An experimental feasibility study of a hybrid telephone counseling/text messaging intervention for post-discharge cessation support among hospitalized smokers in Brazil.

Objective: Text messaging interventions are effective. Despite high utilization of smart phones, few studies evaluate text messaging for cessation in middle/lower income countries. Initiating tobacco treatment in hospitals is an effective but underutilized approach for reaching smokers. We evaluated a hybrid phone counseling/text messaging intervention for supporting cessation among hospitalized smokers in Brazil.

Methods: We used an experimental design to assess the feasibility and potential effect size of the intervention. Participants (N= 66) were recruited from a university hospital and randomized in a 2:1 ratio into TXT (1 session of telephone counseling plus 2 weeks of text messaging; N=44)or Standard Care control group (N= 22). Participants lost to follow up were counted as smokers.

Results: Counselors sent 1,186 texts, of which 924 (77.9%) were received by study participants. Participants rated the TXT content as "helpful" (80.4%) and the phone counseling length to be "just right" (95.1%). Although the study was not powered to evaluate abstinence rates, we did observe a higher prevalence of abstinence in the TXT compared to control group at both 1-month follow up (25.0% vs. 9.1%)and3-month follow up (31.8% vs. 9.1%). Carbon monoxide-verified abstinence at month 3 was also higher in TXT (20.5% vs 4.5%).

Conclusions: This hybrid telephone/text intervention should progress to full-scale effectiveness testing as it achieved favorable outcomes, was acceptable to participants, and was readily implemented. This type of intervention has strong potential for expanding the reach of hospital-initiated tobacco treatment in middle/lower income countries.

Implications: This study extends research on hospital-initiated smoking cessation by establishing the feasibility of a novel text-messaging approach for post-discharge follow up. Text messaging is a low-cost alternative to proactive telephone counseling that could help overcome resource barriers in middle and lower income countries. This hybrid texting/counseling intervention identified smokers in hospitals, established rapport through a single telephone follow-up, and expanded acceptability and reach of later support by using text-messaging, which is free of charge in this and other low-income countries. The favorable cessation outcomes achieved by the hybrid intervention provide support for a fully powered effectiveness trial.