Crave-Out! A Smartphone Game to Prevent Relapse after Quitting Smoking
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Abstract
Background: Smoking is the number one preventable cause of death. Cessation programs have had success; however, most smokers relapse. Strategies to prevent relapse include active management of cravings. Distraction is a key behavioral tool to manage cravings. We designed a smartphone game available at the point-of-need that can be used to distract cravings when they arise and remind smokers of the benefits of quitting smoking.
Objective: Describe the development and launch of Crave-Out!
Methods: We used a two step process to develop the game, concept refinement and dissemination planning. Using multiple prototypes, we refined the game concept using iterative think-aloud usability testing with smokers (N= 14). We conducted usability testing using Morae software that allows for live, remote observation of the subject being tested (ex: recording of clicks, keystrokes, and other events). After playing the game, smokers answered a survey and provided open-ended comments. Themes from open-ended comments were summarized. The smartphone game was developed using the Unity3D game development framework. We released Crave Out! on Apple’s App Store and are tracking downloads.
Results: 60% of our participants were between the ages of 19-24, with a median number of cigarettes per day of 5. 100% of our smokers have tried to quit, and failed. In the survey, all the smokers strongly agreed or agreed that the game would help me think about reasons to quit smoking. 80% of participants agreed that they would recommend the game, and 60% agreed or strongly agreed that they would play the game again. Smokers disagreed on whether the game would distract them from carvings, but 100% of smokers agreed that it would help them think about reasons to quit smoking. Smokers made comments on the following themes: a) look and feel, b) positive reinforcements, c) negative reinforcements, and d) game mechanics. Example comments: a) “the game was pretty simple and understandableâ€; b) “gave me reasons why but did not necessarily push me to (quit smoking)â€; 3) “Good but looking at bad can remind you of negative effectsâ€; d) Provide “instructions - different scenariosâ€. In response, we conceptualize the following functions: 1) Multi-level game with a crave-out function: Instead of the traditional end game function, we designed the Crave-Out! function, that allows smokers to choose to end the game after their craving has reduced. 2) Only gave positive reinforcement: We removed negative reinforcements and designed the game to present smokers a token highlighting a benefit of staying quit after each level. Between 12/22/2011 and 02/28/2012, the game was downloaded 413 times from App-Store. In the past week, the game was announced on the ATTUD (Association for the Treatment of Tobacco Use and Dependence) listserv, which resulted in an increase of 110 downloads (as of 03/05/2012).
Conclusions: Based on initial usability testing, we developed an engaging smartphone game. Future assessments will include evaluating the impact of the game on preventing relapses.
Objective: Describe the development and launch of Crave-Out!
Methods: We used a two step process to develop the game, concept refinement and dissemination planning. Using multiple prototypes, we refined the game concept using iterative think-aloud usability testing with smokers (N= 14). We conducted usability testing using Morae software that allows for live, remote observation of the subject being tested (ex: recording of clicks, keystrokes, and other events). After playing the game, smokers answered a survey and provided open-ended comments. Themes from open-ended comments were summarized. The smartphone game was developed using the Unity3D game development framework. We released Crave Out! on Apple’s App Store and are tracking downloads.
Results: 60% of our participants were between the ages of 19-24, with a median number of cigarettes per day of 5. 100% of our smokers have tried to quit, and failed. In the survey, all the smokers strongly agreed or agreed that the game would help me think about reasons to quit smoking. 80% of participants agreed that they would recommend the game, and 60% agreed or strongly agreed that they would play the game again. Smokers disagreed on whether the game would distract them from carvings, but 100% of smokers agreed that it would help them think about reasons to quit smoking. Smokers made comments on the following themes: a) look and feel, b) positive reinforcements, c) negative reinforcements, and d) game mechanics. Example comments: a) “the game was pretty simple and understandableâ€; b) “gave me reasons why but did not necessarily push me to (quit smoking)â€; 3) “Good but looking at bad can remind you of negative effectsâ€; d) Provide “instructions - different scenariosâ€. In response, we conceptualize the following functions: 1) Multi-level game with a crave-out function: Instead of the traditional end game function, we designed the Crave-Out! function, that allows smokers to choose to end the game after their craving has reduced. 2) Only gave positive reinforcement: We removed negative reinforcements and designed the game to present smokers a token highlighting a benefit of staying quit after each level. Between 12/22/2011 and 02/28/2012, the game was downloaded 413 times from App-Store. In the past week, the game was announced on the ATTUD (Association for the Treatment of Tobacco Use and Dependence) listserv, which resulted in an increase of 110 downloads (as of 03/05/2012).
Conclusions: Based on initial usability testing, we developed an engaging smartphone game. Future assessments will include evaluating the impact of the game on preventing relapses.
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