Process Evaluation of the First Computer Tailored Program for Smoking Cessation among Romanian Smokers

  • Lotrean, Lucia Maria (Department of Hygiene, Faculty of Medicine, Iuliu Hatieganu University of Medicine and Pharmacy) ;
  • Ailoaiei, Roxana (Department of Hygiene, Faculty of Medicine, Iuliu Hatieganu University of Medicine and Pharmacy) ;
  • Popa, Monica (Department of Hygiene, Faculty of Medicine, Iuliu Hatieganu University of Medicine and Pharmacy) ;
  • De Vries, Hein (Department of Health Education and Health Promotion, Faculty of Health, Medicine and Life Sciences, Maastricht University)
  • Published : 2014.11.06


The objective of this paper is to present the implementation and process evaluation of the first computer tailored program for smoking cessation among Romanian smokers. The program targeted adult smokers who declared the intention to quit smoking in the next six months. The intervention consisted of a letter tailored to several respondent characteristics: gender, cognitive variables (attitude, social influence, and self-efficacy), intention to quit smoking, goal and relapse prevention strategies (action and coping plans), and smoking behaviour. The first 80 participants entered into the program filled in a process evaluation questionnaire one month after the intervention. The results of our study confirmed that the participants had read and remembered the letter. Moreover, new for Romania, this approach was positively appreciated by the participant and the score received for the tailored letter was high. The opinions of the participants confirmed that the tailored letter provided information that was useful, trustworthy and relevant for the individual. At the same time, the participants appreciated the polite, easy to understand content of the letter. These data underlined the premises for continuing the program and for using the information and communication technologies for healthy lifestyle promotion among Romanian population.


  1. Center for Health Policies and Services (2007). Fumatul si sanatatea publica in Romania. Cunostintele, atitudinile si comportamentul legate de fumat in randul populatiei generale. (Smoking and public health in Romania. Knowledge, attitudes and practices regarding tobacco use among general population in Romania). The Center, Bucharest.
  2. Civljak M, Sheikh A, Stead LF (2010). Internet-based interventions for smoking cessation. Cochrane Database Syst Rev, 9, 007078.
  3. De Vries H, Mudde A, Leijs I, et al (2003). The european smoking prevention framework approach (EFSA): an example of integral prevention. Health Educ Res, 18, 611-26.
  4. Brouwer W, Kroeze W, Crutzen R, et al (2011). Which intervention characteristics are related to more exposure to internet-delivered healthy lifestyle promotion interventions? A systematic review. J Med Internet Res, 13, 2.
  5. Dijkstra A, De Vries H, Roijackers J (1998). Long-term effectiveness of computer-generated tailored feedback in smoking cessation. Health Educ Res, 13, 207-14.
  6. Eurobarometru (2012). Attitudes of Europeans towards Tobacco Accessed May 2014.
  7. Eurostat (2012). Internet use in households and by individuals in 2012. Accessed May 2014.
  8. Gupta B, Kumar N (2014). A cross-country comparison of knowledge, attitudes and practices about tobacco use: findings from the global adult tobacco survey. Asian Pac J Cancer Prev, 15, 5035-42.
  9. Hawkins RP, Kreuter M, Resnicow K, Fishbein M, Dijkstra A (2008).Understanding tailoring in communicating about health. Health Educ Res, 23, 454-66.
  10. Lancaster T, Stead L, Silagy C, Sowden A (2000). Effectiveness of interventions to help people stop smoking: findings from the Cochrane Library. British Med J, 321, 355-58.
  11. Jayakrishnan R, Uutela A, Mathew A et al (2013).Cessation intervention in rural Kerala, India: findings of a randomised controlled trial. Asian Pac J Cancer Prev, 14, 6797-802.
  12. Kim H, Jin-Kyoung O, Lim MK, et al (2013). The national "smoking cessation clinics" program in the republic of Korea: socioeconomic status and age matter. Asian Pac J Cancer Prev, 14, 6919-24.
  13. Krebs P, Prochaska JO, Rossi JS (2010). A meta-analysis of computer-tailored interventions for health behavior change. Prev Med, 51, 214-21.
  14. Lancaster T, Stead LF (2005). Self-help interventions for smoking cessation, cochrane database of systematic Reviews, 3, 001118.
  15. Lotrean LM, Mocean F, Laza V, Poledna S (2009). The role of information technology in health education: strengths and weaknesses. Proceedings of the International Conference on advancements of medicine and health care through technology23-26 September, 2009, Cluj-Napoca, Romania, Springer Berlin Heidelberg, 72-6.
  16. Lotrean LM, Popa M, Radu Loghin C, de Vries H (2013). Smoking prevention for adolescents in Romanian schools. Asian Pac J Cancer Prev, 14, 7017-21.
  17. Lustria M, Cortese J, Noar S, et al (2009). Computer-tailored health interventions delivered over the web: Review and analysis of key components. Patient Educ Couns, 74, 156-73.
  18. Lustria ML, Noar SM, Cortese J, et al (2013). A meta-analysis of web-delivered tailored health behavior change interventions. J Health Commun, 18, 1039-69.
  19. Schulz DN, Schneider F, de Vries H, et al (2012). Program completion of a web-based tailored lifestyle intervention for adults: differences between a sequential and a simultaneous approach. J Med Internet Res, 14, 26.
  20. McDonnell DD, Kazinets G, Lee HJ, Moskowitz JM (2011). An internet-based smoking cessation program for Korean Americans: results from a randomized controlled trial. Nicotine Tob Res, 13, 336-43.
  21. Paek YJ, Lee S,Yun-Hee K, et al (2014). Effect on smoking quit rate of telling smokers their health risk appraisal in terms of health age: a randomized control Trial. Asian Pac J Cancer Prev, 15, 4963-68.
  22. Rimer BK, Kreuter MW (2006).Advancing tailored health communication: a persuasion and message effects perspective. J Communication, 56, 184-201.
  23. Shahab L, McEwen A (2009). Online support for smoking cessation: a systematic review of the literature. Addict, 104, 1792-804.
  24. Smit ES, de Vries, H, Hoving C (2012).Effectiveness of a web-based multiple tailored smoking cessation program: a randomized controlled trial among dutch adult smokers. J Med Internet, 14, 82.
  25. Smit ES, Evers SM, de Vries H, Hoving C (2013). Costeffectiveness and cost-utility of Internet-based computer tailoring for smoking cessation. J Med Internet Res, 15, 57.
  26. Te Poel F, Bolman C, Reubsaet A, de Vries H (2009). Efficacy of a single computer-tailored e-mail for smoking cessation: results after 6 months. Health Educ Res, 24, 930-40.
  27. US Department of Health and Human Services (2014). The Health Consequences of Smoking-50 Years of Progress: A Report of the Surgeon General. Accessed June 2014.
  28. Yarnall K, Pollak K, Krause K, Michener J (2003). Primary care: is there enough time for prevention? Am J Public Health, 93, 635-41.
  29. Van Keulen HM, Mesters I, Ausems M, et al (2011). Tailored print communication and telephone motivational interviewing are equally successful in improving multiple lifestyle behaviors in a randomized controlled trial. Ann Behav Med, 41,104-18.
  30. World Health Organization (2012). WHO Global report: mortality atribuatable to tobacco. Accessed June 2014.
  31. World Health Organization (2013). Mpower in action. Defeating the global tobacco epidemic. Accessed on May 2014.

Cited by

  1. A recommender system to quit smoking with mobile motivational messages: study protocol for a randomized controlled trial vol.19, pp.1, 2018,