A cognitive dissonance-based mobile app intervention for smoking cessation: A single-arm pilot trial

Despite overall declines in the rate of tobacco use in the United States over the past 30 years, nearly 38 million Americans still smoke, posing extremely high risk for long-term health problems and death. Recent reviews note that there has been significant progress in the application of both clinical and public health interventions to help smokers quit; however, they have also concluded that the overall success rate has not significantly improved. There remains a need for novel, theory-driven approaches to enhance quit rates and innovative interventions that increase reach and engagement. In the current pilot study, we evaluated the use of a cognitive dissonance intervention for smoking cessation that was delivered via a mobile app.

The Support2Quit app was evaluated in a single arm pilot study with 72 adult daily smokers who were assessed at baseline, 1 month and 3 months. Feasibility, usability, participant satisfaction, and intervention outcomes were evaluated.

The evaluation demonstrated promise that the Support2Quit app could effectively invoke significant increases in cognitive dissonance (average effect r=0.55; a large effect) and significant increases in readiness to quit smoking (average effect r=0.36; a medium effect). Outcomes showed a decrease in the number of cigarettes smoked each day for 41 (72%) of this sample; the non-parametric Wilcoxen signed-rank test showed an overall decrease in the number of cigarettes smoked per day from pretest to posttest (Z-score= -5.64, asymptotic p<0.001). User satisfaction ratings using a 5-point Likert scale indicated that the majority of 87.5% of participants reported liking the app (mean=3.7; SD=1.0) and that 82.5% reported that the app was helpful in reducing or stopping using cigarettes (mean=3.3; SD=1.0).

Outcomes suggest that the Support2Quit mobile app was effective at inducing cognitive dissonance and might be a useful tool for reducing or quitting the use of cigarettes.