This research aims to assess the impact of instant messaging reinforcement on the learning outcomes of smoking cessation counseling (SCC) training among master of nursing (MN) students at the University of Hong Kong. The hypotheses suggest that this reinforcement can enhance students' SCC knowledge and techniques, improve their perception of SCC, and increase their application of SCC in clinical work.

The study is a pragmatic randomized controlled trial (RCT) with a 1:1 allocation ratio, using WhatsApp Messenger (WhatsApp) messages for intervention and control groups. The intervention group receives messages related to SCC, while the control group receives generic mental health information. The subjects are MN students enrolled in the "Tobacco Dependency Nursing Intervention and Management" course.

The study uses various tools for measurement, including Ecological momentary assessment (EMA) and Providers Smoking Cessation Training Evaluation (ProSCiTE). The main outcome measures include SCC practice frequency, SCC knowledge score, SCC attitude score, and SCC practice score.

Data analysis will be performed in Statistical Package for the Social Sciences (SPSS), using descriptive statistics, intention-to-treat analysis, Chi-square and t-tests, Cohen's d for effect size, and linear mixed models. The expected results suggest that instant messaging reinforcement will enhance SCC knowledge, attitude, and practice among MN students.

This study aims to evaluate the efficacy of instant messaging reinforcement on the learning outcomes of smoking cessation counseling (SCC) training among master of nursing (MN) students at the University of Hong Kong.

Hypotheses to be tested: (1) Instant messaging reinforcement can increase MN students' mastery of SCC knowledge and techniques. (2) Instant messaging reinforcement can increase MN students' positive perception towards SCC and their willingness to provide SCC in their clinical work. (3) Instant messaging reinforcement can increase MN students' SCC practice, i.e. the frequency at which they perform Ask, Advise, Assess, Assist, and Arrange (5As), during their clinical work.

Design and subjects: This proposed study is a 2-arm, placebo-control, pragmatic randomized controlled trial (RCT) with a 1:1 allocation ratio. The intervention involves sending reinforcement WhatsApp messages to participants. To ensure that the subjects do not know their assigned group, the investigators also sent WhatsApp messages to the control group, but these messages are unrelated to smoking cessation counseling. The targeted subjects are MN students who are taking the course "Tobacco Dependency Nursing Intervention and Management (NURS8205)" in the spring semester of 2024. The course mentioned would be attended by all students regardless of their participation in this study.

Intervention group: 3 WhatsApp messages per week for six weeks after course training. These messages are about the core content of the course developed based on the Knowledge-Attitude-Practice (KAP) model.

Control group: WhatsApp messages about generic mental health information with the same frequency and schedule as the intervention group.

Instruments: Ecological momentary assessment (EMA) measurement of SCC practice frequency; Providers Smoking Cessation Training Evaluation (ProSCiTE); Self-compiled questionnaire on SCC knowledge; Self-compiled baseline questionnaire.

Main outcome measures: (1) MN students' SCC practice frequency, measured by EMA; (2) MN students' SCC knowledge score, measured by self-compiled questionnaire; (3) MN students' SCC attitude score, measured by attitude subscale of Providers Smoking Cessation Training Evaluation (ProSCiTE); (4) MN students' SCC practice score, measured by behavior subscale of Providers Smoking Cessation Training Evaluation (ProSCiTE).

Data analysis: Data analysis will be conducted in SPSS for Windows (version 20), using descriptive statistics (frequency, percentage, mean) to summarize outcomes and variables. Intention-to-treat analysis will handle participants lost to follow-up as no change. Outcome comparisons between groups will utilize Chi-square and t-tests, calculating Cohen's d for effect size. Linear mixed models will evaluate intervention effects on KAP, considering multiple observations and data clustering within subjects. SCC practice frequency, as measured by EMA, will be analyzed at between- and within-person levels using the "xtcenter" module, exploring associations with outcomes simultaneously.

Expected results: Instant messaging will improve MN students' SCC knowledge and skills, positive attitude toward providing SCC, and eventually increase their SCC practice frequency in their clinical practice.

Inclusion Criteria:

• MN students (1 or 2 years)
• Able to access WhatsApp and receive messages

Exclusion Criteria:

• Currently attending any other SCC training program other than this course

Research data and documentation will be available upon request.

Data will be available for 10 years.

Research data and documentation will be available upon request.

Double-blinding technique will be used to conceal the allocation. Participants will not know which group they are in as placebo messages will be introduced. Using a central allocation web-based-controlled randomization, outcome assessors and data analysts will be blind to group allocation, only the principal investigator will be aware of who belongs to the control and intervention groups.