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GEMS & GEMS+

September 2022: Article by Jennifer McClure, PhD, Director of Investigative Science and Michelle Oliver, Product and Engagement Lead

Background

The majority of cigarette smokers want to quit someday but are not ready to commit to a long-term abstinence. However, available smoking cessation treatments are not well-suited for ambivalent smokers. Low-cost, high-reach mobile health (mHealth) interventions may be a costefficient means of helping this group quit smoking, but there are currently no evidence-based options available for them. Given this, the National Cancer Institute funded researchers at the KP Washington Health Research Institute to develop and test 2 new apps designed for smokers who want to quit someday, but who are ambivalent about quitting: GEMS & GEMS+.

The Telehealth and Mobility Digital Care Delivery and the MCoE is supporting the development and deployment of these programs.

Overview

GEMS was designed for a general population of smokers. The app has two states: “usual care” with best practice intervention and advice typically offered to smokers who are ready to quit smoking and the “enhanced” state that adds additional content designed for ambivalent smokers. Both versions share a code base. The appropriate content is unlocked with a code.

GEMS+ also includes a “usual care” and “enhanced” state with a shared code base, but the enhanced version includes additional content tailored for Smokers Living with HIV (SLWH). Smoking has particularly deleterious health effects among SLWH: it is associated with increased incidence of bacterial pneumonia, malignancies and other AIDS defining illness; increased cardiovascular risk; increased mortality risk; and increased antiretroviral treatment failure. In fact, SLWH are now more likely to die from a smoking-related disease than AIDS, given advances in medical treatment that have transformed HIV from a terminal illness to a chronic, manageable condition. Thus, it is critical that SLWH quit smoking.

graphical survey text

Usual Care vs. Enhanced Content

Users can unlock the appropriate program content with a code. This design allows the app content in both GEMS and GEMS+ to be tailored to the users’ readiness to quit smoking: the usual care content for people ready to quit or the enhanced content for those who are not.

The usual care version represents a standard, evidence-based, best practice intervention to quit smoking. This includes a 6-step guide for how to quit smoking, referral to 1-800-Quit now (which connects people with free counseling through their local state-sponsored tobacco Quitline), and other tools (e.g., a cigarette tracker, calculator for estimated savings from quitting smoking, and peer testimonials design to encourage and support quit attempts).

The enhanced version of each app contains generally the same information as the usual care version, with additional content designed specifically for ambivalent smokers. In both GEMS and GEMS+ this includes a series of brief cognitive and behavioral exercises designed to help users clarify their values, strengthen their motivation for quitting, and learn critical skills needed to stop smoking, called Experiments.

GEMS+ includes additional content tailored for people living with HIV.

Sample Usual Care Content
Sample Usual Care Content
Sample Experiment in Enhanced Care Content
Sample Experiment in Enhanced Care Content

Randomized Pilot Studies

Both GEMS and GEMS+ are being evaluated in separate randomized pilot studies, each comparing the usual care “control” to the enhanced “experimental” version.
Findings will inform future improvements and be leveraged to seek additional federal funding to test the effectiveness of each app.

The GEMS pilot study (n = 57) is complete, and results are being analyzed. Preliminary findings indicated good engagement and acceptability of both app versions. 95% said they would recommend the app to others.

GEMS+ is currently in pilot and continuing to recruit study participants. Findings will be available late 2022 or early 2023.

GEMS + Randomized Control Trial (RCT) Pilot
GEMS + Randomized Control Trial (RCT) Pilot

Key outcomes: feasibility, acceptability (satisfaction & utilization metrics), impact on intermediate outcomes (e.g., SE, motivation) and behavioral indicators of change (quit attempt, smoking reduction, & abstinence)

Benefits to KP

Smoking remains the leading cause of death and illness in the US, killing nearly ½ a million people each year. Each KP market offers different smoking cessation treatments however, to our knowledge, KP does not have a single intervention solution for all markets and no smoking cessation apps of its own.

GEMS/GEMS+ could be leveraged to provide smoking cessation treatment services to KP members (with only minor content modifications), or even marketed to smokers outside KP (as is currently designed).

Offering the app(s) to KP members addresses a current intervention gap in KP’s portfolio.

Offering the app(s) to non-KP members could be a good marketing tool and help KP fulfill its mission to “improve the health of our members and the communities we serve.”

Target Audience

People who smoke, which represents an estimated 12.5% of adults in the US as of 2020 (~32.3 million people).

GEMS + Journal screenshot

Both apps were designed by Jennifer McClure, PhD, her research team and collaborators, funded by the National Cancer Institute and developed and supported by the Telehealth and Mobility Digital Care Delivery team.
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For questions or feedback about this article reach us at MCoE-Comms@kp.org.
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