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This study investigated the feasibility of a cognitive dissonance-based mobile app for smoking cessation (CDI). Cognitive dissonance refers to the conflict between beliefs and behaviors; interventions are designed to promote this conflict to motivate people to change their behavior. Recent research has demonstrated the efficacy and potential of using cognitive dissonance interventions for a wide range of health and behavioral problems including smoking cessation. This study developed an initial version of the CDI mobile app and evaluated the app in an evaluation study with 60 adult smokers.
An initial version of the CoQuit app was developed and tested with 60 adult smokers. All participants were recruited through social media and were screened and consented online. After enrolling, participants received a link to the baseline survey which asked about past and current tobacco use, nicotine dependence, motivation to quit, cognitive dissonance and demographic information. All participants were assigned to an online support group of 5 or 6 people. The group received simultaneous invites to the app so they were able to move through the 25 day program together. The app contained short videos of a CoQuit facilitator who presented instructions for specific tasks, such as writing a brief letter to a friend or family member explaining their commitment to stop smoking. Participants recorded videos of themselves related to these activities and posted the videos within the app where they were viewed by other members of the group. All participants completed a six weeks post baseline online assessment asking about past and current tobacco use, quit attempts, as well as feedback on usability and possible improvements to the app.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Intervention | Experimental | All participants will use the CoQuit App for Smoking Cessation |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| CoQuit App | Behavioral | The CoQuit App is a cognitive dissonance based app for smoking cessation. |
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| Measure | Description | Time Frame |
|---|---|---|
| Cognitive Dissonance | Participants were asked to give a "gut-level response" to 14 words used to describe various attributes of cognitive dissonance (e.g., uncomfortable, shame). Response options for each attribute were on a 7-point scale (1 = does not apply at all, 7 = applies very much). A mean score was computed across all 14 words. A higher score was associated with greater levels of cognitive dissonance. In addition to the baseline and six-week follow-up assessment of cognitive dissonance, participants were asked five times during the 25 days of using the app. The five times were after completing the "Costs" activity on day 3, the "Quit Letter" activity on day 6, the "Planning for Pitfalls" activity on day 10, the "Staying Smoke Free" activity on day 14, and the "Letter to Youth" activity on day 19. | Baseline, 5 times during app use (days 3, 6, 10, 14 and 19 of the 25 day program), Six weeks post baseline |
| Number of Participants With Number Cigarettes Smoked Per Day | A one-item question that asked about the number of cigarettes smoked per day. Response options were on a 6-point scale, where 1 = 5 or less, 2 = 6-10, 3 = 11-15, 4 = 16-20, 5 = 21-30, and 6 = 31 or more. A higher score indicates a greater number of cigarettes smoked per day. | Baseline and Six Weeks Post Baseline |
| Measure | Description | Time Frame |
|---|---|---|
| Readiness to Quit | Participants were asked to rate what best describes how they currently think about quitting smoking. The one item had a 1-point scale (0 = I have no thought about quitting smoking, 2 = I think I need to consider quitting smoking someday, 5 = I think I should quit smoking, but I am not quite ready, 8 = I am starting to think about how to reduce the number of cigarettes I smoke a day, 10 = I am taking action to quit smoking, 11 = I have stopped smoking). A higher score was associated with greater readiness to quit smoking. In addition to the baseline and six-week follow-up assessment of readiness to quit, participants were asked five times during the 25 days of using the app. The five times were after completing the "Costs" activity on day 3, the "Quit Letter" activity on day 6, the "Planning for Pitfalls" activity on day 10, the "Staying Smoke Free" activity on day 14, and the "Letter to Youth" activity on day 19. |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Dana Smith, PhD | Influents Innovations/Oregon Research Institute | Principal Investigator |
| Herb Severson, PhD | Influents Innovations/Oregon Research Institute | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| ORBIS/Oregon Research Institute | Springfield | Oregon | 97477 | United States |
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| ID | Title | Description |
|---|---|---|
| FG000 | Intervention | All participants will use the CoQuit App for Smoking Cessation CoQuit App: The CoQuit App is a cognitive dissonance based app for smoking cessation. |
| Title | Milestones | Reasons Not Completed | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
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| ID | Title | Description |
|---|---|---|
| BG000 | Intervention | All participants will use the CoQuit App for Smoking Cessation CoQuit App: The CoQuit App is a cognitive dissonance based app for smoking cessation. |
| Units | Counts |
|---|---|
| Participants |
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| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Mean |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Cognitive Dissonance | Participants were asked to give a "gut-level response" to 14 words used to describe various attributes of cognitive dissonance (e.g., uncomfortable, shame). Response options for each attribute were on a 7-point scale (1 = does not apply at all, 7 = applies very much). A mean score was computed across all 14 words. A higher score was associated with greater levels of cognitive dissonance. In addition to the baseline and six-week follow-up assessment of cognitive dissonance, participants were asked five times during the 25 days of using the app. The five times were after completing the "Costs" activity on day 3, the "Quit Letter" activity on day 6, the "Planning for Pitfalls" activity on day 10, the "Staying Smoke Free" activity on day 14, and the "Letter to Youth" activity on day 19. | Due to conceptual concerns about imputing smoking status, decreases in smoking from pretest to posttest were evaluated with participants who completed both the pretest and posttest assessment | Posted | Mean | Standard Deviation | units on a scale | Baseline, 5 times during app use (days 3, 6, 10, 14 and 19 of the 25 day program), Six weeks post baseline |
6 weeks
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Intervention | All participants will use the CoQuit App for Smoking Cessation CoQuit App: The CoQuit App is a cognitive dissonance based app for smoking cessation. |
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Dr. Dana Smith | Oregon Research Behavioral Intervention Strategies Inc. | 541-484-2123 | danas@ori.org |
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot_SAP_ICF | Yes | Yes | Yes | Study Protocol, Statistical Analysis Plan, and Informed Consent Form | May 5, 2020 | Jul 3, 2025 | Prot_SAP_ICF_000.pdf |
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| ID | Term |
|---|---|
| D016540 | Smoking Cessation |
| ID | Term |
|---|---|
| D015438 | Health Behavior |
| D001519 | Behavior |
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| Baseline, 5 times during app use (days 3, 6, 10, 14 and 19 of the 25 day program), Six weeks post baseline |
| years |
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| Sex: Female, Male | Count of Participants | Participants |
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| Race (NIH/OMB) | Count of Participants | Participants |
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| Education Level | Count of Participants | Participants |
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| ID |
|---|
| Title |
|---|
| Description |
|---|
| OG000 | Intervention | All participants will use the CoQuit App for Smoking Cessation CoQuit App: The CoQuit App is a cognitive dissonance based app for smoking cessation. |
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| Primary | Number of Participants With Number Cigarettes Smoked Per Day | A one-item question that asked about the number of cigarettes smoked per day. Response options were on a 6-point scale, where 1 = 5 or less, 2 = 6-10, 3 = 11-15, 4 = 16-20, 5 = 21-30, and 6 = 31 or more. A higher score indicates a greater number of cigarettes smoked per day. | Due to conceptual concerns about imputing smoking status, decreases in smoking from pretest to posttest was evaluated with participants who completed both the pretest and posttest number of cigarettes smoked item. | Posted | Count of Participants | Participants | Baseline and Six Weeks Post Baseline |
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| Secondary | Readiness to Quit | Participants were asked to rate what best describes how they currently think about quitting smoking. The one item had a 1-point scale (0 = I have no thought about quitting smoking, 2 = I think I need to consider quitting smoking someday, 5 = I think I should quit smoking, but I am not quite ready, 8 = I am starting to think about how to reduce the number of cigarettes I smoke a day, 10 = I am taking action to quit smoking, 11 = I have stopped smoking). A higher score was associated with greater readiness to quit smoking. In addition to the baseline and six-week follow-up assessment of readiness to quit, participants were asked five times during the 25 days of using the app. The five times were after completing the "Costs" activity on day 3, the "Quit Letter" activity on day 6, the "Planning for Pitfalls" activity on day 10, the "Staying Smoke Free" activity on day 14, and the "Letter to Youth" activity on day 19. | Due to conceptual concerns about imputing smoking data, readiness to quit from was evaluated with participants who completed both the pretest and posttest readiness items. | Posted | Mean | Standard Deviation | units on a scale | Baseline, 5 times during app use (days 3, 6, 10, 14 and 19 of the 25 day program), Six weeks post baseline |
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| 0 |
| 72 |
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| 72 |
| 0 |
| 72 |
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| 16-20 |
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| 21-30 |
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| 31 or more |
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| 6 Weeks Post Baseline |
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| Title | Measurements |
|---|---|
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| In app 3 - After Pitfalls Activity |
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| In app 4 - After Smoke Free Activity |
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| In app 5 - After Letter to Youth Activity |
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| 6 week Post Baseline |
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| .219 |
| Mean Difference (Final Values) |
| -0.72 |
| Standard Error of the Mean |
| 0.45 |
| 2-Sided |
| Superiority |
This model is a paired t-test that tests for change in readiness to quit smoking from baseline to after the Quit Latter activity |
| t-test, 2 sided | .043 | Mean Difference (Final Values) | -1.29 | Standard Error of the Mean | 0.55 | 2-Sided | Superiority | This model is a paired t-test that tests for change in readiness to quit smoking from baseline to after the Pitfalls activity |
| t-test, 2 sided | .219 | Mean Difference (Final Values) | -0.98 | Standard Error of the Mean | 0.67 | 2-Sided | Superiority | This model is a paired t-test that tests for change in readiness to quit smoking from baseline to after the Smoke Free activity |
| t-test, 2 sided | .110 | Mean Difference (Final Values) | -1.41 | Standard Error of the Mean | 0.54 | 2-Sided | Superiority | This model is a paired t-test that tests for change in readiness to quit smoking from baseline to after the Letter to Youth activity |
| t-test, 2 sided | .868 | Mean Difference (Final Values) | 0.02 | Standard Error of the Mean | 0.26 | 2-Sided | Superiority | This model is a paired t-test that tests for change in readiness to quit smoking from baseline to 6 week post baseline assessment |