Developing A Mindfulness Based Smoking Cessation Smartphone Application For People Living With HIV: Results From a Mixed Methods Study of the Content Development. (Preprint)

BACKGROUND Half of people living with HIV (PLWH) are cigarette smokers. Stress and craving to smoke are two major predictors of smoking relapse in PLWH. Mindfulness is effective in reducing stress and controlling craving to smoke. Contingency Management (CM) improves cessation in hard-to-treat smokers. Smartphone applications (app) improve access to treatment. OBJECTIVE Guided by the Spiral Technology Action Research Model (Listen, Plan, Do, Act, Study), we sought to adapt an existing evidence-based mindfulness smoking cessation app “Craving to Quit” to PLWH. Appling user-centered participatory mixed methods of qualitative and quantitative design, this study involves “Listen” to PLWH smokers to adapt the content of the app, and “Plan” for the creation of the new app. METHODS We conducted 8 focus groups combined with a brief survey among PLWH smokers (n=59; 47.5% females; >18 years) receiving treatment at an academic clinic. Participants completed a brief survey, then were instructed to download the “Craving to Quit” app and received a demonstration explaining the app content. Focus group discussion explored previous quit attempts, thoughts concerning the app, and perception about adding CM and strategies to track adherence to HIV treatment in the app. Participants were also asked to practice 3 mindfulness exercises and watch 3 videos from the app presented on a big screen in the conference room to discuss their experience, reaction, and concerns. Sessions were audio-taped, transcribed verbatim, and analyzed thematically using NVivo. RESULTS Participants were mostly non-Hispanic black (67.8%), heterosexual (79.7%), on Medicaid (61.0%), heavy alcohol users (30.5%), and depressed (44.1%). In focus group discussion, participants reported multiple drug use (alcohol, marijuana) and being surrounded by smokers as tremendous challenges to quitting, and that nicotine replacement treatment was not helpful. Participants considered mindfulness (RAIN, body scan, loving kindness) helpful in reducing stress, and videos (habit loop, costs benefits, tripping on thoughts) as effective in motivating quit attempts. Participants felt it is necessary to make the app available for free, add information about smoking medications and the effects of smoking on HIV treatment. Participants were supportive of adding CM and considered receiving $20-$50 weekly cash incentives helpful in supporting quit attempts. Participants thought that adding strategies to track adherence to ART helpful, but a few were concerned about confidentiality in case they lost their phone. CONCLUSIONS Findings from this formative qualitative research underscore the need for comprehensive approaches to smoking cessation in PLWH that integrate mindfulness, short-term CM, and strategies to improve adherence to HIV treatment. Further clinical research is needed to test the feasibility and acceptability of comprehensive interventions to address smoking as a key driver of morbidity and mortality in PLWH. CLINICALTRIAL N/A