Real-world uptake of a tailored, text message, pregnancy smoking cessation programme (MiQuit) when offered online

Abstract

Background: Prenatal smoking is a major public health concern and uptake of NHS cessation support is low in this group. Text message-based self-help is a promising intervention for this population but little is known about its likely real-world uptake, an essential parameter for estimating public health impact. Aims were to explore uptake (including cost) of a tailored, theory-guided, text message intervention for pregnant smokers (‘MiQuit’) when offered online. Methods: Links to a website providing MiQuit activation information (texting a shortcode) were advertised online on a cost-per-click basis for two commercial websites (Google AdWords, Facebook Ads) and free of charge for two smoking-in-pregnancy webpages (National Childbirth Trust, NHS Choices). Activations per advert click, per advert exposure and cost per activation were calculated. Findings: Low-visibility links on free-of-charge webpages generated few activations. For the commercial websites, cost per click was lower with Facebook but a higher proportion of Google advert clickers activated support (5.2% of 812 Google, 2.2% of 1889 Facebook), making their cost per activation very similar (£23.86 Google, £23.81 Facebook). Compared to participants of a prior MiQuit trial, those activating support online appeared more motivated (intended to quit smoking sooner) and those activating support via Google were earlier in pregnancy, with a sharp peak at 4-5 weeks gestation. Incremental costs per quitter were £746.19 (95% CI -£1,886.654 to £4,595.08) at the end of pregnancy and -£76.22 (-£2,790.33 to £3,844.02) when extended to mother’s lifetime. Discussion: Online advertisements are a feasible, potentially cost-saving method for engaging pregnant smokers in cessation support.