The feasibility of implementing text messaging system to support smoking cessation for smokers in Hanoi
ISSN: 1859-2171
e-ISSN: 2615-9562
TNU Journal of Science and Technology
225(05): 69 - 76
THE FEASIBILITY OF IMPLEMENTING TEXT MESSAGING SYSTEM
TO SUPPORT SMOKING CESSATION FOR SMOKERS IN HANOI
Doan Thi Hue1*, Nguyen Thi Trang2, Donna Shelley3, Kim Bao Giang4, Nguyen Truong Nam4
1TNU - University of Medicine and Pharmacy, 2Institute of Social & Medical Studies,
3NYU Langone Hospitals, 4Hanoi Medical University
ABSTRACT
The study was carried out to assess the feasibility of implementing text messaging system to
support smoking cessation smokers in Hanoi. This was a pilot study done on 40 smokers in Hanoi.
The participants received short message service texting within 6 weeks to get smoking cessation
support. The study was an intervention one which compared the participants’ smoking before and
after the intervention done. The participants were interviewed directly with a questionnaire that
includes the following contents: suitability of number/ content of messages, frequency/ time of
sending messages, use of received messages, interaction with the program, satisfaction with the
messaging system, and change in smoking behavior. The results showed that there were 82.5%
reading/using text messages daily, 82.5% interacted with program – by 2-way text messaging;
90% of the participants found the messages useful; 97.7% were satisfied with the program. The
researched subjects commented that the program was easy to use. 20% of the participants quit
smoking/ waterpipe tobacco completely; 15% quit smoking but still smoke waterpipe tobacco.
Smoking behavior changed positively compared to the initial survey; the statistical significance
included the number of cigarettes/waterpipe tobaccos smoked a day, the status of smoking
cigarettes/waterpipe tobacco (p <0.001). The rate of research subjects who tried to stop smoking
cigarettes/pipe tobacco in 4 weeks was quite high (52.5% before the intervention and 25% after the
intervention). This study provided evidence of the feasibility of the use of a text messaging
program to provide intervention supports in smoking cessation for Vietnamese people.
Key words: smoking cessation; Interventions, adults; SMS texting, mhealth
Received: 25/3/2020; Revised: 29/4/2020; Published: 29/4/2020
TÍNH KHẢ THI CỦA VIỆC TRIỂN KHAI HỆ THỐNG TIN NHẮN
HỖ TRỢ CAI THUỐC LÁ CHO NGƯỜI HÚT THUỐC TẠI HÀ NỘI
Đoàn Thị Huệ1*, Nguyễn Thị Trang2, Donna Shelley3, Kim Bảo Giang4, Nguyễn Trương Nam4
1Trường Đại học Y Dược – ĐH Thái Nguyên, 2Viện Nghiên cứu Y - Xã hội học,
3Bệnh viện NYU Langone, 4Trường Đại học Y Hà Nội
TOM TẮT
Nghiên cứu này được thực hiện nhằm đánh giá tính khả thi của việc triển khai hệ thống tin nhắn (SMS)
hỗ trợ cai thuốc lá. Nghiên cứu thử nghiệm trên 40 người hút thuốc lá tại Hà Nội. Đối tượng nghiên cứu
nhận tin nhắn điện thoại hỗ trợ cai thuốc lá trong 6 tuần. Thiết kế nghiên cứu can thiệp, so sánh trước và
sau can thiệp. Đối tượng nghiên cứu được phỏng vấn trực tiếp bằng bộ câu hỏi gồm: sự phù hợp số
lượng/nội dung SMS, tần suất/thời gian gửi tin, sử dụng tin nhắn nhận được, tương tác với chương
trình, hài lòng với chương trình tin nhắn; thay đổi hành vi hút thuốc. Kết quả nghiên cứu cho thấy: có
82,5% đối tượng nghiên cứu đọc/ sử dụng tin nhắn hàng ngày, 82,5% người tương tác với chương trình
- SMS hai chiều, 90% người thấy tin nhắn hữu ích, 97,7% hài hòng. Đối tượng nghiên cứu nhận xét
chương trình dễ sử dụng và 92,5% bạn bè người thân đều khuyến khích đối tượng tham gia sử dụng
chương trình. Có 20% đối tượng nghiên cứu bỏ thuốc lá/thuốc lào hoàn toàn, 15% đối tượng nghiên
cứu bỏ thuốc lá nhưng vẫn hút thuốc lào. Hành vi hút thuốc lá thay đổi tích cực so với khảo sát ban đầu.
Có ý nghĩa thống kê bao gồm số lượng điếu thuốc lá/thuốc lào hút/ngày, tình trạng hút thuốc lá/thuốc
lào (p<0,001). Tỷ lệ đối tượng nghiên cứu từng cố gắng cai thuốc lá/thuốc lào trong 4 tuần khá cao
(trước can thiệp: 52,5%, sau can thiệp: 25%). Như vậy, việc áp dụng một chương trình SMS hỗ trợ can
thiệp cai nghiện thuốc lá cho người Việt Nam là có tính khả thi.
Từ khóa: cai thuốc lá; can thiệp; người trưởng thành; tin nhắn SMS; ứng dụng y tế điện thoại.
Ngày nhận bài: 25/3/2020; Ngày hoàn thiện: 29/4/2020; Ngày đăng: 29/4/2020
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TNU Journal of Science and Technology
225(05): 69 - 76
Some authors have studied the feasibility and
acceptability of text messaging intervention
programs on elderly people living in rural
areas in the US; the results showed that 81% of
the participants could read all the information
and found that text messages very useful as a
measure to support smoking cessation; the rate
of smoking cessation in the intervention group
decreased significantly [5], [10], [11], [12]. In
Vietnam up to now, there have not been any
research projects on the implementation of
mobile phone-based messaging system to
support smoking cessation.
1. Introduction
According to estimates from the 2015
smoking survey on adults (aged 15 and over),
Vietnam is a country with the high rate of
smoking in Asia [1]. The smoking rate in
adults in Vietnam was 22.5%, of which,
45.3% was males, and 1.1% was females; in
total there were 15 million adults smoking
cigarettes and water-pipe tobacco [2].
Tobacco use is the leading, but interventional
and preventable, common cause of many fatal
diseases in the world. Tobacco use increases
the risk of myocardial ischemia more than 2.5
times, lung cancer more than about 20 times,
etc [3], [4]. The total cost of treatment and
loss of ability to work due to illnesses and
premature deaths in 5 common tobacco-
related diseases including lung cancer, upper
digestive-respiratory tract cancers, myocardial
infarction, stroke, and COPDs is more than
VND 23,000 billion per year [5].
Institute of Medical Research - Sociology
(ISMS), New York University of Medicine
(NYUSOM), and Hanoi Medical University
have cooperated to implement the project of
developing and testing the mobile phone-
based message system to support smoking
cessation in Nam Tu Liem District, Hanoi
city. The study was carried out to assess the
feasibility of implementing text messaging
system to support smoking cessation smokers
in Hanoi.
In recent years, in Vietnam, the activities of
preventing tobacco-related harms have made
significant progress and achievements
including communication activities on health
education, building smoke-free environments,
controlling sources of supplying tobacco
products, setting up a fund to prevent tobacco
harms from tobacco enterprises’ revenues.
However, activities to support smoking
cessation have just been implemented in some
Central and provincial hospitals [6], [7].
2. Research subjects and methods
2.1. Research subjects
Criteria for selecting participants: Participants
are smokers (including cigarette/ware pipe
dua users) who are 21 - 55 years old, smoke
cigarettes (including water-pipe tobacco)
daily and use 5 or more cigarettes per day;
they are now living in Nam Tu Liem district;
they wish to quit smoking/water-pipe
tobacco; they consider or intend to quit in the
next month; they own at least one mobile
phone; they desire to receive mobile phone
messages of support for quitting; they are not
taking any quit smoking counseling or using
nicotine patches or other smoking cessation
medications.
The rapid development of mobile medical
technology has offered unprecedented
opportunities to improve health services and
bring them to more people. Mobile text-based
short messaging (SMS) can provide smoking
cessation assistance to people in the
community, and the effectiveness of SMS
programs has been reported in other countries
in the world with different population groups
[8]-[10]. There have been more and more
studies proving the effectiveness of text-based
smoking cessation interventions, but these
have largely been done in western countries.
Selection method: Medical collaborators
(MCs) introduced the study through
community meetings and offered invitations
to participate in the study. Smokers were
invited to come for the baseline survey, were
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225(05): 69 - 76
explained about the research carefully, agreed
to participate in the study and met the criteria
for selecting study subjects.
Data collection methodology:
- Baseline assessment: direct interviews using
the questionnaires covering topics such as:
demographics, smoking history, use of other
addictive substances, family smoking policy,
three top factors that make people want to
smoke, social norms on tobacco use, level of
confidence in quitting smoking, social
behavior of smoking, and getting social
support to quit and use mobile phones and
text messaging features on mobile phones
2.2. Research location
Ha Noi is a densely populated city with 29
districts. The research got support from the
Nam Tu Liem District Health Center during
the recruitment of participants. Nam Tu Liem
District has an area of 32.27 km2 and a
population of 236,700 people (12/2017).
Thus, the study was conducted in 2 wards of
Nam Tu Liem District in Hanoi City [8].
- Assessment after 4 weeks of intervention:
direct interview using the pre-designed
questionnaires covering the following
contents: Feasibility: 1) rate of the smokers
with eligibility, 2) recruitment rate; 3)
retention rate; Suitability: quantity / content
of appropriate messages, frequency/time of
delivering messages, use of received
messages, interaction with the program
(frequency of 2-way messaging feedbacks,
responses to daily surveys, responses to
weekend surveys), satisfaction with the text
messaging system; Changes in smoking
behaviors: Smoking cessation is measured by
not smoking even once in the past 4 weeks
and confirmed by measuring carbon
monoxide level (CO <10 ppm), attempts to
quit, attempts to cut down on smoking
tobacco, water-pipe tobacco.
2.3. Research design
The pilot study started from April to
September 2018, delivering SMSs to 40
subjects to assess the feasibility of the text
messaging system. The study included a
baseline survey and a survey after 6 weeks of
intervention.
Intervention description: The messaging
system was designed based on two messaging
systems: smokefree.gov/txt and Text2Quit
with the technical support from Voxiva nc,
tested in western countries and completely
free. These two message libraries have been
translated from English into Vietnamese in
the right process. The total number of
messages in the entire process was 188,
divided into the following stages: The
messages before the day of smoking was 34
messages; The day of quitting smoking: 4
messages; After the day of quitting smoking:
83 messages; Messages of tips: 22 messages;
Daily survey messages: 1 message / day
(Fig.1) [8].
2.4. Data analysis
Stata 12.0 software was used to analyze data
2.5. Ethical issues in research
Subjects invited to participate in the study
were fully explained about the content,
purpose and rights of participants, and signed
agreements to participate in the research. The
study was approved by the ethics council of
New York Medical University (NYUSOM),
the Institute of Medical Research - Sociology
(ISMS) and Hanoi Medical University.
3. Research results
Figure 1. The process of sending messages and
the number of messages delivered in 6 weeks
3.1. Characteristics of participants
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225(05): 69 - 76
Table 1. Characteristics of participants
Features (N = 40)
n
%, mean (SD)
Gender
Male
Female
40
0
100
0
Age (mean)
38.8 (+ 10.7)
Marital status
Married
Single/Never married
Education
33
7
82.5
17.5
Junior Secondary School
Secondary School
Vocational education /College
University/Post-graduate
Occupation
11
15
6
27.5
40.0
15.0
17.5
7
Civil servants
Working for foreign agencies
Business/freelance
10
9
14
7
25.0
22.5
35.0
17.5
Househusband wife)/
unemployed/students/retirement
Total household income / last 12 months (n=39)
< VND 50 million
VND 50 million - < VND100 million
VND100 million - < VND 300 million
> VND 300 million
The first smoking time of the day after getting up
< less than 5 minutes
5 - 30 minutes
6
29
2
15.0
72.5
5.0
2
5.0
6
14
4
15.0
35.0
10.0
40.0
31 – 60 minutes
> 60 minutes
16
Smoking status
Smoking only cigarettes
Smoking both cigarettes and water-pipe
tobacco
17
23
42.5
57.5
Mobile phone usage
Using smartphones
Using ordinary mobile phones
Numbers of delivered/received messages/week
1 - 10
34
6
85.0
15.0
7
24
9
22.5
60.0
17.5
11 - 50
> 50
Table 1 reveals that 100% of the participants were male; the average age was 38.8 years old, 82.5%
married; most of them had the education level from high school up to university (40%, 15% and
17.5 %); 25% of the participants were civil servants and 35% of people were freelance traders. The
family income from 50 million to <100 million accounted for the highest rate of 72.5%. 57.5% of
smokers/pipe tobacco smokers; 85% of participants use smartphones; 60% send/receive 11- 50
messages /week.
3.2. The feasibility
The results in table 2 reveal that most research participants commented that the number of messages
of the program was moderate (80%); the frequency of reading messages was 82.5%. They rated the
overall experience of the text messaging program very positively; 90% rated the messages quite
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225(05): 69 - 76
useful/very useful; 82.5% interacted with the program; only 78.8% responded to the message in the
correct syntax; the program satisfaction rate was very high with 97.5%.
Table 2. Assessing the participants’ overall experience with the program after 6 weeks
Features
n
%
Number of messages received from the program
Too small
Moderate
Too big
1
32
7
2.5
80.0
17.5
Frequency of reading messages
Sometimes
7
33
17.5
82.5
Usually/Always
Frequency of applying the information from the program
Sometimes
24
16
60.0
40.0
Usually/Always
The level of concern if others see the messages you receive from the program
Worry-free
39
1
97.5
2.5
Worry a little / worry a lot
Overall overview of the usefulness of the messages
A little useful
4
36
10.0
90.0
Quite useful/very useful
The level of your satisfaction with the program
Unsatisfied
1
2.5
Satisfied/Very satisfied
Interaction with the program (2-way messages)
Feedback messages in the correct syntax (n = 33)
39
33
26
97.5
82.5
78.8
Table 3. Assessment of participants’ general experience of the program after 6 weeks of intervention
Features
Agree/Strongly
agree (%)
Mean Scores
(Mean)
25.8
Expect efficiency from the program (score range from 8 to 32)a
Messages to help with smoking cessation
Learn a lot via using the program
95.0
95.5
97.5
3.15
3.27
3.10
Text messaging program helps me gain
confidence to quit smoking
The messages motivated me to quit smoking
The messages helped me deal with cravings for smoking
Get motivated to try to quit smoking
97.5
92.5
92.5
97.5
92.5
3.27
3.22
3.20
3.42
3.12
6.4
3.17
3.2
6.2
Trust the information in the messages
Feel the messages were designed suitably
Expectattempts to quit smoking (score range2-8)b
Use the text messaging program easily
95.0
97.5
The text messaging program was easy to use
Social influences (score range 2-8)c
People who are important to me think that I should use the
text messaging program
92.5
90.0
3.15
People who influence me think I should use the text
messaging program
3.07
Good conditions (score range 3-12)d
9.4
Have necessary knowledge necessary to use the program
The messages are easy to understand
Text messaging program suitable for my mobile phones
Motivation for enjoyment (score range 5-20)e
The use of text messaging program was funny
Desire to use the text messaging program
92.5
92.5
95.0
3.07
3.17
3.17
14.9
3.02
3.17
87.5
87.5
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TNU Journal of Science and Technology
Features Agree/Strongly
225(05): 69 - 76
Mean Scores
(Mean)
2.00
agree (%)
12.5
The use of text messaging program was boring
The messages bothered me
7.5
2.02
Using the text messaging program helped me entertain
62.5
2.67
6.1
Values/price (score range 2-8)f
Worthy of the time I spent
92.5
85.0
3.07
3.05
The free messaging program has increased my possibility to
use the program
Habits (score range 2-8)g
5.8
2.82
2.95
6.0
3.02
2.95
Want to use the messaging program every day
The use of the messaging program has become natural
Intended behaviors (score range 2-8)h
Want to continue to use the program if available
Will use themessaging program every day if theprogram isavailable
85.0
87.5
85.0
82.5
Table 3 reveals that most of research participants highly appreciate and have a positive view on
the text messaging program for interventions in smoking cigarettes/water-pipe tobacco cessation.
More than 95% of subjects expected to quit smoking after joining the program. More than 95% of
smoking cessation made attempts; more than 90% rated the program facilitated smoking cessation.
More than 85% of the participants found the program worthy of the time they spent, and wanted to
continue using the program if available (85%). However, 7.5% thought the message bothered them.
3.3. Change in smoking behaviors after intervention
Table 4. The rate of total abstinence within 6 weeks (having not smoked in the past 7 days and CO
breathing <10 ppm)
Features
Quit smoking cigarettes/water-pipe tobacco completely
Quit smoking cigarettes, but still smoke water-pipe tobacco
Still smoke both cigarettes and water-pipe tobacco
n
8
6
%
20.0
15.0
65.0
26
Table 4 shows that 20% of the participants quit smoking cigarettes/water-pipe tobacco completely;
15% stopped smoking cigarettes, but still continued smoking water-pipe tobacco. The percentage of
participants still smoked cigarettes/water-pipe tobacco was 65 %.
Table 5. Change in smoking behaviors after 6 weeks of interventions
Features
Baseline survey
(n, %, Mean
+ SD)
After 6 weeks
(n, %, Mean
+ SD)
p
Number of cigarettes smoked/day, average
Number of water-pipe tobacco smoked/day, average
Frequency of smoking cigarettes now
Sometimes
18.0
11.8
3.0
2.0
<0.001
<0.005
2.5
97.5
53.8
46.2
<0.001
Every day
Frequency of smoking water-pipe tobacco now
Sometimes
34.8
65.2
56.3
4.4
Every day
< 0.1
No cigarette use/quit attempts made over 4 weeks after
the program started
21 (52.5%)
No water-pipe tobacco use/quit attempts made over 4
weeks after the program started
10 (25%)
Table 5 reveals that the changes were statistically significant in the number of cigarettes
smoked/day, smoking status (p <0.001); the number of cigarettes smoked per day (p <0.005),
current status of water-pipe tobacco smoking (p <0.1). There were 52.5% of participants who
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225(05): 69 - 76
tried to quit smoking cigarettes and 25% who tried to stop smoking water-pipe tobacco within 6
weeks participating in the program.
4. Discussion
smoking status (p <0.001), number of
cigarettes smoked per day (p <0.005),
waterpipe tobacco smoking (p <0.1). The rate
of research participants who tried to quit
smoking cigarettes/ water-pipe tobacco within
6 weeks was quite high.
4.1. Feasibility
Most subjects participated in the reading and
using messages programs every day (82.5%).
The level of interaction of research
participants with the program was very high,
which is similar to the results found in other
studies [12], [13]. Our results once again
show that text messaging-based smoking
cessation intervention programs are highly
feasible, because the messages in the program
are directly delivered to the smokers for the
sake of smoking cessation [11], [12]. The
relatively high interaction between research
participants and the intervention program
could be due to the average age group in the
study was only 38.8 (+ 10.7), and most
research participants have smartphones
(85%); 90% of them found the messages
useful / very useful; 82.5% interacted with the
program via 2-way messages, but only 78.8%
responded to the messages with the correct
syntax; 97.6% were satisfied with the program.
The participants found the program easy to use.
Overall, the study proves that a text messaging-
based support program for smoking cessation is
likely to be accepted in Vietnam.
5. Conclusion
This study demonstrated the advantages of
applying a supportive messaging program to
help a group of smokers in Hanoi to quit
smoking, and showed that a program can be
designed to meet all the needs of
interventions for all groups of smokers in
other areas. It might suggest that there should
be a need to expand this smoking cessation
intervention program: They rated the overall
experience of the text messaging program
very positively; 90% rated the messages quite
useful/very useful; 82.5% interacted with the
program; only 78.8% responded to the
message in the correct syntax; the program
satisfaction rate was very high with 97.5%.
Most research participants commented that
the number of messages of the program was
moderate (80%); the frequency of reading
messages was 82.5%. Most of research
participants highly appreciate and have a
positive view on the text messaging program
for interventions in smoking cigarettes/water-
pipe tobacco cessation. More than 95% of
subjects expected to quit smoking after
joining the program.
4.2. Change in smoking behaviors
Although the result of quitting is not the main
objective in this study, there are still 8
participants who completely quit smoking
cigarettes/water-pipe tobacco (20%),
6
The text messaging-based support program
for smoking cessation can be used as an
independent intervention supporting method
or used to supplement or combine with other
services, such as group counseling and
telephone counseling. More than 95% of
smoking cessation made attempts; more than
90% rated the program facilitated smoking
cessation. More than 85% of the participants
found the program worthy of the time they
participants who quit smoking cigargettes,but
still smoked water-pipe tobacco (15%). Our
results are similar to those carried out in some
other countries in the world [12] and [14].
After 6 weeks of intervention, 65% still
smoked. However, smoking cigarettes/
smoking waterpipe tobacco behaviors have
changed positively compared to the baseline
survey; statistical analyses
include the
number of cigarettes smoked/day (p <0.001),
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225(05): 69 - 76
[5]. World Health Organization, "WHO report on
the global tobacco epidemic 2019", 2019.
cco/global_report/en/. [Accessed July 29, 2019].
[6]. Bach Mai Hospital, "An Evaluative Study of
the Smoking Cessation Quitlines at Bach Mai
Hospital," Report from VINACOSH, 2016.
[7]. V. P. Dang and N. K. Luong, Ministry of
Health of Viet Nam Smoking Cessation
Guidelines, 2018.
[8]. R. S. Donna, and N. T. Nguyen, "Feasibility
and Acceptability of a Text Messaging
Intervention to Increase Smoking Cessation in
Vietnam", 2017. [Online]. Available:
mhealth-R21CA225852.aspx. [Accessed Aug.
28, 2019].
spent, and wanted to continue using the
program if available (85%). However, 7.5%
thought the message bothered them. 20% of
the participants quit smoking cigarettes/water-
pipe tobacco completely; 15% stopped
smoking cigarettes, but still continued
smoking water-pipe tobacco. The percentage
of participants still smoked cigarettes/water-
pipe tobacco was 65 %. There were 52.5% of
participants who tried to quit smoking
cigarettes and 25% who tried to stop smoking
water-pipe tobacco within
6
weeks
participating in the program (p <0.001).
Although this study provides evidence of
feasibility, future large-scale studies will be
needed to evaluate the effectiveness of the
program in other areas and across the country.
[9]. X. B. Tran et al., "Feasibility of e-Health
Interventions on Smoking Cessation among
Vietnamese Active Internet Users," Int. J.
Environ. Res. Public Health, 15(165), pp. 2-8,
2018.
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Adults in Lima, Peru: Pilot Study," JMIR
MHealth UHealth, 5(8), p. e116, 2017.
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