cessation Health E-applications) was developed based on guidelines from the NTCP (India) and NICE (UK). The framework evaluates applications across five domains using a 0-3 scale for 76 items (maximum score: 228). Framework reliability was confirmed through Cohen's κ (0.90) and Pearson's correlation (r = 0.88). Through systematic searches on Google Play Store and Apple iOS store, 45 applications (9 for smoking, 36 for smokeless tobacco) were evaluated. Descriptive statistics and Spearman's rank correlation were used for analysis.
Results:
Most applications (48.9%) were rated "inadequate," with only one receiving a "good" rating and none achieving "excellent" status. Smoking cessation applications scored higher overall (107.44 ± 27.73) compared to smokeless tobacco applications (88.56 ± 37.79). Significant gaps were identified in behavioral science elements and technology utilization, particularly for smokeless tobacco applications. No significant correlations were found between application attributes and BREATHE scores.
Conclusions:
The study reveals suboptimal quality of tobacco cessation applications in India, with smoking cessation applications performing better than smokeless tobacco applications. The BREATHE Framework provides a standardized benchmark for evaluating and developing more evidence-informed cessation applications. Collaboration among researchers, healthcare professionals, developers, and policymakers are essential to create user-friendly, culturally relevant cessation tools.
Implications:
This study provides a structured understanding of the current landscape of tobacco cessation apps in India using the newly developed BREATHE Framework. It highlights opportunities to strengthen app design by integrating evidence-based content, behavioral support, and user-focused features. The framework offers a valuable benchmark for researchers, developers, and policymakers to guide the creation of more evidence-informed, engaging, and culturally appropriate cessation tools. These insights can contribute to improving digital tobacco control strategies and expanding accessible support for individuals seeking to quit.
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