Experiences of Ex-Smokers Serving as Peer Supporters in an Instant Messaging-Based Smoking Cessation Program: A Qualitative Study

Objectives: To explore the experiences of ex-smokers acting as peer supporters delivering chat-based instant messaging smoking cessation support in a post- randomized controlled trial qualitative study. Methods: We used purposive sampling to recruit 21 ex-smokers, who had previously provided chat-based instant messaging behavioral support to smokers in Hong Kong. Individual online semi-structured interviews were conducted. All interviews were audiotaped and transcribed verbatim. The transcripts were analyzed using inductive thematic analysis following Braun and Clarke’s six-phase framework. Results: Five themes were identified: stepping into the supporter role as ex-smokers, contributions beyond facilitating smoking cessation, mutual benefits as ex-smoking peer supporters, challenges in providing support, and the potential of mobile health-based peer support. Participants identified experiential sharing as a key mechanism for engaging motivated smokers, although its impact was limited by low user responsiveness. They described extending their support beyond smoking cessation (e.g., stress relief and healthier lifestyles), and reported mutual benefits, such as enhanced happiness, a positive attitude, and prevention of smoking relapse. Nevertheless, participants’ ability to effectively support smoking was challenged by limited interaction in the mHealth setting, difficulties offering timely responses, and uncertainty about how to handle complex personal situations. They suggested that future mobile health peer support can consider involving famous people as peer supporters, using personalized messaging, and adding incentives in the program to increase smokers’ motivation. Conclusions: Ex-smoking peer support in mHealth settings appears feasible and mutually beneficial, but its effectiveness may be constrained by low engagement and unclear role expectations.