Smokers' and drinkers' choice of smartphone applications and expectations of engagement: a think aloud and interview study

Background: Public health organisations such as the National Health Service in the United Kingdom and the National Institutes of Health in the United States provide access to online libraries of publicly endorsed smartphone applications (apps); however, there is little evidence that users rely on this guidance. Rather, one of the most common methods of finding new apps is to search an online store. As hundreds of smoking cessation and alcohol-related apps are currently available on the market, smokers and drinkers must actively choose which app to download prior to engaging with it. The influences on this choice are yet to be identified. This study aimed to investigate 1) design features that shape users' choice of smoking cessation or alcohol reduction apps, and 2) design features judged to be important for engagement. Methods: Adult smokers (n = 10) and drinkers (n = 10) interested in using an app to quit/cut down were asked to search an online store to identify and explore a smoking cessation or alcohol reduction app of their choice whilst thinking aloud. Semi-structured interview techniques were used to allow participants to elaborate on their statements. An interpretivist theoretical framework informed the analysis. Verbal reports were audio recorded, transcribed verbatim and analysed using inductive thematic analysis. Results: Participants chose apps based on their immediate look and feel, quality as judged by others' ratings and brand recognition ('social proof'), and titles judged to be realistic and relevant. Monitoring and feedback, goal setting, rewards and prompts were identified as important for engagement, fostering motivation and autonomy. Tailoring of content, a non-judgmental communication style, privacy and accuracy were viewed as important for engagement, fostering a sense of personal relevance and trust. Sharing progress on social media and the use of craving management techniques in social settings were judged not to be engaging because of concerns about others' negative reactions. Conclusions: Choice of a smoking cessation or alcohol reduction app may be influenced by its immediate look and feel, 'social proof' and titles that appear realistic. Design features that enhance motivation, autonomy, personal relevance and credibility may be important for engagement.