Development of a WeChat-based mobile messaging smoking cessation intervention for Chinese immigrant smokers: Qualitative interview Study (Preprint)

BACKGROUND Smoking remains a major public health issue among Chinese immigrants. Smoking cessation programs that focus on this population are scarce and have a limited population-level impact due to the low reach. Mobile messaging interventions have the potential to reach large audiences and expand smokers’ access to cessation programs. OBJECTIVE This study describes the development of a culturally and linguistically appropriate mobile messaging smoking cessation intervention for Chinese immigrant smokers delivered via WeChat, the most frequently used social media platform among Chinese globally. METHODS This study consisted of two phases. In phase 1, we developed a mobile message library based on Social Cognitive Theory (SCT). We culturally adapted messages from two SCT-based text messaging smoking cessation programs (i.e., SmokefreeTXT and Decídetexto). We also developed new messages tailored to Chinese immigrant smokers who are not ready to quit smoking and messages addressing their barriers to quitting and misconceptions (e.g., willpower, nicotine replacement therapy). In phase 2, we conducted in-depth interviews with 20 Chinese immigrant smokers (7 females) in New York City between July and August 2021. The interviews explored participants’ smoking and quitting experiences, followed by the assessment of messages. Participants reviewed 17 messages (6 educational messages, 3 self-efficacy messages, and 8 skill messages) on their phone via WeChat. They rated each message on a 0-10 visual analog scale to indicate to what extent the message enhanced their motivation to quit, promoted confidence in quitting, and increased awareness about quitting strategies. We assessed participants’ understanding of the messages, sought feedback on poorly rated messages, and explored their preferences for content, length, and format. Participants also provided feedback about their concerns with the WeChat cessation intervention and recommendations for frequency and timing of messages. RESULTS Overall, participants reported that the messages enhanced their motivation to quit, offered encouragement, and made them more informed about how to quit. Participants particularly liked the messages about the harms of smoking and strategies for quitting. They reported barriers to applying some of the quitting strategies, including the lack of skills to cope with stress and stay abstinent at work. Participants expressed strong interests in the WeChat mobile messaging cessation intervention and commented on the intervention’s potential to expand their access to smoking cessation treatment (e.g., take minimum time, access information at times of their convenience). CONCLUSIONS Mobile messages are well accepted by Chinese immigrant smokers. Research is needed to assess the feasibility, acceptability, and efficacy of WeChat mobile messaging smoking cessation interventions on promoting abstinence among Chinese immigrant smokers. CLINICALTRIAL NA