Individuals who have mixed feelings about smoking may find value in utilizing a mobile health application (GEMS) focused on assisting in quitting or reducing smoking, even if they do not have immediate intentions of altering their behavior.

A randomized pilot study was conducted to evaluate the potential impact, acceptability, and feasibility of a novel mobile health application (mHealth app) designed for individuals who smoke and aspire to quit at some point but currently have mixed feelings about quitting in the immediate future.

The study included 60 adults who smoked >10 cigarettes daily and had mixed feelings about quitting. These volunteers were randomized into 2 groups, with each group using a different version of the GEMS app: Enhanced care (EC) and standard care (SC). Both versions had a comparable layout and provided evidence-based guidance and resources for smoking cessation, including the option to earn free nicotine patches.

However, the EC version offered additional features, such as a series of exercises called experiments. These exercises were designed to assist ambivalent smokers in clarifying their objectives, strengthening their motivation, and acquiring essential behavioral skills for modifying their smoking habits, all without committing to quitting outright. The study's outcomes were assessed by utilizing data automatically collected by the app and through self-reported surveys conducted at the 1-month and 3-month marks after enrollment.

The individuals who downloaded the app (95%, 57 out of 60 participants) were predominantly female, of White ethnicity, faced socioeconomic disadvantages, and displayed a high level of nicotine dependency. As anticipated, the key results leaned toward the EC group. When compared to SC users, those in the EC group exhibited higher levels of engagement, with a mean of 19.9 sessions compared to 7.3 sessions for SC users. A deliberate attempt to quit smoking was reported by 37.9% (11/29) of SC users and 39.3% (11/28) of EC users.

During the 3-month follow-up, 14.7% (4 out of 28) of individuals using EC and 6.9% (2 out of 29) of SC users achieved a seven-day period of smoking abstinence. Among the participants who qualified for a complimentary trial of nicotine replacement therapy on the basis of their app usage, 36.4% (8 out of 22) of EC participants and 11.1% (2 out of 18) of SC participants opted for the treatment. Overall, 17.9% (5 out of 28) of EC users and 3.4% (1 out of 29) of SC users made use of an in-app feature to reach out to a toll-free tobacco quitline. Other performance metrics were also favorable.

EC volunteers completed an average of 6.9 (standard deviation 3.1) out of 9 experiments. The median ratings for the helpfulness of completed experiments fell between 3 and 4 on a 5-point scale. Lastly, user satisfaction with both versions of the app was highly positive, with a mean rating of 4.1 on a 5-point Likert scale, and an impressive 95.3% (41 out of 43) of all respondents expressing their willingness to recommend their respective app version to others.

Smokers who had mixed feelings about quitting smoking were open to the intervention through the app. However, the EC version, which integrated best-practice cessation guidance with self-guided experiential activities, showed increased usage and signs of behavior change. This suggested the need for more development and assessment of the EC program.