Use of the behaviour change wheel to develop an application supporting adherence to nicotine replacement therapy

Abstract

Background: Effectiveness of nicotine replacement therapy (NRT) purchased over the counter (OTC) is low, which has been attributed to poor adherence. Digitally-delivered interventions, including smartphone apps, could assist smokers with NRT use. However, little is known about how to develop and design such interventions. This study aimed to systematically apply behaviour change theory to develop a prototype app supporting smokers during quit attempts with OTC NRT (NRT2Quit). Methods: Intervention development involved two phases. Phase 1 focused on identification and development of intervention content and components. The process followed the guidelines outlined in the Behaviour Change Wheel (Michie et al, 2014), and included behavioural analysis using COM-B model and Theoretical Domains Framework that facilitated selection of behaviour change techniques (BCTs). The intervention was further informed by PRIME Theory of Motivation and Necessity-Concerns Framework, empirical evidence, as well as guidance from the National Centre for Smoking Cessation and Training. Phase 2 involved implementation of the designed intervention into an iPhone app, which was informed by user testing and expertise in iOS design. Findings: NRT2Quit app offers a theory- and evidence-informed eight week quit programme that incorporates 25 BCTs across 14 theoretical domains, addressing intentional and non-intentional non-adherence to OTC NRT. Discussion: Behaviour Change Wheel can facilitate the development of smartphone interventions for cessation medication adherence by supporting integration of information from a range of sources. The process of intervention implementation on iPhones has helped identify several challenges for delivering support for medication use through apps, which will be discussed, alongside potential solutions.