Process and Information Needs When Searching for and Selecting Apps for Smoking Cessation: Qualitative Study Using Contextual Inquiry

Background Hundreds of apps are available to support people in their quest to quit smoking. It has been hypothesized that selecting an app from a sizable volume without any aid can be overwhelming and difficult. However, little is known about how people choose apps for smoking cessation and what exactly people want to know about an app before choosing to install it. Understanding the decision-making process may ultimately be helpful in creating tools to help people meaningfully select apps. Objective The aim of this study is to obtain insights into the process of searching and selecting mobile apps for smoking cessation and map the range of actions and the accompanying reasons during the search, focusing on the information needs and experiences of those who aim to find an app. Methods Contextual inquiries were conducted with 10 Dutch adults wanting to quit smoking by using an app. During the inquiries, we observed people as they chose an app. In addition, 2 weeks later, there was a short semistructured follow-up interview over the phone. Through convenience and purposive sampling, we included participants differing in gender, age, and educational level. We used thematic analysis to analyze the transcribed interviews and leveraged a combination of video and audio recordings to understand what is involved in searching and selecting apps for smoking cessation. Results The process of finding smoking cessation apps is comprehensive: participants explored, evaluated, and searched for information; imagined using functions; compared apps; assessed the trustworthiness of apps and information; and made several decisions while navigating the internet and app stores. During the search, the participants gained knowledge of apps and developed clearer ideas about their wishes and requirements. Confidence and trust in these apps to help quitting remained quite low or even decreased. Although the process was predominantly a positive experience, the whole process took time and energy and caused negative emotions such as frustration and disappointment for some participants. In addition, without the participants realizing it, errors in information processing occurred, which affected the choices they made. All participants chose an app with the explicit intention of using it. After 2 weeks, of the 10 participants, 6 had used the app, of whom only 1 extensively. Conclusions Finding an app in the current app stores that contains functions and features expected to help in quitting smoking takes considerable time and energy, can be a negative experience, and is prone to errors in information processing that affect decision-making. Therefore, we advise the further development of decision aids, such as advanced filters, recommender systems and curated health app portals, and make a number of concrete recommendations for the design of such systems.

Problem formulation Description and significance of the problem/phenomenon studied; review of relevant theory and empirical work; problem statement.
p.1-3 -The "theoretical and/or practical issues or concerns that make the study necessary" are described in the Introduction under the headings: Background, Challenges in searching and selecting health apps and Related research. S4 Purpose or research question Purpose of the study and specific objectives or questions. p.3,4 -The "statement of study intent" can be found in the Introduction under the heading Objectives Methods S5 Qualitative approach and research paradigm Qualitative approach (e.g., ethnography, grounded theory, case study, phenomenology, narrative research) and guiding theory if appropriate; identifying the research paradigm (e.g., postpositivist, constructivist/ interpretivist) is also recommended; discuss rationale 1 . * p.4 -Explanation why the chosen approach (contextual inquiry) is appropriate for the research question * The starting point of this study is to identify the different ways people search for a smoking cessation app. We assumed in advance that there would be diversity in beliefs, interpretation of information, and personal information needs. This implies a belief that there is no one 'truth'. We focus on 'understanding', use inductive reasoning, and believe that meaning is constructed in the researcher-participant interaction in the natural environment. All of this aligns with an Interpretivist paradigm (Bunniss & Kelly, 2010 [90]). S6 Researcher characteristics and reflexivity Researchers' characteristics that may influence the research, including personal attributes, qualifications/experience, relationship with participants, assumptions, and/or presuppositions; potential or actual interaction between researchers' characteristics and the research questions, approach, methods, results, and/or transferability.
The research was primarily designed, developed, and conducted by YH. YH is a PhD student, who has experience with both quantitative and qualitative research through doing two master's studies. Through some journalistic work experience, the researcher was used to and familiar with interviewing. Contextual Inquiry, however, she had not done before. In the context of 'Researcher characteristics and reflexivity', two things are good to mention. First of all, despite the intrpretivist character of the studie, YH tends rather toward the postpositivist paradigm. This means that she has tried to pursue objectivity by recognizing the possible effects of her own theories, background, knowledge and values. During the interviews she thus took care not to bias the work with her own opinions. Secondly, it should be noted that due to YH's personality, all interviews were conducted in a very relaxed, laid-back manner, often with an almost personal connection between the researcher and the participants. This, regardless of the goal for objectivity, probably did influence the results. S7 Context Setting/site and salient contextual factors; discuss rationale. See p. 8 'Sample descriptive', as well as the paragraphs 'Quitting smoking' and 'Experience with smoking cessation aids and apps' on p. 6-9. S13 Data processing Methods for processing data prior to and during analysis, including transcription, data entry, data management and security, verification of data integrity, data coding, and anonymization/deidentification of excerpts.
The description of methods for processing data, including the instruments and technology that were used, can be found on p. 6,7 under Data analysis. S14 Data analysis Process by which inferences, themes, etc., were identified and developed, including the researchers involved in data analysis; usually references a specific paradigm or approach; discuss rationale.
See table 1 on p. 7 S15 Techniques to enhance trustworthiness Techniques to enhance trustworthiness and credibility of data analysis (e.g., member checking, audit trail, triangulation); discuss rationale.
Independent co-coding of first transcript (p. 7), feedback of peers was sought in diverse research meetings (such as lab groups meetings), multiple iterations of the report were shared, discussed, and refined by all authors (p. 7), member checking by jointly creating a summary of the whole search process (p.6). We reflect on trustworthiness and validity in Strengths & limitations p. 25, 26.

Results/findings S16 Synthesis and interpretation
Main findings (e.g., interpretations, inferences, and themes); might include development of a theory or model, or integration with prior research or theory.
The main findings are described in the Results section (p. 7-22). We have chosen to separate (as much as possible) literal findings (what we observed) and interpretation of these events. Interpretation of, and integration with prior literature and theory, was done mainly in the Discussion (p. 23-28).
We have identified several facets that are involved in searching for, and selecting an app for smoking cessation. These (sub)themes are reported in table 2 (p.7) and under Principal Findings (p. 23-25). The Results section is however structured based on the various process steps, and not (as is usually done) on themes and subthemes. The clarification for this choice, can be found in the first paragraph of the Results section (p. 7). S17 Links to empirical data Evidence (e.g., quotes, field notes, text excerpts, photographs) to substantiate analytic findings.
We have provided a plethora of quotes. Furthermore, we have provided one process flow chart in the Multimedia Appendices as an illustration of both the method of analysis, as well as an example of the data we used. Discussion S18 Integration with prior work, implications, transferability, and contribution(s) to the field Short summary of main findings; explanation of how findings and conclusions connect to, support, elaborate on, or challenge conclusions of earlier scholarship; discussion of scope of application/generalizability; identification of unique contribution(s) to scholarship in a discipline or field.
A short summary of the main findings can be found directly under Principal findings. The description of the results is interwoven with some interpretation of the data in the context of previous findings (p. 23-25).

S19
Limitations Trustworthiness and limitations of findings See Strengths & limitations, p. 25, 26. Other S20 Conflicts of interest Potential sources of influence or perceived influence on study conduct and conclusions; how these were managed. p.28

S21 Funding
Sources of funding and other support; role of funders in data collection, interpretation, and reporting.
This study was funded by the University of Tilburg as part of the principal researchers PhD project.