Web-Based Acceptance and Commitment Therapy Tobacco Cessation Program for Veterans With Mental Health Disorders: Adaptation and Usability Testing (Preprint)

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Abstract
BACKGROUND US veterans with mental health disorders have high rates of smoking and low rates of smoking cessation. OBJECTIVE This study aims to focus on an adaptation of a web-based acceptance and commitment therapy (ACT) tobacco cessation intervention (Vet WebQuit) for veterans with mental health disorders who use tobacco and used a qualitative approach to test its usability (n=16). METHODS Participants were asked to walk through the site during laboratory-based usability testing and “think aloud” about the features of the intervention. A trained facilitator used semistructured interview questions to assess participants’ experiences with Vet WebQuit and obtain feedback on their impressions of the site. Qualitative analyses identified themes regarding participants’ experiences with the intervention, usability concerns, and recommendations for improving Vet WebQuit. RESULTS Overall, veterans found that the Vet WebQuit layout was simple and easy to navigate and use. Veterans reported that several features of the program were useful, including the quit plan, identification of triggers, content that targets mental health concerns (eg, dealing with anger), information on the health effects of smoking, tools for managing triggers (eg, urge surfing), and involving others in their quit plan. Veterans reported that particular features of the ACT approach for tobacco cessation were appealing to them, including the distinction between internal and external smoking triggers, the inclusion of the serenity prayer, and mindfulness exercises, which they could use as a tool reduce the intensity of cravings. Veterans reported wanting more information on the health aspects of smoking (ie, effects on breathing and lung capacity) as a way to motivate them to quit smoking. In addition, they suggested targeting specific mental health concerns that serve as triggers for smoking, including nightmares, boredom, and social isolation. CONCLUSIONS Overall, results from this project identified important elements of ACT digital tobacco cessation interventions for veterans with mental health disorders.
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