The first smoking cessation application for the severely mentally ill.

The Short of It

In partnership with Dr. Roger Vilardaga of Duke University’s Center for Addiction Science and Technology Department, we planned, designed and built a revolutionary smoking cessation app for one of the most underserved segments of our population – people with serious mental illness who are addicted to nicotine.

The Situation

According to Dr. Roger Vilardaga, while the rates of smoking have reduced for the general population over the last 50 years, up to 80% of people with serious mental illness are still smokers, leading to the detriment to the smoker, their families and the community at large. This drastically underserved population, whose mental and behavioral diagnoses range from schizophrenia to chronic major depression, is estimated to smoke 45% of all cigarettes consumed in the United States. Sadly, there are very few programs designed to address the very specific mental, physical and emotional factors that contribute to smoking in this population.
Research also shows that 70% of this population has some form of mobile device or direct access to the internet, and there’s an indication that the vast majority are Android users. With the belief that a clinically-supported mobile application could provide around-the-clock patient access and support, Dr. Vilardaga – during his work at the University of Washington – sought funding and received a grant by the National Institute of Drug Abuse and partnered with Smashing Ideas to create a smoking cessation application that used a new behavioral therapy approach, called Acceptance Commitment Therapy (ACT), to teach people how to quit. Dr. Vilardaga’s field research indicated that an effective approach to deliver ACT would be by focusing on gaming, storytelling and highly engaging graphics; and Smashing Ideas’ creativity and innovative portfolio, with a particular focus on Motivational UX, was the ideal agency to partner with.
Dr. Roger Vilardaga, Acting Assistant Professor at the Department of Psychiatry and Behavioral Sciences at the University of Washington http://cbsopenlab.com/

Complex treatment theories found in Acceptance Commitment Therapy were translated into a digital experience not currently seen in the healthcare field.

The Challenge

With over 530 smoking cessation applications flooding the market, none directly addressed the unique needs of the SMI population. Of those 530 smoking cessation applications, only two have been tested with users, and none with SMI. Additionally, the cognitive and physical limitations of the severely mentally ill make completing simple tasks like registering initial information or tapping a button accurately very challenging. This is not only detrimental to long-term engagement, but it can create stress or anxiety when using applications that were not built with their unique needs in mind.

Our Approach

Based on Dr. Vilardaga’s original design, Smashing Ideas collaborated with Dr. Vilardaga and his team on a refined approach that combined the concepts of Acceptance Commitment Therapy, Motivational UXTM and a visually beautiful, easy-to-use, guided application. Through progressive disclosure, the experience guides the patient along a visual path to track progress, participate in multifaceted exercises throughout the duration of the journey and plan for future success in becoming cigarette free. Each point in the journey provides them with positive reinforcement, giving them increased motivation to continue. The metaphor of a path also lets them see where they are headed along their journey, creating a feeling of empowerment and long-term accomplishment.
With the physical and behavioral limitations of the user group, the app was designed with a muted color palette to lessen sensitivity to over-stimulation, buttons were created instead of swiping to account for users with pharma-induced tremors, and simple illustrations conveyed complex, abstract concepts. The motivational concept of challenge and reward was particularly useful to reinforce what they were learning. As the user navigates their journey through a “swamp of urges,” they move through modules where they are taught lessons about how to be mindful and change their psychological relationship with them. As they master each lesson, new modules are unlocked. These intrinsic motivators are reinforced extrinsically as well through a financial tally showing how much money a user has saved by reducing their cigarette consumption. As the amount grows over time, the user learns a literal correlation between their physical and financial health.
Once the patient hits a certain level within their journey of learning how to quit, they are able to set a Quit Date and make a quit attempt. Coaches provide each patient lozenges and nicotine patches to support the physical urges, and the physical aids are tracked and managed within the application. As the patient moves through the actual quitting process they track their mood, how the physical aids are contributing, cost savings tallies, and are provided immediate access to their coach via the application.

The Result

What began as 200 hours of patient testing with simple paper prototypes has progressed into a high fidelity application that initially underwent rigorous NIH funded scientific testing through the University of Washington and Harborview Medical Center. Now at Duke University, Dr. Vilardaga is conducting a second phase of randomized clinical trials. He notes that “I haven’t seen any app that matches our quality of design and background research, not to mention that there are only 2 smoking cessations apps out there that have been tested in clinical trials, yet none with the specific audience of the severely mentally ill.”
With Smashing Ideas’ aim to make things that matter, Learn to Quit applies social responsibility to a serious health hazard (nicotine addiction in people with serious mental illness) that for a long time has been ignored by many of America’s health organizations. With such a marginalized demographic lining the pockets of big tobacco, we’re more than happy to help bring to market a long-term solution that will ultimately put a dent in the tobacco industry.

“Learn to Quit was a rare opportunity to have a digital experience make a social impact on society.”

Brian Marr, CSO

Winning

  • GOLD W3 Award | Best Mobile App/Site Health & Wellness
  • SILVER Davey Award | Best Mobile App/Health & Wellness
  • Exclusive feature in Fast Company.
  • Featured in Psychiatric News.

Services

  • UX Design
  • Strategy
  • Motivational UX
  • Visual/UI Design
  • Application Development
“I needed a digital partner that understood the social responsibility associated with Learn to Quit – Smashing Ideas just gets it. They became a true strategic partner by taking very complex treatment theories found in Acceptance Commitment Therapy and translated them into a digital experience not currently seen in the healthcare field. This partnership will have broader implications as we move forward with patient testing, as therapists will need to learn how to integrate digital applications into their on-going treatment methods.”
Dr. Roger Vilardaga

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