A Systematic Review on the Impact of Digital Interventions for Smoking Cessation in Asian Populations

Among the 25 included studies, nine focused on telephone or text message–based counseling approaches [2, 10, 27, 28, 30, 33, 37, 42, 44]. Eleven studies delivered smoking cessation support through social media platforms or mobile applications [29, 31, 32, 34–36, 39–41, 45, 46]. Two studies evaluated multimedia or mass media–based messaging [23, 43], while another two implemented web-based e-learning programs [38, 47]. One study investigated the impact of audio-visual health education as a cessation aid [48].

Study design

The selected studies employed diverse research designs. Fifteen were randomized controlled trials [10, 28, 30, 31, 33–37, 39–42, 45, 46]; four used quasi-experimental or non-randomized designs [27, 43, 47, 48]; another four applied pre–post assessments [2, 29, 38, 44]; one was a prospective cohort study [32]; and one employed a longitudinal design [23]. The follow-up periods also varied considerably: 33 days [29]; 4 weeks [31]; 5 weeks [47]; 10 weeks [43]; 12 weeks [40]; 3 months [2, 36, 37]; 4 months [44]; 6 months [27, 30, 33, 34, 38, 39, 41, 42, 45]; 12 months [10, 28, 46]; and up to 3 years for the longitudinal study [23]. One trial assessed outcomes at four points—baseline, post-intervention, and at two subsequent follow-ups [35].

Smoking cessation outcomes

Marked variation was observed in effectiveness across intervention types. Eleven trials using social media platforms and mobile applications [29, 31, 32, 34–36, 39–41, 45, 46] reported particularly promising results. A Facebook-based intervention achieved the highest quit rate at 70% [35]. WhatsApp demonstrated abstinence rates of 59.5% [35] and 65.9% when integrated with standard care [39]. A smartphone application grounded in cognitive behavioural theory (CBT) enabled 60% of users to quit smoking [29]. WeChat interventions yielded 7-day point prevalence abstinence (PPA) rates of 41.8% when combined with a quitline [32]. The quit US app, delivered alongside pharmacist counselling, achieved a 58.4% abstinence rate [40]. Another WeChat program (“Quit smoking help”) demonstrated 28- and 7-day PPA rates of 15.6% in one group receiving two weeks of smoking-related messages, and 20.6% in another group that additionally received dental health content [31].

Telephone- and text–message–based interventions [2, 10, 27, 28, 30, 33, 37, 42, 44] generally produced more modest outcomes. For example, abstinence rates were 9.1% at 7 days and 8.0% at 12 months in one trial [28]. “Happy quit” text messaging interventions produced quit rates of 6.3% and 6.9% in separate studies [2, 30, 33]. A higher continuous abstinence rate of 16.8% was observed when face-to-face counselling was supplemented with follow-up telephone support [27]. Another trial reported an 11% quit rate with text messages [37], while one study found no significant difference at 12 months [10]. A combination of counselling and SMS achieved 44.3% abstinence by study end [42].

In contrast, web-based e-learning approaches [38, 47] did not demonstrate a notable effect on cessation outcomes. Similarly, media and multimedia messaging [23, 43] failed to produce significant improvements in smoking behavior. By comparison, the audio-visual health education intervention [48] showed encouraging results by enhancing participants’ motivation to quit, surpassing traditional health education alone.

Discussion

Technological progress has significantly contributed to improvements in health care delivery, particularly through the introduction of digital interventions. In the present review, the impact of such interventions on smoking cessation was assessed. Social media platforms appear to provide a practical and engaging medium for delivering cessation support, as they can attract smokers, sustain their participation, and deliver customized interventions while simultaneously collecting valid smoking-related data. These digital approaches generally work by enhancing smokers’ motivation to quit, maintaining abstinence, and encouraging quit attempts. Despite their promise, further well-designed trials are still needed to validate their effectiveness, evaluate cost-effectiveness and long-term feasibility, and determine whether these resources can be effectively accessed by socioeconomically disadvantaged groups, youth, and other populations with higher smoking prevalence.

Among the included studies, Facebook [35] and WhatsApp [34–36, 39] were frequently evaluated and showed notable success. For instance, one study reported that 70% of participants in a Facebook-based cessation program quit smoking [35]. Similar investigations conducted internationally also highlighted Facebook as an effective cessation platform for young adults [49–51]. WhatsApp interventions demonstrated comparable effectiveness, with Cheung et al. [35] reporting that 59.5% of participants in the WhatsApp group successfully quit smoking, experiencing fewer relapses compared to the participants in the Facebook group. Likewise, Durmaz et al. [39] and Luk et al. [36] documented abstinence rates of 40.9% and 31.4%, respectively, at six months.

Smartphone applications also demonstrated encouraging outcomes. Interventions delivered through WeChat [31, 32], pharmacist-supported cessation using the Quit US app [40], and programs integrating Cognitive Behavioral Theory (CBT) [29] all facilitated successful quitting. For example, Luo et al. [31] found that participants receiving smoking-related messages via WeChat achieved 15.6% and 20.6% 7-day PPA rates, depending on message type, while Chu et al. [32] reported a higher rate of 41.8%. A meta-analysis further confirmed that WeChat-based programs significantly improved abstinence compared to conventional interventions [52]. Given WeChat’s extensive use in China, participants often expressed that these digital reminders boosted their motivation, confidence, and knowledge about quitting [53]. Similarly, the integration of face-to-face counseling with the Quit US app produced an abstinence rate of 58.4% [40], while CBT-oriented app-based interventions enabled 60% of participants to remain abstinent from the designated quit date through program completion [29]. The integration of CBT into a digital interface allows clinicians to deliver tailored support and combine behavioral therapy with pharmacological treatment, which has proven to be an effective strategy for smoking cessation [54].

Instant messaging platforms such as WhatsApp, WeChat, and Facebook Messenger offer a widely accessible, low-cost, and interactive alternative to traditional SMS-based services, making them an appealing option for smokers seeking support in quitting [34].

Counseling delivered through telephone or text messaging has shown promise as a supportive strategy for smoking cessation, offering motivation, guidance, and encouragement to individuals attempting to quit. In this review, abstinence outcomes ranged from 8% to 44.3% [28, 42], while quit rates varied between 6.3% and 16.8% when such interventions were applied [2, 27, 30, 33, 37]. These observations align with evidence from a meta-analysis conducted in Western populations, which reported that individuals receiving text message support were 1.37 times more likely to remain abstinent compared with those in control groups [55]. Still, findings are not entirely consistent—one included study observed no significant difference in smoking cessation rates between intervention and control arms when using SMS or telephone support [10]. Notably, the degree of effectiveness appears to depend on factors such as the format and intensity of the intervention, characteristics of the study population, and length of follow-up. For instance, a US trial demonstrated significantly higher PPA among participants who received text messages compared to those who did not [56].

Strengths and Limitations

This review holds particular value as the first to synthesize evidence on the use of digital platforms—including Facebook, WhatsApp, WeChat, and smartphone applications—together with telephone and text-based interventions for smoking cessation in Asian populations. One of its strengths lies in identifying which digital tools are associated with favorable outcomes, particularly in achieving 7-day PPA, thereby providing insight into the most promising approaches for future cessation programs in the region. Nonetheless, several limitations should be noted. First, the wide variety of interventions tested, often in combination with additional methods, limited the ability to isolate the independent effect of each tool through quantitative meta-analysis. Moreover, heterogeneity in study design, participant demographics, and sample sizes posed additional challenges. Another limitation was the restriction to English-language publications, which raises the possibility that relevant findings from non-English sources were excluded. Future research should address these methodological gaps by employing larger, more uniform study designs and incorporating non-English literature.

Conclusion

Evidence from the included studies suggests that digital platforms represent effective tools for promoting smoking cessation. Social media platforms, such as Facebook and WhatsApp, have produced encouraging results, with Facebook-based interventions demonstrating particularly high quit rates among younger populations. In contrast, WhatsApp interventions yielded comparable abstinence levels but somewhat lower relapse rates. Similarly, smartphone apps—including WeChat and the Quit US application—proved effective, particularly when combined with Cognitive Behavioral Theory (CBT) frameworks or pharmacist counseling. Instant messaging applications, such as WhatsApp, Facebook Messenger, and WeChat, are increasingly viewed as practical, inexpensive, and interactive alternatives to SMS-based approaches. Telephone and text messaging interventions were also shown to be beneficial, though outcomes varied across studies. Ultimately, this review concludes that digital cessation tools can serve as cost-effective alternatives or complements to traditional cessation programs. However, optimal effectiveness depends on tailoring the intervention to individual needs, preferences, and contexts.

Acknowledgments: None.

Conflict of interest: None.

Financial support: None.

Ethics statement: None.