Real-world uptake of tailored, text message, smoking cessation support in pregnancy (MiQuit) when offered online
Background: Smoking in pregnancy is a major public health concern. Pregnant smokers are particularly difficult to reach, with low uptake of support options and few effective interventions. Text message-based self-help is a promising, low-cost intervention for this population, but its real-world uptake is largely unknown. Objectives: To explore the uptake and cost-effectiveness of a tailored, theory-guided, text message intervention for pregnant smokers (‘MiQuit’) when advertised online. Methods: Links to a website providing MiQuit initiation information (texting a short code) were advertised online on a cost-per-click basis on two websites (Google Search, Facebook; £1000 budget each), and free of charge within smoking-in-pregnancy webpages on two non-commercial websites (National Childbirth Trust, NHS Choices). Daily budgets were capped to allow the Google and Facebook adverts to run for one and three months, respectively. We recorded the numbers of times adverts were shown and clicked on, the number of MiQuit initiations, the characteristics of those initiating MiQuit, and whether support was discontinued prematurely. For the commercial adverts, we calculated the cost per initiation and, using quit rates obtained from an earlier clinical trial, estimated the cost per quitter. Results: With equal capped budgets, there were 812 and 1,889 advert clicks to the MiQuit website from Google (search-based) and Facebook (banner) adverts, respectively. MiQuit was initiated by 5.2% of those clicking via Google (N=42, 95% confidence interval [CI]=3.9-6.9%) and 2.2% of those clicking via Facebook (N=42 [CI=1.7-3.0%]). Adverts on non-commercial webpages generated 53 clicks over 6 months, with 9 initiations (17.0% [CI=9.2-29.9%]). Mean cost per initiation for the commercial websites combined was £24.73; estimated cost per quitter, including text delivery costs, was £735.86 (CI=£227.66-£5,223.93). Those initiating MiQuit via Google were typically very early in pregnancy (median gestation=5 weeks, IQR=10 weeks); those initiating via Facebook were distributed more evenly across pregnancy (median gestation=16 weeks, IQR=14 weeks). Conclusions: Commercial online adverts are a feasible, likely cost-effective method for engaging pregnant smokers in digital cessation support, and may generate uptake at a faster rate than non-commercial websites. As a strategy for implementing MiQuit, online advertising has large reach potential and can offer support to a hard-to-reach population of smokers.