Exploring levels and predictors of adherence to a blended smoking cessation treatment

L. Siemer (1,2), M. Brusse-Keizer (3), M.G. Postel (2,4), S. Ben Allouch (1), A. Patrinopoulos (2), R. Sanderman (2,5), M.E. Pieterse (2)

(1) Technology, Health & Care Research Group, Saxion; (2) Centre for eHealth and Well-being Research, University of Twente, Enschede; (3) Medical School Twente, Medisch Spectrum Twente, Enschede; (4) Tactus, Enschede, (5) Dept. of Health Psychology, University Medical Center Groningen, Groningen


Blended face-to-face and web-based treatment is a promising way to deliver cognitive behavioral therapy. Since adherence has been shown to be a measure for treatment’s acceptability and a determinant for treatment’s effectiveness, this study explored adherence to a new blended smoking cessation treatment (BSCT).


This study aimed to estimate adherence to BSCT and to explore possible predictors of adherence to BSCT.


Patients’ (n=75) data were analyzed to trace adherence to BSCT delivered at an outpatient smoking cessation clinic. The number of adherent patients was calculated for each of the 18 selected activities; the degree of adherence over the course of the treatment was displayed; and the number of patients that were adherent was analyzed. The relationship between adherence and 33 person-, smoking- and health-related characteristics was examined.


Adherence declined over the course of the treatment; the percentage of adherent patients per treatment activity ranged from 82% at treatment start and 11% to 19% in the final third of BSCT; applying a 61% threshold, 18% of the patients were classified as adherent. Marital status and social modelling were the best independent predictors of adherence. Patients having a partner had 11-times higher odds of being adherent (OR=11.3; CI: 1.33-98.99; P=.03). For social modeling – graded from 0 (=partner and friends are not smoking) to 8 (=both partner and nearly all friends are smoking) – each unit increase was associated with 28% lower odds of being adherent (OR=0.72; CI: 0.55-0.94; P=.02).

Figure 1 Adherence over the course of the treatment


The current study is the first study exploring adherence to a blended face-to-face and web-based treatment (BSCT) based on a substantial group of patients. It revealed a rather low adherence rate to BSCT: applying a 61% threshold for adherence, only 18% of the patients were classified as adherent. Furthermore, this study revealed that marital status and social modelling were independent predictors of adherence.