Process evaluation of a mHealth program: Lessons learned from Stop My Smoking USA, a text messaging-based smoking cessation program for young adults

• We analyzed process data from an RCT of young adult smokers ready to quit.
• Programs need to be flexible to different “paths” of behavior change.
• Proactive messaging that promotes pharmacotherapy options for young adults are needed.
• Text messaging surveys can be used as a gateway to longer online surveys in RCTs.

ObjectiveReport lessons learned in an RCT of Stop My Smoking (SMS) USA, a mHealth smoking cessation program for young adult smokers.Methods164 18–24-year-olds were recruited nationally, online in 2011. Program evaluation data were provided at 12-week post-Quit Day.Results(1) Inviting participants to complete a brief text messaging survey and then asking them to complete a longer online survey resulted in the highest response rate (89%). (2) The positive tone of program messages was the most commonly noted program strength. (3) Suggested improvements included more social connectivity and additional assistance overcoming stressful situations. (4) Half of intervention participants moved through the program linearly and half went through various paths that reflected multiple relapses. Suggestions to use pharmacotherapy resulted in 22% of heavy smokers to utilize it.ConclusionParticipant feedback provided concrete ways in which this and other young adult-focused interventions can improve messaging and program features to be even more salient.Practice implicationsFuture young adult mHealth interventions could: Integrate models that are flexible to different “paths” of behavior change; address stressful life events directly and comprehensively; integrate proactive messaging that promotes pharmacotherapy options; and use text messaging as a gateway to longer online surveys.