Smoking is a risk factor for some of the world's leading causes of death, including lung cancer and other forms of cancer [8] as well as heart and respiratory disease [9]. Focusing on smoking cessation programs, patient-physician contact, and follow-up are very important psychological aspects of the smoking cessation process because they provide support and help maintain patient empowerment [21, 23]. Psychological reinforcement of patients' willpower is another important feature of TControl, because it is the only way to reduce the frequency of hospital visits by patients.
It is an extension added to expand the communication between each specialist and his patients, since, as mentioned above, patient-doctor contact and follow-up are very important psychological aspects of the process of quitting smoking, as they provide support and help maintain the patient. reinforcement [21, 23].
TControl: Web portal
Design
The presentation layer is implemented using Groovy Server Pages (GSP) for the structure and CSS (Cascading Style Sheets) is used in the presentation. Java Servlets is used in the controller layer and Java in the model layer.
Operation
Outpatient” and “hospitalized” and it depends on the situation in which the patient participates in the smoking cessation program. Initial status: Initially the default status is 'Remembered', but the doctor can change it, for example in case the new patient has not yet started the program. He can then select 'Smoking' and return to the patient status. profile and edit it when treatment finally begins. Other patient data that the doctor can manage is the clinical history, but this depends on the patient types mentioned above.
Finally, if the patient agrees to participate in the anti-smoking program, the doctor can fill in some details of a new appointment when the patient leaves the hospital, when this happens, the next time they met, the patient's type will change to "Outpatient". Likewise, the last day the patient smoked/will stop smoking and the next appointment date. This form can be completed many times and each of them will continue to be able to be consulted to track the patient's progress in this matter.
These messages will be received by the patient through their mail or the TControl mobile complement, depending on what they chose when they signed up. He asks the patient how he feels about smoking and treatment clearly, always being the same question to avoid patient confusion. These messages are sent automatically to encourage the patient to continue treatment in the anti-smoking program based on the patient's current status, stored in SHUITE.
TControl: Mobile complement
Design
Nowadays, when we talk about a "mobile supplement", most of the people will think of an app. In this case, for TControl even we could have developed one, we decided to make it in a different way. Three important design requirements were that the application must be compatible with Android and iOS, the most popular mobile operating systems, while guaranteeing optimal performance and communication security.
Functional requirements were collected from the clinics of the Tobacco Unit at Xarxa d'Hospitals de Catalunya. It has been implemented using JAVA, one of the languages allowed by this API, and the point of doing it this way is that you take profit from an already existing secure communication system, it's proven performance and the fact that that it is available for both Android and iOS markets, which perfectly fits all our requirements. It's honest to admit that this has been possible as we could handle all TControl's mobile complement functions this way because it fits all our needs like a charm, otherwise it wouldn't have been an option as an API has limitations, that can t we deal with.
That keyboard disappears when the bot is waiting for an action from the patient, so the user knows that something is missing on their end, and reappears when the action is complete, making navigation simple and intuitive. The implementation as a Telegram Bot ensures low data capacity requirements in the device as it does not require an app installation, only Telegram which in most cases is already installed in the user's device and makes a new chat to TControl bot open. It also avoids legal problems with clinical data that only stays securely stored in the SHUITE server and never in the devices.
Operation
Each week, the patient receives a Telegram message via the TControl bot that asks about their current smoking status and provides 4 options on a new button pad, each accompanied by an emotion that helps represent the patient's feelings . These messages are sent to the patient to encourage the patient to continue treatment in the anti-smoking program and depend on the patient's status. The patient can consult whenever he wants his statistics and achievements just by pressing a button.
Once it does, TControl sends a query to the SHUITE server to retrieve the data the user provided when the bot was first used to calculate the patient's achievements. Whenever the patient needs to send a message to his doctor, he will only have to press the corresponding button in the function menu (keyboard), when the patient does this, the TControl bot will respond with an informational message, letting the patient know that the next message he sends will be , went directly to the chat clinic inbox from the TControl web portal. When the attending doctor saw the message on the web portal, he could reply back from the "Inbox" chat and the patient would receive an immediate reply via the TControl bot.
When pressed, TControl bot sends a message to the patient asking him to confirm the cancellation, to avoid false alarms. TControl bot offers the patient a possibility of relaxation through a very entertaining web browser embedded game. Telegram bot API offers the possibility to create your own games [42], register it as a new game on their API for the affected bot, so when the patient wants to play, just press the correspondent button of the chat keyboard and TControl bot will open the linked game on Telegram's built-in browser.
Stability
If you do it this way, the game is developed and hosted on the SHUITE server, so neither Telegram nor the user's device will suffer from extra space problems. The game has been mostly developed with JavaScript [43] for the logic side and HTML5 [44] for the graphics.
Usability
Participants will rank each question from 1 to 5 based on how much they agree with the statement they are reading. Also half of them are smokers, so they can be potential users in the future, especially after the generalization of good opinions after participating in the testing program.
Performance
The group contains representative proportions of age, gender and physical condition compared to the entire treatment group. Knowing these limitations, even our bot is a specific use and this never happened during the trial period. There may occasionally be a slight delay in the bot's response that is not due to performance. of the server, but of the API's ability to process and send the requests. To make a rigorous evaluation of the robustness of TControl's web portal, we recorded all crashes that occur when using the application, to determine where and when they occur.
For TControl bot, since it depends heavily on Telegram, the problems on the backend caused by mobile complement interaction have been taken into account. In addition, about half of them currently smoke, which means that they are potential real users. While for the mobile supplement, the users were required to test all the skilled functionalities.
As it has been mentioned in Correspondent Usability chapters above, the System Usability Scale (SUS) has been used to evaluate the usability of the platform, so all the testers had to complete one SUS survey for web portal and one for the mobile supplement. After a 15-day test period, a total of 17 crashes were recorded on the web portal, while only 6 on the mobile complement. Most of them (about 80%) were produced by database exceptions due to bad queries and incorrect data processing or due to simple programming errors (9%) as unexpected casuistic, also few communication errors between client and server (11%).
Usability
After which, by multiplying by 2.5, you ensure that the maximum is 10 for each of the questions. These results are incredibly satisfying since, according to the general guideline for the interpretation of a SUS score (Table 5), we obtained an A grade on both, which means an excellent. Is robust and easy to use, as most of the users who took the test indicated that it was not difficult to use, as shown in the Results section.
It is difficult to compare the performance of the bot, because after analyzing the Telegram community, we did not find any other bots for this purpose. In this case, Table 7 compares the functionalities of TControl robots and those offered by some of the top-rated applications, also presented in the Related work section. This article presents TControl, a complete platform to provide the best support to potential stakeholders in quitting tobacco based on their needs and goals, to facilitate their work and improve the satisfaction of users, doctors and patients, which actually means improving the success of the program.
It is also important to understand the contextual use of the platform and how important the communication services are to achieving that success. However, our trial had some limitations regarding the number of patients involved in the study. Considering this, our immediate goal is to go live with the full version of the TControl platform implementing it on the "Xarxa d'Hospitals de Catalunya" to continue testing it and the results with a to analyze a larger sample, in order to compare it with the collected on this test period with the aim of consolidating our projects' success.
In: Projections of Global Mortality and Burden of Disease from 2002 to 2030./ Available at: https://journals.plos.org/plosmedicine/article?id=. In: Tobacco smoke as a risk factor for bronchioloalveolar lung cancer: pooled analysis of seven case-control studies in the International Lung Cancer Consortium (ILCCO) / Cancer Causes Control.
