By Giorgi Mzhavanadze, Healthy Initiatives
A smoking-cessation app can provide reminders, self-monitoring tools and behavioral support long after a patient leaves a clinic. [1] But there is a practical problem that software developers cannot solve through features alone: who helps patients find and use these tools?
For digital-health innovators, the question is not simply whether an intervention works. It is whether the intervention becomes part of routine care.
A new survey conducted by Healthy Initiatives in Ukraine offers a useful perspective on this challenge. Between October 2025 and September 2026, 1,538 respondents participated in a survey of healthcare professionals examining cessation practices, recommended methods, training and familiarity with clinical guidelines. Among the 1,475 respondents who answered the question about recommended methods, only 14.7% selected digital applications or online cessation services. [2]
The survey is not nationally representative, and it did not measure actual patient use of digital tools. Nevertheless, the findings raise a practical question: how can healthcare organizations make digital cessation support easier to recommend, access and integrate into everyday patient care?
Digital Support Is Rarely Recommended
Digital tools were among the less frequently selected cessation-support methods in the Ukrainian survey. While 57.2% of respondents reported usually recommending social or family support, 36.3% selected psychological or psychiatric counselling, and 14.7% selected digital applications or online services. Referral to a specialized cessation or addiction service was selected by only 13.9%. [2]
Interestingly, among the 217 respondents who recommended digital tools, only five selected that option alone. The remaining 212 also selected at least one additional support method. This does not tell us whether different methods were recommended together to individual patients, but it suggests that digital support was rarely the only approach identified by those respondents. This matters because the strongest role for digital tools may not be to replace clinical care, but to extend its reach between appointments and provide additional support when face-to-face contact is limited.
The World Health Organization’s 2024 clinical treatment guideline recognizes this potential. It conditionally recommends making digital tobacco-cessation interventions, including text messaging, smartphone applications and internet-based services, available either as self-management tools or alongside other cessation support. [3]
The Technology Has Potential, but Its Effectiveness Varies Across Technologies
Digital cessation interventions are not all equally effective. A 2026 systematic review and meta-analysis published in BMJ Evidence-Based Medicine, covering 31 randomized trials and 12,802 participants, found that smartphone applications may improve smoking cessation, particularly when combined with established interventions. Applications based on psychological and behavioral theories showed promising results. However, evidence for several principal cessation outcomes remained of low certainty, and the authors called for further high-quality research. [4]
A successful digital cessation product cannot be judged simply by downloads, attractive interfaces or the number of messages delivered. Its value depends on whether it provides evidence-informed support and helps patients achieve meaningful outcomes. The same applies to clinical integration. Even an effective intervention may have limited impact if it is difficult for healthcare professionals to identify, recommend or incorporate into existing workflows.
Clinical Familiarity Matters, but Training Alone Is Not the Answer
The Ukrainian survey provides another interesting perspective. Among respondents familiar with approved tobacco-dependence treatment guidelines, 20.7% selected digital cessation tools, compared with 13.5% among those unfamiliar with the guidelines. This represents a statistically significant association in the sample, although it does not establish causality. The relationship with previous cessation training was less clear. Digital tools were recommended by 18.0% of respondents with prior cessation training, compared with 14.3% without training. This difference was not statistically significant.
These findings do not demonstrate that training itself drives digital-tool recommendations. Nor do they establish why respondents chose or did not choose digital services. They do, however, reinforce the importance of understanding clinical decision-making.
A 2025 systematic review in the Journal of Medical Internet Research examined factors influencing the implementation of digital interventions in healthcare. It identified workflow compatibility, appropriate training, clear value to users and organizational readiness as important facilitators. Disruption to existing workflows and inadequate preparation were among the barriers. [5]
The implication is straightforward: healthcare professionals need to understand what a digital tool offers, which patients it is suitable for, and how to incorporate it into the care they already provide.
Build a Referral Pathway, Not Just an App
A digital cessation program becomes more useful to healthcare organizations when recommending it requires little additional effort. Consider a routine consultation with a patient who smokes. The healthcare professional identifies smoking status, discusses quitting and offers appropriate support. If a suitable digital service is available, the next step could be as simple as providing a verified enrollment link or initiating an electronic referral.
The process should not end there. Where appropriate and with patient consent, the care team could record whether the referral was accepted, whether the patient enrolled and whether further assistance is needed. There is evidence that making referral easier can change clinical practice: A randomized study published in the Journal of the American Medical Informatics Association compared electronic referrals with fax-based referrals to a smoking-cessation telephone service across 23 primary-care clinics in the United States. Electronic referral produced substantially higher referral and patient-connection rates. The findings illustrate how workflow design can improve access to cessation services, although the results cannot automatically be generalized to Ukraine or to smartphone apps. [6]
A Cochrane review examining 16 studies of electronic health record interventions also found modest improvements in some recommended clinical actions, particularly smoking-status documentation and referrals. However, none of the included studies directly assessed patient quit rates. Better digital documentation and referral processes should therefore not be confused with demonstrated improvements in cessation outcomes. [7]
For digital-health developers, the lesson is not that every clinic needs complex software integration. It is that the pathway from clinical recommendation to patient support should be easy to complete. This may involve a simple referral form, an approved resource directory, automated appointment reminders or integration with an existing electronic health record. The right solution depends on the healthcare setting, available infrastructure and patient needs.
Measure Engagement, Not Just Availability
Healthcare organizations also need better ways to evaluate digital cessation support. The Ukrainian survey found that only 15.8% of respondents reported often or always arranging follow-up with patients who smoke. This is not a measure of digital engagement, but it illustrates a broader limitation in continuing cessation support. [2]
Digital services could help extend contact between appointments, but their success should be assessed through meaningful indicators. Organizations should distinguish between tools being available, patients receiving a recommendation, referrals being completed, patients engaging with the service and eventual cessation outcomes. These are different stages, and performance at one stage does not guarantee success at the next.
Technology should also pay attention to accessibility, data privacy, usability and the additional workload created for healthcare professionals. A complicated solution that requires duplicate data entry or disrupts routine care may struggle to gain sustained use.
From Digital Products to Digital Care
The Ukrainian survey relied on convenience sampling and self-reported practices. It did not measure the availability of digital cessation services, clinicians’ reasons for recommending them, patient engagement or treatment outcomes. Its findings therefore cannot establish the causes of low digital-tool recommendations or estimate adoption across Ukraine’s healthcare system.
Nevertheless, the survey offers a useful starting point for healthcare innovators. Digital cessation interventions have potential, and the evidence supporting some approaches is growing. But evidence of effectiveness is only one part of successful implementation. Clinical familiarity, straightforward referrals, appropriate integration and outcome measurement are also important.
For healthcare technology providers, the next challenge is not simply to build another smoking-cessation app. It is to make evidence-based digital support easier for healthcare professionals to recommend and easier for patients to use.
References
- Zhang, M., Wolters, M., O’Connor, S., Wang, Y., & Doi, L. (2023). Smokers’ user experience of smoking cessation apps: A systematic review. International Journal of Medical Informatics, 175, Article 105069. https://doi.org/10.1016/j.ijmedinf.2023.105069
- Healthy Initiatives. (2026). Куріння, нікотин та альтернативи тютюну (Responses) as of October 1 2026 [Unpublished survey dataset].
- World Health Organization. (2024). WHO clinical treatment guideline for tobacco cessation in adults. https://www.who.int/publications/i/item/9789240096431
- Chu, S., Feng, L., Jing, H., Zhang, D., Li, J., Meng, X., Liu, X., Ma, Q., Jing, C., Lu, C.-L., Wu, F., Tian, F., Liu, J., Tong, Z. H., & Liang, L. (2026). Efficacy of smartphone apps used alone or with traditional interventions for smoking cessation: A systematic review and meta-analysis. BMJ Evidence-Based Medicine, 31(4), 242–253. https://doi.org/10.1136/bmjebm-2025-113971
- Patel, S. B., Iqbal, F. M., Lam, K., Acharya, A., Ashrafian, H., & Darzi, A. (2025). Characterizing behaviors that influence the implementation of digital-based interventions in health care: Systematic review. Journal of Medical Internet Research, 27, Article e56711. https://doi.org/10.2196/56711
- Fiore, M., Adsit, R., Zehner, M., McCarthy, D., Lundsten, S., Hartlaub, P., Mahr, T., Gorrilla, A., Skora, A., & Baker, T. (2019). An electronic health record-based interoperable eReferral system to enhance smoking Quitline treatment in primary care. Journal of the American Medical Informatics Association, 26(8–9), 778–786. https://doi.org/10.1093/jamia/ocz044
- Boyle, R., Solberg, L., & Fiore, M. (2014). Use of electronic health records to support smoking cessation. Cochrane Database of Systematic Reviews, 2014(12), Article CD008743. https://doi.org/10.1002/14651858.CD008743.pub3
Funding Disclosure
This study was funded through a grant from Global Action to End Smoking (formerly known as the Foundation for a Smoke-Free World), an independent U.S. nonprofit 501(c)(3) grantmaking organization. The funder had no role in the conception, design, implementation, data analysis, interpretation of the study results, or preparation of this article.
