Arief Hargono, Zhao Ni, Kurnia Dwi Artanti, Rizma Dwi Nastiti, Santi Martini

Development of a Mobile App for Smoking Cessation: a Qualitative Study

Introduction

Development of a mobile app for smoking cessation: a qualitative study. This qualitative study details developing a culturally-tailored mobile app for smoking cessation in Indonesia, identifying key features and WHO strategies for effective intervention.

Abstract

Smoking is a public health concern in Indonesia. A challenge facing Indonesian healthcare system is that the use rate of in-person smoking cessation counseling is low due to smokers’ concerns about their privacy. This challenge has limited the ability of Indonesian health researchers and policy makers to develop and implement evidence-based practices to prevent smoking. The development of digital technologies in Indonesia has offered various opportunities to address this issue. Mobile devices are ubiquitous in Indonesia and have the potential to deliver counseling services for smokers. This study was part of the Mobile Application System for Smoking Cessation program and aimed to investigate the culturally-tailored features of mobile apps to prevent smoking in Indonesia. Data were collected through structured interviews and Focus Group Discussions (FGDs) among Indonesian policy makers and experts from universities and NGOs. We also reviewed relevant documents recommended by participants. We found that to develop a culturally-tailored mobile app for smoking cessation in Indonesia, it is important to understand smokers’ characteristics, smoking status, smoking behavior, and level of motivation to quitting smoking. We also found that following the World Health Organization’s 5A (Ask, Assess, Advise, Assist, Arrange) and 5R (Relevance, Risk, Reward, Roadblocks, Repetition) strategies is a key to improve the feasibility and acceptability of a smoking-cessation mobile app. App-based interventions need to be integrated with the practices performed by counselors and health workers and should be easily accessed by smokers.

Review

This study addresses a critical public health issue in Indonesia, where low uptake of traditional smoking cessation counseling, primarily due to privacy concerns, hinders effective intervention. The development of a culturally-tailored mobile application offers a highly relevant and timely solution, leveraging the ubiquitous presence of mobile devices to bridge this gap. The qualitative methodology, employing structured interviews, Focus Group Discussions with policymakers and experts, and document review, is well-suited for a foundational exploration of key features necessary for such an intervention, providing valuable insights into the strategic and contextual requirements. The research identifies several crucial factors for the successful implementation of a smoking cessation app. These include the imperative to understand nuanced smoker characteristics—such as smoking status, behavior, and motivation—and the strategic integration of established frameworks like the WHO's 5A and 5R strategies. The findings also correctly emphasize the need for seamless integration with existing healthcare practices and ensuring easy accessibility for users. However, a significant observation for a study focused on "culturally-tailored features" is the apparent lack of direct input from Indonesian *smokers* in the data collection. While expert and policy perspectives are invaluable for establishing strategic direction and feasibility, direct user feedback is indispensable for truly understanding and embedding the cultural nuances and personal preferences of the target population into the app's design. This foundational qualitative work provides a robust conceptual framework for the subsequent development of the Mobile Application System for Smoking Cessation. To further enhance the cultural relevance, user-acceptability, and ultimate effectiveness of the proposed app, future stages should explicitly integrate comprehensive user-centered design approaches, actively involving smokers in the co-design, testing, and refinement processes. Incorporating direct user voice would ensure that the app not only aligns with expert recommendations but also genuinely resonates with the lived experiences and cultural contexts of its intended beneficiaries, significantly increasing its potential for successful adoption and impact on smoking cessation rates in Indonesia.

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