Blended smoking cessation treatment: User experience | Adherence | Effectiveness

The topic of this thesis - the blending of face-to-face and web-based interventions - and the related question of whether a blended treatment offers "the best of both worlds" was taken forward in this thesis in the scope of smoking cessation treatment. In order to contribute to the research on smoking cessation treatment and to improve clinical practice, the Blended Smoking Cessation Treatment (BSCT), which is the focus of this work, was addressed by highlighting three themes: user experience, adherence and effectiveness. Patients experienced BSCT predominantly positively. However, BSCT's UX is characterized by a "hedonistic gap" resulting from the mostly negative identification, stimulation and evocation of the Web-mode. This gap was then compensated for by the F2F-mode, giving an indication that BSCT may be "the best of both worlds", as the strength of one mode (in this case the stronger hedonistic aspects of the F2F-mode) could offset the weaknesses of the other mode. However, this compensation was largely unidirectional: the F2F-mode compensated for the Web-mode but not vice versa. For adherence, to compare face-to-face versus blended treatment, the picture was that patients spent similar amounts of time in BSCT and F2F without it being clear whether this was to be considered high or low adherence, as different measurement procedures and evaluations prevented a simple comparison of the two results in the end. However, at least for BSCT, the two measuring methods brought up an interesting point: On the one hand, BSCT patients showed little activity, but at the same time exhausted the planned treatment time. Also, for BSCT it was noticeable that within BSCT the adherence for the two modes was very different. Contrary to the planned 50-50 distribution, patients only used the Web-mode for about 1/3 of the time and the F2F-mode for 2/3 of the time. For effectiveness, contrary to our expectations, we did not find any evidence of non-inferiority of BSCT to F2F. The most important measurement - cotinine-validated point prevalence abstinence - showed significantly lower abstinence rates of BSCT (4.8%) compared to F2F (17.5%) in the intention-to-treat analysis (difference of 12.7 (95% CI 6.2-19.4); P<.001). Based on a Bayes factor calculation, we interpreted this difference as very strong evidence for the inferiority of BSCT.