Preventing postpartum smoking relapse among inner city women: development of a theory-based and evidence-guided text messaging intervention

Abstract

Background: Underserved women are at high risk for smoking relapse after childbirth due to their unique socioeconomic and postpartum stressors and barriers. Mobile text messaging technology allows delivery of relapse prevention programs targeted to their personal needs over time.

Objective: To describe the development of a social-cognitive theory-based and evidence-guided text messaging intervention for preventing postpartum smoking relapse among inner city women.

Methods: Guided by the cognitive-social health information processing framework, user-centered design, and health communication best practices, the intervention was developed through a systematic process that included needs assessment, followed by an iterative cycling through message drafting, health literacy evaluation and rewriting, review by target community members and a scientific advisory panel, and message revision, concluding with usability testing.

Results: All message content was theory-grounded, derived by needs assessment analysis and evidence-based materials, reviewed and revised by the target population, health literacy experts, and scientific advisors. The final program, "Txt2Commit," was developed as a fully automated system, designed to deliver 3 proactive messages per day for a 1-month postpartum smoking relapse intervention, with crave and lapse user-initiated message functions available when needed.

Conclusions: The developmental process suggests that the application of theory and best practices in the design of text messaging smoking cessation interventions is not only feasible but necessary for ensuring that the interventions are evidence based and user-centered.

Keywords: low-income women; mHealth; smoking relapse intervention; text messaging.

Figure 1

Steps and results from each development phase. ¹Messages may fall under multiple categories; thus, percentages do not sum to 100%. ²Eleven messages required additional revision to fit within the 159-character limit for text messages. ³Highly rated messages received a mean rating over 4.5 (out of 5) for “Overall Helpful” and were found to be “Helpful If Stressed” by all raters. ⁴Messages were flagged if they received a mean rating less than 4 (out of 5) for “Overall Helpful”; these were then identified for possible removal if two-thirds or more of raters found it “Not Helpful If Stressed,” or designated “Problematic” in all other cases.