Understanding acceptance of digital smoking cessation interventions: user behavior, key influencing factors, and the role of reimbursement

Smoking remains a prominent preventable health risk in Germany, creating a need for effective cessation interventions. Digital smoking cessation interventions (DSCIs) present promising support for individuals aiming to quit, yet their utilization and acceptance are not thoroughly understood. This study analyzes usage patterns and acceptance levels of DSCIs among smokers, occasional smokers, and former smokers in Germany, focusing on user behavior, acceptance determinants, and the influence of prescription and reimbursement status. An online questionnaire based on the Unified Theory of Acceptance and Use of Technology 2 (UTAUT2) model was administered to participants. Data were collected through recruitment via social media, email lists, counseling groups, and public postings. The responses were analyzed using SPSS. The study included 173 participants (61.85% female, 37.57% male, 0.58% diverse) with an average age of 35.28 years. They reported smoking for an average of 18.21 years and attempting cessation 3.42 times. Among respondents, 41.62% had used DSCIs, predominantly former smokers (54.17%) and women (79.17%), with the "Smoke Free" app being the most utilized intervention. Although 73.05% expressed willingness to (re)use DSCIs, actual usage showed moderate acceptance levels. Significant predictors of acceptance included willingness to pay (p = 0.013), self-efficacy (p = 0.018), and physician prescription with clinical evidence (p = 0.019). The results highlight a rising demand for digital solutions focused on long-term smoking cessation, particularly among middle-aged women, emphasizing the need for a deeper understanding of acceptance drivers and model expansions to address healthcare dynamics.