Development of a Culturally Adapted Smartphone App (IndigeQuit) Designed to Help American Indian and Alaska Native...

Due to the colonization of tobacco plants by European settlers and the subsequent intensive marketing of commercial tobacco products to American Indian and Alaska Native (AI/AN) communities in the United States, commercial cigarette smoking accounts for half of all deaths among AI/AN people. Limited awareness, access to treatment, and the absence of culturally relevant, effective smoking cessation interventions contribute to these high death rates.

This study aims to culturally adapt iCanQuit, a smartphone smoking cessation app proven efficacious for the general population, for AI/AN people.

A user-centered and community-based participatory research (CBPR) mixed methods approach was applied to culturally adapt iCanQuit for AI/AN people in collaboration with a community advisory board (CAB) of AI/AN individuals using a 3-step process. Step 1 identified ways to culturally adapt the iCanQuit for AI/AN people through 1-on-1 qualitative interviews with 8 prior iCanQuit AI/AN participants. Step 2 involved developing prototypes of cultural refinements identified in step 1 through regular biweekly meetings of the CAB, research, and app development teams. The prototypes were then evaluated with a separate group of 4 prior iCanQuit AI/AN participants through 1-on-1 qualitative interviews. Step 3 involved beta testing the app through a 6-day diary study followed by 1-on-1 qualitative interviews with a nationally recruited group of 7 AI/AN adults who smoke commercial cigarettes. The development work associated with step 3 was further informed by the CAB and the research and app development teams.

Key findings identified 5 cultural refinements that informed subsequent app development and testing: (1) stories featuring AI/AN adults and elders emphasizing culture, spirituality, family, and community; (2) honoring the Earth as a motivator for cessation; (3) a guide character representative of AI/AN people; (4) clear distinction between ceremonial and commercial tobacco use; and (5) use of earth tones in visual design. In Step 3, all 7 (100%) diary study participants rated the beta version of the app as excellent or good/meets expectations (5/7, 71%, and 2/7, 29%, respectively) and that it felt made for them. They suggested 6 modifications which were incorporated into the final version of the app: (1) include vaping frequently asked questions, (2) feature motivation icons more prominently, (3) increase notification frequency, (4) track today's cigarettes rather than yesterday's, (5) allow users to update how much they spend per pack of cigarettes; and (6) rename the medications tool to reflect the inclusion of AI/AN traditional healing modalities.

A user-centered and CBPR development process yielded IndigeQuit-one of the first known apps developed specifically to help AI/AN adults quit commercial cigarette smoking.

ClinicalTrials.gov NCT06145763; https://clinicaltrials.gov/ct2/show/NCT06145763.