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Brinker, Titus Josef; Brieske, Christian Martin; Esser, Stefan; Klode, Joachim; Mons, Ute; Batra, Anil; Ruther, Tobias; Seeger, Werner; Enk, Alexander H.; Kalle, Christof von; Berking, Carola; Heppt, Markus V.; Gatzka, Martina V.; Bernardes-Souza, Breno; Schlenk, Richard F. and Schadendorf, Dirk (2018): A Face-Aging App for Smoking Cessation in a Waiting Room Setting: Pilot Study in an HIV Outpatient Clinic. In: Journal of Medical Internet Research, Vol. 20, No. 8, e10976 [PDF, 3MB]


Background: There is strong evidence for the effectiveness of addressing tobacco use in health care settings. However, few smokers receive cessation advice when visiting a hospital. Implementing smoking cessation technology in outpatient waiting rooms could be an effective strategy for change, with the potential to expose almost all patients visiting a health care provider without preluding physician action needed. Objective: The objective of this study was to develop an intervention for smoking cessation that would make use of the time patients spend in a waiting room by passively exposing them to a face-aging, public morphing, tablet-based app, to pilot the intervention in a waiting room of an HIV outpatient clinic, and to measure the perceptions of this intervention among smoking and nonsmoking HIV patients. Methods: We developed a kiosk version of our 3-dimensional face-aging app Smokerface, which shows the user how their face would look with or without cigarette smoking 1 to 15 years in the future. We placed a tablet with the app running on a table in the middle of the waiting room of our HIV outpatient clinic, connected to a large monitor attached to the opposite wall. A researcher noted all the patients who were using the waiting room. If a patient did not initiate app use within 30 seconds of waiting time, the researcher encouraged him or her to do so. Those using the app were asked to complete a questionnaire. Results: During a 19-day period, 464 patients visited the waiting room, of whom 187 (40.3%) tried the app and 179 (38.6%) completed the questionnaire. Of those who completed the questionnaire, 139 of 176 (79.0%) were men and 84 of 179 (46.9%) were smokers. Of the smokers, 55 of 81 (68%) said the intervention motivated them to quit (men: 45, 68%;women: 10, 67%);41 (51%) said that it motivated them to discuss quitting with their doctor (men: 32, 49%;women: 9, 60%);and 72 (91%) perceived the intervention as fun (men: 57, 90%;women: 15, 94%). Of the nonsmokers, 92 (98%) said that it motivated them never to take up smoking (men: 72, 99%;women: 20, 95%). Among all patients, 102 (22.0%) watched another patient try the app without trying it themselves;thus, a total of 289 (62.3%) of the 464 patients were exposed to the intervention (average waiting time 21 minutes). Conclusions: A face-aging app implemented in a waiting room provides a novel opportunity to motivate patients visiting a health care provider to quit smoking, to address quitting at their subsequent appointment and thereby encourage physician-delivered smoking cessation, or not to take up smoking.

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