I'll Txt U if I Have a Problem: How the Societe Canadienne du Cancer in Quebec Applied Behavior-Change Theory, Data Mining and Agile Software Development to Help Young Adults Quit Smoking

Introduction: For many organizations, limited budgets and phased funding restrict the development of digital health tools. This problem is often exacerbated by the ever-increasing sophistication of technology and costs related to programming and maintenance. Traditional development methods tend to be costly and inflexible and not client centered. The purpose of this study is to analyze the use of Agile software development and outcomes of a three-phase mHealth program designed to help young adult Quebecers quit smoking. Methods: In Phase I, literature reviews, focus groups, interviews, and behavior change theory were used in the adaption and re-launch of an existing evidence-based mHealth platform. Based on analysis of user comments and utilization data from Phase I, the second phase expanded the service to allow participants to live text-chat with counselors. Phase II evaluation led to the third and current phase, in which algorithms were introduced to target pregnant smokers, substance users, students, full-time workers, those affected by mood disorders and chronic disease. Results: Data collected throughout the three phases indicate that the incremental evolution of the intervention has led to increasing numbers of smokers being enrolled while making functional enhancements. In Phase I (240 days) 182 smokers registered with the service. 51% (n = 94) were male and 61.5% (n = 112) were between the ages of 18-24. In Phase II (300 days), 994 smokers registered with the service. 51% (n = 508) were male and 41% (n = 403) were between the ages of 18-24. At 174 days to date 873 smokers have registered in the third phase. 44% (n = 388) were male and 24% (n = 212) were between the ages of 18-24. Conclusions: Emerging technologies in behavioral science show potential, but do not have defined best practices for application development. In phased-based projects with limited funding, Agile appears to be a viable approach to building and expanding digital tools.