Users' Experiences of novel smoking cessation technologies: A convergent parallel mixed study

Abstract

Abstract Introduction: The growing demand for safer, noninvasive treatments with fewer side effects has led to increased interest in using novel technologies for smoking cessation. A better understanding of users' experiences with these technologies can aid in their development. This study aimed to explore and define the experiences of individuals using these technologies. Methods: This parallel convergent mixed-methods study was conducted in quantitative and qualitative phases. In the quantitative phase, a descriptive study was carried out with a sample size of 400 participants. Participants were selected through stratified random sampling from individuals attending clinics utilizing non-invasive stimulation-based smoking cessation technologies. Data were collected using questionnaires on demographic and social characteristics, smoking history, smoking cessation challenges, and preferences for smart smoking cessation technologies. Descriptive statistics were used for data analysis. In the qualitative phase, 25 users of these technologies from Tehran, Tabriz, and Karaj were selected through purposive and snowball sampling. Data collection was conducted using in-depth, semi-structured individual interviews, and qualitative content analysis was performed using a conventional approach. To integrate the quantitative and qualitative data, the merging strategy and convergence model were applied. Results: The mean age at smoking initiation was 14.17 years (SD = 4.84, range: 5–32 years). On average, participants started daily smoking at 17 years old (range: 10–33 years) and continued smoking daily for an average of 22 years (range: 4–54 years), with over six quit attempts. In the qualitative phase, the category "initiation and continuation of smoking" included ten subcategories: relaxation, social and peer pressure, family problems, presence of a smoker in the family, habit, pleasure, dependency, curiosity, and lack of awareness about smoking risks. One of the main categories related to users' experiences with cessation technologies was "changes after using the technology," which comprised seven subcategories: positive physical changes, reduced cigarette cravings, greater resilience in life challenges, increased self-confidence in accomplishing tasks, reduced appeal of smoking, satisfaction with a smoke-free life, and changes in family and social relationships. Quantitative results showed that 75.5% of participants ranked fear of side effects as the primary challenge, making it the most significant concern. Qualitative data reinforced this finding, highlighting it as a major barrier to quitting. Fear of failure was reported as a key challenge by 60.5% of participants (n=242), with qualitative data indicating that this often stemmed from previous unsuccessful quit attempts. Emotional attachment to smoking was a major challenge for 32.2% of participants (n=129), demonstrating deep emotional dependence on smoking. While concern about the cost of technology use was a challenge for 19.0% of participants (n=76), qualitative data presented a different perspective, with some participants viewing the cost of quitting as an investment compared to potential future savings from not buying cigarettes. Fear of relapse was identified as a significant concern in qualitative data, emphasizing the importance of managing triggers and environments during the cessation process. Quantitative findings indicated that the highest preference was for wearable smoking cessation smartwatches, interactive mobile applications, and the use of intelligent smoking cessation technologies. In the qualitative phase, eight subcategories were identified: high effectiveness and efficiency, better management of the quitting process, personalized technologies, safe and side-effect-free technologies, attractive and innovative designs, scientific basis, mobile applications, and smart monitoring devices for smoking cessation. By merging the quantitative and qualitative results, it was concluded that users primarily seek wearable technologies and interactive mobile applications for smoking cessation. Conclusion: The integration of quantitative and qualitative data indicates that smoking behavior among participants is influenced by a complex interaction of social, familial, psychological, and environmental factors. Findings from this study suggest that non-invasive stimulation technologies can positively impact reducing cravings and urges, increasing resistance to smoking triggers, and modifying smoking behaviors. These technologies can be used as effective tools alongside other treatments to enhance outcomes and support coping mechanisms for managing cravings and withdrawal symptoms. The study’s findings can assist developers of smoking cessation technologies design and improving their tools based on user needs and preferences to enhance effectiveness and acceptability.