Fred Hutch Smoking Cessation Actify App
Actify is a smoking cessation app that helps users track their smoking behavior and replace it with meaningful activities that align with their values. The app also provides resources to guide users along their journey and stories from others smokers who quit.
Actify has since gone through clinical trials, outperforming the National Cancer Institute’s app in helping people quit smoking and achieving a breakthrough by turning the group that typically struggles the most—those with depression symptoms—into the group with the highest quit rates. View publication
Overview
What started as a student grad school project turned into a pro-bono passion project. We partnered with Fred Hutchinson Cancer Research Center to help smokers who have depressive symptoms improve their mood and quit smoking.
Role
Lead Designer, Dec 2020 - Mar 2022
Started a volunteer team of 3 designers and 1 researcher, mentored University of Washington grad students, & collaborated with Fred Hutch and development agency
“Cigarette smoking is the leading preventable cause of death in the US and worldwide.” - CDC
Vision
Collaborate with Fred Hutch to develop an app-based smoking cessation solution leveraging proven treatment methods to help users quit smoking without the need for in-person therapy.
Focus
Our focus was to target depressive symptoms to help smokers quit.
There is a correlation between smoking and depression in adults. Adults with depression are more likely to be current cigarette smokers than non cigarette smokers, and depressive symptoms are associated with failure of quitting or nicotine withdrawals.
“As a smoker who is seeking to quit, I want an easy way to track my smoking, access resources, and work toward a smoke-free habit to lead a healthier lifestyle, without having to seek in-person counseling. ”
Initial Research & Prototyping
Translating Program to an App
We reviewed scientific research and collaborated with Fred Hutch to understand the foundation of Behavioral Activation Treatment for smoking cessation. Through Behavioral Activation Therapy (BAT), we help users identify their core values and engage in activities that align with them, which boosts their mood and facilitates quitting smoking by replacing it with healthier habits.
When in a low mood, it can be hard to feel motivated, but participating in meaningful activities can help rewire our brains to improve our well-being.
The original in-person program consisted of the following:
Week 1: Monitor daily activities & their enjoyment/importance, set quit date
Week 2: Identify life areas and values, select activities
Week 3: Monitor progress and integrate meaningful activities into daily life
Week 4: Quit Week, strategies & identifying high-risk situations
Week 5-8 +: Beyond quit week, support & monitoring, adjust to life as non-smoker
However, with so many phone distractions and today’s consumer expectations of apps, it’s very difficult to make users follow the same program in the context of an app.
We decided to simplify the treatment to retain usage and interest, without removing the core foundations of the program.
The app program allowed users to begin thinking about their values and access important resources early on:
Week 1: Learn about the program, identify values and select meaningful activities to do, track smoking
Week 2: Continue to track smoking and complete meaningful activities, read more of the quit guide and browse inspiration, complete milestones
Week 3+: All the above and continue to monitor progress, relapse prevention and treatment
Since the initial weeks of in-person treatment are key for onboarding, we wanted to provide guidance upfront to ensure users understood the program's goals.
Initial Prototype Concept Testing
From the foundational research we gathered, we pulled together initial low-fidelity screens focusing on onboarding and helping users select what’s meaningful to them. We conducted rapid guerrilla testing to make sure that users understood the purpose of the app and how values, activities, and smoking tie together.
High Level Findings
Participants understood that it was an app to track smoking behavior and ultimately help user quit but were unsure why they needed to track their activities
Once participants arrived on dashboard, they weren’t sure what to do next
The app itself was easy to navigate, but participants could not quite verbalize how the program works
Iteration & Usability Testing
From previous rapid concept testing, we discovered participants did not understand the core of the app and how values and activities tied to smoking cessation. They also felt lost when thrown into the dashboard, so we focused on a guided onboarding to help users identify their values and really understand why that is core to the program.
Partnership with University of Washington
We partnered with students from a user research course from the Master’s program in Human Centered Design and Engineering at UW to assist with user research.
Key Questions:
Do participants understand the purpose of the program and how values align with activities, which help with smoking cessation?
How easily are users able to go through onboarding and arrive on the dashboard without confusion?
How do we encourage users to schedule and complete activities?
How likely are they to use the app to help them quit smoking and/or improve their mood?
Participants:
Nicotine smokers between 18 and 55
Have smart phones, and familiar with using apps
Mixed prior attempts to quit smoking, with 2 participants previously trying smoking cessation apps
Methods:
Usability Test - In-person session to complete tasks and provide feedback upon each step
Desirability Test - Which words best describe your experience with the app
Participatory Design Activity - What might help you stay engaged with the app?
Findings:
“If the dashboard is the first thing I see after the onboarding process, I’m craving to see something valuable. What is the first activity? What do I do?”
Navigating the app and scheduling activities were clear and easy to do for all participants but many were unsure of what to do when they arrived at the dashboard
Guided onboarding was valuable, though extremely lengthy
Most participants still did not fully grasp relationship between life areas, values, activities, and smoking cessation
General sentiments of the experience include the app feeling: personal, useful, easy, comfortable, but also annoying, irrelevant, and busy
Participatory design ideas:
Additional metrics to show progress and easily view smoking behavior over time
Suggestion on activities to try to remove initial barrier or scheduling activities
Visual way of seeing upcoming activities
Examples of participant sketches
From the research insights, we continued to iterate on the designs, and we welcomed one of the students from the class to continue working with us as a researcher after the course ended.
Partnership with Branding & Development Agency
Branding Considerations
We wanted the app to feel…
Non-judgmental
Welcoming
Inclusive
Positive
Calming yet action-oriented
Friendly but professional
Inspirational
As the project progressed, Fred Hutch secured a research grant to fund app development. We partnered with Moby, a Seattle-based firm, for branding, visual design, and development.
At this stage, we formed strong partnerships across Salesforce design volunteers, recruited another designer, and collaborated with Fred Hutch and the University of Washington to develop the app. This project was both cross-disciplinary and cross-organizational.
App Components & Development
With our guidance and UX, Moby helped us with visual design polish and implementation of the Fred Hutch app we call Actify. We worked closely with the agency to improve flows and ensure contrast was accessible by WCAG standards.
Onboarding
Provide guidance to learn more about how the program works, with the ability to skip through
Collect smoking behavior information from the get go
Introduce daily to-dos showing resources and upcoming tasks
Dashboard
Show progress of smoking cessation, quit date, money saved
Provide guidances to users around why life areas and values are important and how to think about scheduling meaningful activities within those areas
Track upcoming activities, with the ability to reflect and rate importance and mood upon completion
Quit Guide & Inspiration
Surface Quit Guide content throughout the program in daily to-dos and check-ins, which can also be accessed in the Quit Guide tab
Inspire users with with stories and quotes of previous smokers who have quit using behavioral activation therapy treatment
Milestones & To-dos
Encourage users to return to the app and check in each day with daily to-dos, which include their scheduled activities and a daily smoking behavior check-in
Show streaks and milestones of the smoking cessation journey and progress
Diary Study
With version 1 developed, we launched a diary study involving 6 smokers to track adherence, bugs, general usability, and understanding of the app.
Though motivation to quit smoking stayed around the same before and after the program, confidence of quitting in the next 30 days slightly increased from 7.2 to 8.4 out of 10 points
Most participants appreciated the smoking cessation information and reported a change in smoking behavior
One participant requested the app to be used in combination with a patch in order to be successful
A few technical issue and bugs made parts of the app tricky to use
We brought these findings back to the Moby team, who quickly fixed the bugs.
Reflection & Results
We completed that clinical trial of the Actify app and published the trial results. As a next step, a grant was submitted to take the next steps and hopefully test Actify in a large randomized controlled trial with around 1800 people.
It was really well-liked by participants, had a higher rate of helping people quit smoking than the National Cancer Institute’s app, and accomplished something that no other smoking cessation intervention has accomplished, to my knowledge—it transformed the group that typically fares the worst in cessation interventions (ie., people with depression symptoms) into the group with the highest quit rates!
- Jaimee Heffner PhD, Fred Hutch
Here are some takeaways reflecting on this project:
Embrace Ambiguity
Diving into a complex project despite many unknowns can be intimidating, but bringing together a group of people with a vision led to securing funding and building a small team by engaging more stakeholders and gaining clarity along the way.
Striking the right balance of design best practices and formal methodology takes time
We faced challenges aligning mobile app expectations with an in-person therapy program, but through iterations and close collaboration with the Fred Hutch team, we developed an app-friendly version of the treatment.
Parting Thoughts
I’m grateful to have worked with Dr. Jaimee Heffner, and dedicated designers Pavithra, Rajiv, and Aaron. Watching this evolve from a graduate project to a clinical-trial-ready app has been an incredible journey. Hopefully, it will help many in their journey to quit smoking and further tobacco cessation research.