Smoking Cessation Coaching in High-Risk Situations: A Virtual Reality Study

Smoking abstinence self-efficacy will be assessed with a single question derived from the 'Smoking Abstinence Self-efficacy Questionnaire' (Spek et al., 2013). The six-item questionnaire measures self-efficacy regarding smoking abstinence in six different situations. However, in this experiment the situation is shown using VR (e.g., a personalized VR environment of a participant's favorite bar). Therefore, participants will only answer the question "Are you confident that you will not smoke in this situation?" while being exposed to the VR environment. Total scores range from 0 to 4, with a higher score indicating higher abstinence self-efficacy.

To identify the level of subjective smoking craving experienced (in the VR environments), a single-item will be used (Shadel & Cervone, 2006; Vinci et al., 2020). Participants are asked to indicate how strong their craving for a cigarette is right now. Answers are given on a scale ranging from 1 (no craving at all) to 10 (extremely strong craving), with a higher score indicating stronger subjective tobacco craving.

The level of positive and negative affect is assessed by having participants indicate to what extent they experienced the four basic emotions on a scale from 1 (not at all) to 10 (very much; Versluis et al., 2018). The scores on anger, anxiety and sadness will be averaged to represent negative affect. The average score on negative affect ranges from 3 to 30, with a higher score indicating stronger feelings of negative affect. The happiness-rating will represent positive affect. The average score on positive affect ranges from 1 to 10, with a higher score indicating stronger feelings of positive affect.

Acceptance of the conversational agent will be assessed using a set of six items. Two example items are: "How satisfied were you with the virtual coach?" and "How easy was it talking to the virtual coach?". Answers are given on a 7-point scale. The questionnaire was originally used in an intervention study (Provoost et al., 2020). Three of the items of the questionnaire had to be adjusted to make them applicable to the experimental set-up of this study. For example, the item "How much would you like to continue working with the virtual coach if the course continued?" was changed into "How much would you like to continue working with the virtual coach if it was available on your smartphone?". Total scores range from 6 to 42, with a higher score indicating higher acceptance of the conversational agent.

The usability of the conversational agent will be measured with a number of items of the System Usability Scale (Brooke, 1996). The total questionnaire consists of ten items and items are rated on a 5-point Likert scale ranging from 0 (strongly disagree) to 4 (strongly agree). Four questions of the original questionnaire are used in this study. In addition, to get a better in-depth understanding of the participants' user experience with the virtual coach, the following open-ended question will be asked: "Would it be useful to have a virtual coach available on your phone to assist with smoking cessation? Please explain.".

To gain insight into whether the participant had the impression of being in the virtual environment. The Single-Item Measure of Presence will be used (Bouchard et al., 2004). Participants will indicate on a scale ranging from 0 to 10 to what extent they experience presence, with higher scores representing a higher sense of presence.

General information about the participants will be obtained, namely gender (i.e., male, female, gender neutral, I would rather not say), age (birth year) and level of education (i.e., primary education, vmbo, havo, vwo, mbo, hbo, wo; as measure for SEP).

Participants familiarity with VR was assessed using the following question: "Have you ever used virtual reality before". If participants answers this question with yes, they will be asked how frequently they have used VR.

Participants indicate whether they intend to quit in the future. Answer categories are based on the stages of change of the Transtheoretical model (Prochaska & DiClemente, 2005) and include: within the next month (1), between 1 to 6 months from now (2), sometime in the future, beyond 6 months (3) or not planning to quit (4; Hummel et al., 2018). Participants that choose answer category four will be categorized as 'non-intenders'. This variable will be recoded so that higher scores indicate stronger intention to quit.

Trait tobacco craving will be assessed using the craving subscale of the Wisconsin Smoking Withdrawal Scale (Welsch et al., 1999). The subscale consists of four items that are scored on a 5-point scale ranging from 0 (strongly disagree) to 4 (strongly agree). An example item is "I have had frequent urges to smoke".

Physical nicotine dependence will be assessed at baseline using the Dutch version of the Fagerström Test of Nicotine Dependence (Heatherton et al., 1991; Penfornis et al., 2021).The questionnaire consists of six items, of which four items are scored on a dichotomous scale (yes / no), one item is scored using four answer categories, and one item has an open answer format (asking participants about the number of cigarettes smoked per day). An example item is "Do you smoke more in the morning than during the rest of the day?". Total scores can range from 5 to 12, with a higher score indicating higher nicotine dependence.

To assess the time since last exposure to nicotine, participants were asked how long ago they had their last cigarette. Participants will be able to specify both the number of hours and/or minutes.