Overcoming Challenges to Remote Biochemical Verification of Smoking Status: Insights From Participant Interviews

Objectives: Remote biochemical verification of smoking abstinence is limited by low adherence rates and technical problems with test completion. Qualitative data from study participants about their experiences completing these remote tests is lacking. The objectives were to interview participants who provided biochemical verification in a randomized trial of a smoking cessation intervention to (1) learn about participants' actual experiences with cotinine saliva testing; (2) examine willingness to conduct smartphone app-based carbon monoxide (CO) breathalyzer testing; and (3) gather recommendations to minimize barriers and improve adherence. Methods: Participants who completed biochemical verification were invited to participate in semi-structured interviews that included watching an instructional video about the breathalyzer test. Audio recordings were professionally transcribed, and 2 independent coders applied an interactive inductive thematic analysis approach. Results: Ten participants, ages 38.7 (9.5) years (30% male) completed interviews. Barriers to successful saliva cotinine testing included: technical issues submitting results (56%), issues following written instructions (44%), saliva collection sponge discomfort (33%), confusion about invalid results (33%), and concerns with device safety/data usage (22%). While more participants said they would, in concept, prefer the CO test or had no preference, they reported more problems with completing the CO test, including potential inaccessibility for people with respiratory illness. Key recommendations for improving compliance included: increasing monetary incentives, diversifying reminders, amplifying reciprocity messaging, managing expectations, and embedding clear, concise in-app guidance. Conclusion: Results suggest that compliance with remote biochemical verification can be improved through a comprehensive approach that includes increasing incentives, managing expectations, streamlining visual instructions, and diversifying reminders.