Patterns of use of an automated interactive personalized coaching program for smoking cessation.

Background: The QuitCoach, an "expert system" program of tailored advice for smoking cessation developed in Australia, has been publicly available since July 2003, albeit with limited promotion. The program is designed to be used on multiple occasions, guiding the user through the process of smoking cessation in the manner of a "life coach". Email reminders are sent at scheduled intervals to prompt optimal and repeated use.

Objectives: The aims of this study were to characterize QuitCoach users and to determine what characteristics of smokers affect their participation over time. Of particular interest was whether users tend to return following a relapse and, thus, use the program as a tool for relapse prevention or recovery. We also explored patterns of change associated with returns to the site, whether prompted by reminder emails or not prompted at all.

Methods: Between July 2003 and June 2007, 28,247 individuals completed an initial assessment on the QuitCoach, of whom 83.7% (n = 23,656) registered. Data were collected during a 10-minute online questionnaire that all users completed in order to obtain tailored cessation advice. This included questions concerning basic demographic information, quitting history, current smoking status and cigarette consumption, stage of change, and use of pharmacotherapy.

Results: The median age of users was 34 years, and 62% were female. Most (96%) were current smokers. Overall, 91% were planning to quit in the next 30 days, and half (49.9%) had set a quit date. Those who had recently relapsed to smoking following a quit attempt made up 37%. Among registered users, 27% returned for a second visit, a median 9 days after their first. Overall, a third visit was completed by 11% and 2% returned within 2 days. Women, older smokers, those who had recently quit, and those using pharmacotherapy were more likely to return. From the second visit on, most people who completed an assessment had quit. Likelihood of responding to a prompt to return was largely unrelated to user characteristics or cessation outcome.

Conclusions: Internet-based programs have considerable potential to reach large numbers of smokers at low cost. The QuitCoach is attracting considerable use, with most using it to make a quit attempt and, for those who continue to use the QuitCoach, to help them stay quit. Nonetheless, most users only visited the site once, suggesting improved strategies are needed for encouraging repeated use.