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Comparison of a Daily Smartphone App and Retrospective Questionnaire Measures of Adherence to Nicotine Replacement Therapy Among Pregnant Women: Observational Study

Emery, Joanne; Naughton, Felix; Huang, Yue; Cooper, Sue; McDaid, Lisa; Dickinson, Anne; Clark, Miranda; Kinahan-Goodwin, Darren; Thomson, Ross; Phillips, Lucy; Lewis, Sarah; Coleman, Tim


Joanne Emery

Felix Naughton

Lisa McDaid

Darren Kinahan-Goodwin

Professor of Primary Care


Few studies have investigated how to best measure adherence to smoking cessation medications, but continuous usage measures are recommended.

In this first study of its kind, we compared methods for measuring adherence to nicotine replacement therapy (NRT) among pregnant women, investigating the completeness and validity of data collected from daily assessments using a smartphone app versus data collected from retrospective questionnaires.

Women aged ≥16 years who were daily smokers and <25 weeks pregnant were offered smoking-cessation counseling and encouraged to use NRT. For 28 days after setting a quit date (QD), women were asked to report NRT use daily to a smartphone app and to questionnaires administered in person or remotely at 7 and 28 days. For both data collection methods, we provided up to £25 (~US $30) as compensation for the time taken providing research data. Data completeness and NRT use reported to the app and in questionnaires were compared. For each method, we also correlated mean daily nicotine doses reported within 7 days of the QD with Day 7 saliva cotinine concentrations.

Of the 438 women assessed for eligibility, 40 participated and 35 accepted NRT. More participants (31/35) submitted NRT usage data to the app by Day 28 (median 25, IQR 11 days) than completed the Day 28 questionnaire (24/35) or either of the two questionnaires (27/35). Data submitted to the app showed a lower reported duration of NRT use compared to that indicated in the questionnaire (median for app 24 days, IQR 10.25; median for questionnaire 28 days, IQR 4.75; P=.007), and there appeared to be specific cases of overreporting to the questionnaire. Mean daily nicotine doses between the QD and Day 7 were lower when calculated using app data (median for app 40 mg, IQR 52.1; median for questionnaire 40 mg, IQR 63.1; P=.001), and some large outliers were evident for the questionnaire. Mean daily nicotine doses, adjusted for cigarettes smoked, were not associated with cotinine concentrations for either method (app r =0.184, P=.55; questionnaire r =0.031, P=.92), but the small sample size meant that the analysis was likely underpowered.

Daily assessment of NRT use via a smartphone app facilitated more complete data (a higher response rate) than questionnaires, and reporting rates over 28 days were encouraging among pregnant women. App data had better face validity; retrospective questionnaires appeared to overestimate NRT use for some participants.


Emery, J., Naughton, F., Huang, Y., Cooper, S., McDaid, L., Dickinson, A., …Coleman, T. (2023). Comparison of a Daily Smartphone App and Retrospective Questionnaire Measures of Adherence to Nicotine Replacement Therapy Among Pregnant Women: Observational Study. JMIR Formative Research, 7, Article e35045.

Journal Article Type Article
Acceptance Date Aug 25, 2022
Online Publication Date Mar 7, 2023
Publication Date 2023
Deposit Date Mar 16, 2023
Publicly Available Date Mar 16, 2023
Journal JMIR Formative Research
Print ISSN 2561-326X
Electronic ISSN 2561-326X
Publisher JMIR Publications
Peer Reviewed Peer Reviewed
Volume 7
Article Number e35045
Keywords mobile health, ecological momentary assessment, smoking cessation, treatment adherence measurement, nicotine, mHealth, questionnaires, smoking, nicotine replacement therapy, pregnancy, smartphone app
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