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Impact of a Collective Intelligence Tailored Messaging System on Smoking Cessation: The Perspect Randomized Experiment
UMass Center for Clinical and Translational Science Supported Publications
  • Rajani S. Sadasivam, University of Massachusetts Medical School
  • Erin M. Borglund, University of Massachusetts Medical School
  • Roy Adams, University of Massaachusttes Amherst
  • Benjamin M. Marlin, University of Massaachusttes Amherst
  • Thomas K. Houston, University of Massachusetts Medical School
UMMS Affiliation
Division of Health Informatics and Implementation Science, Department of Quantitative Health Sciences
Document Type
BACKGROUND: Outside health care, content tailoring is driven algorithmically using machine learning compared to the rule-based approach used in current implementations of computer-tailored health communication (CTHC) systems. A special class of machine learning systems ("recommender systems") are used to select messages by combining the collective intelligence of their users (ie, the observed and inferred preferences of users as they interact with the system) and their user profiles. However, this approach has not been adequately tested for CTHC. OBJECTIVE: Our aim was to compare, in a randomized experiment, a standard, evidence-based, rule-based CTHC (standard CTHC) to a novel machine learning CTHC: Patient Experience Recommender System for Persuasive Communication Tailoring (PERSPeCT). We hypothesized that PERSPeCT will select messages of higher influence than our standard CTHC system. This standard CTHC was proven effective in motivating smoking cessation in a prior randomized trial of 900 smokers (OR 1.70, 95% CI 1.03-2.81). METHODS: PERSPeCT is an innovative hybrid machine learning recommender system that selects and sends motivational messages using algorithms that learn from message ratings from 846 previous participants (explicit feedback), and the prior explicit ratings of each individual participant. Current smokers (N=120) aged 18 years or older, English speaking, with Internet access were eligible to participate. These smokers were randomized to receive either PERSPeCT (intervention, n=74) or standard CTHC tailored messages (n=46). The study was conducted between October 2014 and January 2015. By randomization, we compared daily message ratings (mean of smoker ratings each day). At 30 days, we assessed the intervention's perceived influence, 30-day cessation, and changes in readiness to quit from baseline. RESULTS: The proportion of days when smokers agreed/strongly agreed (daily rating > /=4) that the messages influenced them to quit was significantly higher for PERSPeCT (73%, 23/30) than standard CTHC (44%, 14/30, P=.02). Among less educated smokers (n=49), this difference was even more pronounced for days strongly agree (intervention: 77%, 23/30; comparison: 23%, 7/30, P < .001). There was no significant difference in the frequency which PERSPeCT randomized smokers agreed or strongly agreed that the intervention influenced them to quit smoking (P=.07) and use nicotine replacement therapy (P=.09). Among those who completed follow-up, 36% (20/55) of PERSPeCT smokers and 32% (11/34) of the standard CTHC group stopped smoking for one day or longer (P=.70). CONCLUSIONS: Compared to standard CTHC with proven effectiveness, PERSPeCT outperformed in terms of influence ratings and resulted in similar cessation rates. CLINICALTRIAL: NCT02200432; (Archived by WebCite at
Rights and Permissions
Citation: J Med Internet Res. 2016 Nov 8;18(11):e285. Link to article on publisher's site. This is an open-access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited.
Related Resources
Link to Article in PubMed
  • UMCCTS funding,
  • recommender system,
  • health communication,
  • computer tailoring,
  • smoking cessation
PubMed ID
Citation Information
Rajani S. Sadasivam, Erin M. Borglund, Roy Adams, Benjamin M. Marlin, et al.. "Impact of a Collective Intelligence Tailored Messaging System on Smoking Cessation: The Perspect Randomized Experiment" Vol. 18 Iss. 11 (2016) ISSN: 1438-8871 (Linking)
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