Combined chatbot and counselor support for smoking cessation in China: a pilot, mobile-based, randomized controlled trial

Abstract

<p>Introduction</p><p>Smoking cessation services in China remain unevenly accessible and underutilized. Chatbots offer a cost-effective and scalable alternative to provide cessation support. This two-arm, community-based, randomized controlled pilot trial assessed the feasibility of a chatbot- supported smoking cessation intervention and explored the potential added benefit of personalized counselor support.</p><p>Methods</p><p>Participants were randomly assigned to an intervention group (n=71) or a control group (n=71). Both groups received chatbot-moderated WeChat group support, while the intervention group additionally received one-on-one cessation support from trained counselors for 3 months. The primary outcome was bio-verified abstinence at 6 months. Secondary outcomes included bio-verified abstinence at 3 months, self-reported point prevalence of abstinence (PPA), and smoking reduction. Feasibility outcomes included eligibility, consent, retention, and engagement rate.</p><p>Results</p><p>By intention-to-treat analysis, bio-verified abstinence was higher in the intervention group compared to the control group at 3 months (18.3% vs. 11.3%; risk ratio [RR] 1.62, 95% confidence interval [CI] 0.72-3.69) and 6 months (15.5% vs. 9.9%; RR 1.57, 95% CI 0.64-3.83), though these differences were not statistically significant. Self-reported PPA and smoking reduction were similar between groups.</p><p>Discussion</p><p>The pilot trial demonstrated that combining chatbot-delivered cessation support with personalized counselor via WeChat was feasible and well accepted in community settings. Although abstinence outcomes were not significant, findings suggest that supplementing chatbot support with counselor guidance may enhance engagement and cessation outcomes. This pilot provides preliminary evidence for integrating automated and human-supported approaches into scalable community cessation programs in China.</p>