The feasibility of implementing text messaging system to support smoking cessation for smokers in Hanoi

 ISSN: 1859-2171 
e-ISSN: 2615-9562 
TNU Journal of Science and Technology 225(05): 69 - 76 
 Email: jst@tnu.edu.vn 69 
THE FEASIBILITY OF IMPLEMENTING TEXT MESSAGING SYSTEM 
TO SUPPORT SMOKING CESSATION FOR SMOKERS IN HANOI 
Doan Thi Hue1*, Nguyen Thi Trang2, Donna Shelley3, Kim Bao Giang4, Nguyen Truong Nam4 
1TNU - University of Medicine and Pharmacy, 2Institute of Social & Medical Studies, 
3NYU Langone Hospitals, 4Hanoi Medical University 
ABSTRACT 
The study was carried out to assess the feasibility of implementing text messaging system to 
support smoking cessation smokers in Hanoi. This was a pilot study done on 40 smokers in Hanoi. 
The participants received short message service texting within 6 weeks to get smoking cessation 
support. The study was an intervention one which compared the participants’ smoking before and 
after the intervention done. The participants were interviewed directly with a questionnaire that 
includes the following contents: suitability of number/ content of messages, frequency/ time of 
sending messages, use of received messages, interaction with the program, satisfaction with the 
messaging system, and change in smoking behavior. The results showed that there were 82.5% 
reading/using text messages daily, 82.5% interacted with program – by 2-way text messaging; 
90% of the participants found the messages useful; 97.7% were satisfied with the program. The 
researched subjects commented that the program was easy to use. 20% of the participants quit 
smoking/ waterpipe tobacco completely; 15% quit smoking but still smoke waterpipe tobacco. 
Smoking behavior changed positively compared to the initial survey; the statistical significance 
included the number of cigarettes/waterpipe tobaccos smoked a day, the status of smoking 
cigarettes/waterpipe tobacco (p <0.001). The rate of research subjects who tried to stop smoking 
cigarettes/pipe tobacco in 4 weeks was quite high (52.5% before the intervention and 25% after the 
intervention). This study provided evidence of the feasibility of the use of a text messaging 
program to provide intervention supports in smoking cessation for Vietnamese people. 
Key words: smoking cessation; Interventions, adults; SMS texting, mhealth 
Received: 25/3/2020; Revised: 29/4/2020; Published: 29/4/2020 
TÍNH KHẢ THI CỦA VIỆC TRIỂN KHAI HỆ THỐNG TIN NHẮN 
HỖ TRỢ CAI THUỐC LÁ CHO NGƯỜI HÚT THUỐC TẠI HÀ NỘI 
Đoàn Thị Huệ1*, Nguyễn Thị Trang2, Donna Shelley3, Kim Bảo Giang4, Nguyễn Trương Nam4 
1Trường Đại học Y Dược – ĐH Thái Nguyên, 2Viện Nghiên cứu Y - Xã hội học, 
3Bệnh viện NYU Langone, 4Trường Đại học Y Hà Nội 
TOM TẮT 
Nghiên cứu này được thực hiện nhằm đánh giá tính khả thi của việc triển khai hệ thống tin nhắn (SMS) 
hỗ trợ cai thuốc lá. Nghiên cứu thử nghiệm trên 40 người hút thuốc lá tại Hà Nội. Đối tượng nghiên cứu 
nhận tin nhắn điện thoại hỗ trợ cai thuốc lá trong 6 tuần. Thiết kế nghiên cứu can thiệp, so sánh trước và 
sau can thiệp. Đối tượng nghiên cứu được phỏng vấn trực tiếp bằng bộ câu hỏi gồm: sự phù hợp số 
lượng/nội dung SMS, tần suất/thời gian gửi tin, sử dụng tin nhắn nhận được, tương tác với chương 
trình, hài lòng với chương trình tin nhắn; thay đổi hành vi hút thuốc. Kết quả nghiên cứu cho thấy: có 
82,5% đối tượng nghiên cứu đọc/ sử dụng tin nhắn hàng ngày, 82,5% người tương tác với chương trình 
- SMS hai chiều, 90% người thấy tin nhắn hữu ích, 97,7% hài hòng. Đối tượng nghiên cứu nhận xét 
chương trình dễ sử dụng và 92,5% bạn bè người thân đều khuyến khích đối tượng tham gia sử dụng 
chương trình. Có 20% đối tượng nghiên cứu bỏ thuốc lá/thuốc lào hoàn toàn, 15% đối tượng nghiên 
cứu bỏ thuốc lá nhưng vẫn hút thuốc lào. Hành vi hút thuốc lá thay đổi tích cực so với khảo sát ban đầu. 
Có ý nghĩa thống kê bao gồm số lượng điếu thuốc lá/thuốc lào hút/ngày, tình trạng hút thuốc lá/thuốc 
lào (p<0,001). Tỷ lệ đối tượng nghiên cứu từng cố gắng cai thuốc lá/thuốc lào trong 4 tuần khá cao 
(trước can thiệp: 52,5%, sau can thiệp: 25%). Như vậy, việc áp dụng một chương trình SMS hỗ trợ can 
thiệp cai nghiện thuốc lá cho người Việt Nam là có tính khả thi. 
Từ khóa: cai thuốc lá; can thiệp; người trưởng thành; tin nhắn SMS; ứng dụng y tế điện thoại. 
Ngày nhận bài: 25/3/2020; Ngày hoàn thiện: 29/4/2020; Ngày đăng: 29/4/2020 
* Corresponding author. Email: hueddtn@gmail.com 
DOI: https://doi.org/10.34238/tnu-jst.2020.05.2894
Doan Thi Hue et al. TNU Journal of Science and Technology 225(05): 69 - 76 
 Email: jst@tnu.edu.vn 70 
1. Introduction 
According to estimates from the 2015 
smoking survey on adults (aged 15 and over), 
Vietnam is a country with the high rate of 
smoking in Asia [1]. The smoking rate in 
adults in Vietnam was 22.5%, of which, 
45.3% was males, and 1.1% was females; in 
total there were 15 million adults smoking 
cigarettes and water-pipe tobacco [2]. 
Tobacco use is the leading, but interventional 
and preventable, common cause of many fatal 
diseases in the world. Tobacco use increases 
the risk of myocardial ischemia more than 2.5 
times, lung cancer more than about 20 times, 
etc [3], [4]. The total cost of treatment and 
loss of ability to work due to illnesses and 
premature deaths in 5 common tobacco-
related diseases including lung cancer, upper 
digestive-respiratory tract cancers, myocardial 
infarction, stroke, and COPDs is more than 
VND 23,000 billion per year [5]. 
In recent years, in Vietnam, the activities of 
preventing tobacco-related harms have made 
significant progress and achievements 
including communication activities on health 
education, building smoke-free environments, 
controlling sources of supplying tobacco 
products, setting up a fund to prevent tobacco 
harms from tobacco enterprises’ revenues. 
However, activities to support smoking 
cessation have just been implemented in some 
Central and provincial hospitals [6], [7]. 
The rapid development of mobile medical 
t ... ble 1 reveals that 100% of the participants were male; the average age was 38.8 years old, 82.5% 
married; most of them had the education level from high school up to university (40%, 15% and 
17.5 %); 25% of the participants were civil servants and 35% of people were freelance traders. The 
family income from 50 million to <100 million accounted for the highest rate of 72.5%. 57.5% of 
smokers/pipe tobacco smokers; 85% of participants use smartphones; 60% send/receive 11- 50 
messages /week. 
3.2. The feasibility 
The results in table 2 reveal that most research participants commented that the number of messages 
of the program was moderate (80%); the frequency of reading messages was 82.5%. They rated the 
overall experience of the text messaging program very positively; 90% rated the messages quite 
Doan Thi Hue et al. TNU Journal of Science and Technology 225(05): 69 - 76 
 Email: jst@tnu.edu.vn 73 
useful/very useful; 82.5% interacted with the program; only 78.8% responded to the message in the 
correct syntax; the program satisfaction rate was very high with 97.5%. 
Table 2. Assessing the participants’ overall experience with the program after 6 weeks 
Features n % 
Number of messages received from the program 
Too small 
Moderate 
Too big 
1 
32 
7 
2.5 
80.0 
17.5 
Frequency of reading messages 
Sometimes 
Usually/Always 
7 
33 
17.5 
82.5 
Frequency of applying the information from the program 
Sometimes 
Usually/Always 
24 
16 
60.0 
40.0 
The level of concern if others see the messages you receive from the program 
Worry-free 
Worry a little / worry a lot 
39 
1 
97.5 
2.5 
Overall overview of the usefulness of the messages 
 A little useful 
Quite useful/very useful 
4 
36 
10.0 
90.0 
The level of your satisfaction with the program 
Unsatisfied 
Satisfied/Very satisfied 
1 
39 
2.5 
97.5 
Interaction with the program (2-way messages) 
Feedback messages in the correct syntax (n = 33) 
33 
26 
82.5 
78.8 
Table 3. Assessment of participants’ general experience of the program after 6 weeks of intervention 
Features Agree/Strongly 
agree (%) 
Mean Scores 
(Mean) 
Expect efficiency from the program (score range from 8 to 32)a 
Messages to help with smoking cessation 
Learn a lot via using the program 
Text messaging program helps me gain 
confidence to quit smoking 
The messages motivated me to quit smoking 
The messages helped me deal with cravings for smoking 
Get motivated to try to quit smoking 
Trust the information in the messages 
Feel the messages were designed suitably 
95.0 
95.5 
97.5 
97.5 
92.5 
92.5 
97.5 
92.5 
25.8 
3.15 
3.27 
3.10 
3.27 
3.22 
3.20 
3.42 
3.12 
Expect attempts to quit smoking (score range 2-8)b 
Use the text messaging program easily 
The text messaging program was easy to use 
95.0 
97.5 
6.4 
3.17 
3.2 
Social influences (score range 2-8)c 
People who are important to me think that I should use the 
text messaging program 
People who influence me think I should use the text 
messaging program 
92.5 
90.0 
6.2 
3.15 
3.07 
Good conditions (score range 3-12)d 
Have necessary knowledge necessary to use the program 
The messages are easy to understand 
Text messaging program suitable for my mobile phones 
92.5 
92.5 
95.0 
9.4 
3.07 
3.17 
3.17 
Motivation for enjoyment (score range 5-20)e 
The use of text messaging program was funny 
Desire to use the text messaging program 
87.5 
87.5 
14.9 
3.02 
3.17 
Doan Thi Hue et al. TNU Journal of Science and Technology 225(05): 69 - 76 
 Email: jst@tnu.edu.vn 74 
Features Agree/Strongly 
agree (%) 
Mean Scores 
(Mean) 
The use of text messaging program was boring 
The messages bothered me 
Using the text messaging program helped me entertain 
12.5 
7.5 
62.5 
2.00 
2.02 
2.67 
Values/price (score range 2-8)f 
Worthy of the time I spent 
The free messaging program has increased my possibility to 
use the program 
92.5 
85.0 
6.1 
3.07 
3.05 
Habits (score range 2-8)g 
Want to use the messaging program every day 
The use of the messaging program has become natural 
85.0 
87.5 
5.8 
2.82 
2.95 
Intended behaviors (score range 2-8)h 
Want to continue to use the program if available 
Will use the messaging program every day if the program is available 
85.0 
82.5 
6.0 
3.02 
2.95 
Table 3 reveals that most of research participants highly appreciate and have a positive view on 
the text messaging program for interventions in smoking cigarettes/water-pipe tobacco cessation. 
More than 95% of subjects expected to quit smoking after joining the program. More than 95% of 
smoking cessation made attempts; more than 90% rated the program facilitated smoking cessation. 
More than 85% of the participants found the program worthy of the time they spent, and wanted to 
continue using the program if available (85%). However, 7.5% thought the message bothered them. 
3.3. Change in smoking behaviors after intervention 
Table 4. The rate of total abstinence within 6 weeks (having not smoked in the past 7 days and CO 
breathing <10 ppm) 
Features n % 
Quit smoking cigarettes/water-pipe tobacco completely 8 20.0 
Quit smoking cigarettes, but still smoke water-pipe tobacco 6 15.0 
Still smoke both cigarettes and water-pipe tobacco 26 65.0 
Table 4 shows that 20% of the participants quit smoking cigarettes/water-pipe tobacco completely; 
15% stopped smoking cigarettes, but still continued smoking water-pipe tobacco. The percentage of 
participants still smoked cigarettes/water-pipe tobacco was 65 %. 
Table 5. Change in smoking behaviors after 6 weeks of interventions 
Features Baseline survey 
(n, %, Mean 
+ SD) 
After 6 weeks 
(n, %, Mean 
+ SD) 
p 
Number of cigarettes smoked/day, average 18.0 3.0 <0.001 
Number of water-pipe tobacco smoked/day, average 11.8 2.0 <0.005 
Frequency of smoking cigarettes now 
Sometimes 
Every day 
2.5 
97.5 
53.8 
46.2 
<0.001 
Frequency of smoking water-pipe tobacco now 
Sometimes 
Every day 
34.8 
65.2 
56.3 
4.4 
< 0.1 
No cigarette use/quit attempts made over 4 weeks after 
the program started 
 21 (52.5%) 
No water-pipe tobacco use/quit attempts made over 4 
weeks after the program started 
 10 (25%) 
Table 5 reveals that the changes were statistically significant in the number of cigarettes 
smoked/day, smoking status (p <0.001); the number of cigarettes smoked per day (p <0.005), 
current status of water-pipe tobacco smoking (p <0.1). There were 52.5% of participants who 
Doan Thi Hue et al. TNU Journal of Science and Technology 225(05): 69 - 76 
 Email: jst@tnu.edu.vn 75 
tried to quit smoking cigarettes and 25% who tried to stop smoking water-pipe tobacco within 6 
weeks participating in the program. 
4. Discussion 
4.1. Feasibility 
Most subjects participated in the reading and 
using messages programs every day (82.5%). 
The level of interaction of research 
participants with the program was very high, 
which is similar to the results found in other 
studies [12], [13]. Our results once again 
show that text messaging-based smoking 
cessation intervention programs are highly 
feasible, because the messages in the program 
are directly delivered to the smokers for the 
sake of smoking cessation [11], [12]. The 
relatively high interaction between research 
participants and the intervention program 
could be due to the average age group in the 
study was only 38.8 (+ 10.7), and most 
research participants have smartphones 
(85%); 90% of them found the messages 
useful / very useful; 82.5% interacted with the 
program via 2-way messages, but only 78.8% 
responded to the messages with the correct 
syntax; 97.6% were satisfied with the program. 
The participants found the program easy to use. 
Overall, the study proves that a text messaging-
based support program for smoking cessation is 
likely to be accepted in Vietnam. 
4.2. Change in smoking behaviors 
Although the result of quitting is not the main 
objective in this study, there are still 8 
participants who completely quit smoking 
cigarettes/water-pipe tobacco (20%), 6 
participants who quit smoking cigargettes,but 
still smoked water-pipe tobacco (15%). Our 
results are similar to those carried out in some 
other countries in the world [12] and [14]. 
After 6 weeks of intervention, 65% still 
smoked. However, smoking cigarettes/ 
smoking waterpipe tobacco behaviors have 
changed positively compared to the baseline 
survey; statistical analyses include the 
number of cigarettes smoked/day (p <0.001), 
smoking status (p <0.001), number of 
cigarettes smoked per day (p <0.005), 
waterpipe tobacco smoking (p <0.1). The rate 
of research participants who tried to quit 
smoking cigarettes/ water-pipe tobacco within 
6 weeks was quite high. 
5. Conclusion 
This study demonstrated the advantages of 
applying a supportive messaging program to 
help a group of smokers in Hanoi to quit 
smoking, and showed that a program can be 
designed to meet all the needs of 
interventions for all groups of smokers in 
other areas. It might suggest that there should 
be a need to expand this smoking cessation 
intervention program: They rated the overall 
experience of the text messaging program 
very positively; 90% rated the messages quite 
useful/very useful; 82.5% interacted with the 
program; only 78.8% responded to the 
message in the correct syntax; the program 
satisfaction rate was very high with 97.5%. 
Most research participants commented that 
the number of messages of the program was 
moderate (80%); the frequency of reading 
messages was 82.5%. Most of research 
participants highly appreciate and have a 
positive view on the text messaging program 
for interventions in smoking cigarettes/water-
pipe tobacco cessation. More than 95% of 
subjects expected to quit smoking after 
joining the program. 
The text messaging-based support program 
for smoking cessation can be used as an 
independent intervention supporting method 
or used to supplement or combine with other 
services, such as group counseling and 
telephone counseling. More than 95% of 
smoking cessation made attempts; more than 
90% rated the program facilitated smoking 
cessation. More than 85% of the participants 
found the program worthy of the time they 
Doan Thi Hue et al. TNU Journal of Science and Technology 225(05): 69 - 76 
 Email: jst@tnu.edu.vn 76 
spent, and wanted to continue using the 
program if available (85%). However, 7.5% 
thought the message bothered them. 20% of 
the participants quit smoking cigarettes/water-
pipe tobacco completely; 15% stopped 
smoking cigarettes, but still continued 
smoking water-pipe tobacco. The percentage 
of participants still smoked cigarettes/water-
pipe tobacco was 65 %. There were 52.5% of 
participants who tried to quit smoking 
cigarettes and 25% who tried to stop smoking 
water-pipe tobacco within 6 weeks 
participating in the program (p <0.001). 
Although this study provides evidence of 
feasibility, future large-scale studies will be 
needed to evaluate the effectiveness of the 
program in other areas and across the country. 
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