Research Spotlight: GSDM Faculty Member Led Promising Mobile App Development Targeted for Unmotivated Smoker Intervention


A mobile app focused on stress and mood management shows promise as an intervention for smokers who are not yet motivated to quit, indicating the need for further study, according to the results of a feasibility study published in JMIR Formative Research in April 2024.

Dr. Belinda Borrelli, professor of health policy & health services research, and director of the Center for Behavioral Sciences Research at Boston University Henry M. Goldman School of Dental Medicine (GSDM), is the principal investigator on the pilot randomized controlled trial. The study was born out of a collaboration between Borrelli and researchers at the University of Manchester as well as Boston University’s Sargent College and Hariri Institute for Computing.

“It is critical to find out what is important to unmotivated smokers, provide information on that topic using a mobile app, and then gradually weave in a smoking cessation intervention to increase intervention engagement and motivate quitting,” Borrelli said.

Borrelli led the development of the app with assistance from the team.  The mobile app is based on Behavioral Activation (BA), an evidence-based treatment for depression and depressed mood that uses strategies to increase activation, and thus increase access to natural sources of positive reinforcement, to improve mood. Borrelli hypothesized that increases in positive affect and decreases in negative affect could prime unmotivated smokes to consider quitting.

The app fills an important hole, as most—if not all—of the currently available, evidence-based treatments for smoking cessation are designed for smokers who are ready to quit within 30 days—but this population accounts for just 12 percent of smokers.

“Innovation regarding intervention approaches for unmotivated smokers has stalled,” Borrelli said. “Digital interventions in general have not been sufficiently leveraged to target those who are not motivated to change. The current study presents progress in this direction and also could potentially serves as a paradigm for others to blend social psychology principles (e.g., foot in the door approach) with evidenced-based treatments (BA) to motivate change across different areas of health using digital platforms.”

The pilot study included 56 adult smokers who were not ready to quit smoking within 30 days. These individuals were assigned randomly to eight weeks of the BA-based mobile app or a control group.

Individuals in the intervention group used the app to identify, schedule, and complete values-based activities and encourage to set at least two different types of goals per week. The identification, scheduling, and completion of these values-based activities were used as a “foot in the door” approach to provide motivational messages about quitting smoking. Depending on individuals’ level of motivation to quit—assessed weekly through the app—they also were sent messages to review the “Resources to Quit” sections within the app, and received smoking cessation messages.

Individuals in the control group received an information sheet with resources related to quitting smoking and completed surveys.

“The novel aspect of the app is that it takes a ‘foot in the door’ approach, by focusing on aspects that we found matter most to unmotivated smokers (stress and mood management) with the idea that addressing these risk factors for continued smoking will increase smokers’ receptivity to pushed content on smoking cessation,” the authors wrote.

The study had four key findings: 1) Unmotivated smokers were willing to enroll in the study; 2) Participants reported high levels of satisfaction and engagement with the intervention; 3) Those at highest risk for continued smoking demonstrated high levels of intervention engagement; and 4) The hypothesized associations between theory-based BA constructs and outcomes were in the expected direction.

“There were promising trends in the hypothesized direction regarding number of cigarettes smoked, setting a quit date, and motivation and confidence to quit. [These] findings suggest that the mobile app interventions can be made appealing to smokers who are unmotivated to quit and warrant further efficacy testing,” Borrelli said.