ExSnus: A Persuasive Mobile Health Application for Snus Cessation

Alba Puyuelo Citoler

, Jungna Lee and Eunji Lee

Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden

Keywords: Snus Cessation, Mobile Health Application, Persuasive Technology, Artificial Intelligence, Service Design,

Prototyping, Health Promotion.

Abstract: The use of snus among Swedish youth is increasing, becoming a growing public health concern due to its

associated health risks. To help individuals quit addictive behaviours such as snus consumption, mobile health

applications have emerged as accessible and cost-effective tools. This project presents ExSnus, a mobile

application prototype designed to support users in quitting snus by employing strategies based on a persuasive

systems design framework. The application combines social interaction and self-monitoring to address key

factors influencing snus use, such as social influence, cultural normalization, and health concerns. This

approach ensures that ExSnus not only supports behavioural change but also provides an accessible tool

tailored to the needs of young users.

1 INTRODUCTION

This section provides a comprehensive overview of

the context surrounding snus consumption. It presents

key statistics, highlights the physiological and

cognitive effects of snus addiction, and discusses the

challenges of cessation, including withdrawal

symptoms and available treatments. Furthermore, it

explores the potential role of emerging technologies,

such as mobile health (mHealth) applications, in

addressing this growing public health concern. These

insights support the project's aim to design an

effective mHealth application to assist Swedish

university students in quitting snus.

1.1 Snus Consumption Statistics

Snus is a type of moist oral tobacco typically used by

placing it behind the upper lip so that its active

components, primarily nicotine, are absorbed through

the oral mucosa (Byhamre et al., 2020). Its sale is only

available in Sweden among all the European Union

countries and in Norway. Although snus is usually

considered a less harmful alternative to cigarettes

(Clarke et al., 2019), recent studies are showing that

it has associated health risks, including increased

mortality rates and a potential association with deaths

https://orcid.org/0009-0008-3118-1496

https://orcid.org/0000-0001-8369-7736

from cardiovascular disease and cancer (Byhamre et

al., 2020; France-Presse, 2023; Norwegian Institute

of Public Health, 2019). Recent statistics show that

13.6% of Swedes consume snus every day (Sohlberg

& Wennberg, 2020). This trend is particularly

alarming among younger demographics, where

approximately half of high school students have tried

it at least once (The Public Health Agency of Sweden,

2023).

1.2 Physiological and Cognitive Effects

on Snus Addiction and Motivations

to Quit

Delving into the reasons for consuming it, snus

produces several positive effects in the body, mainly

related to its nicotine content, a highly addictive

substance that encourages its use. Snus promotes

relaxation, helps with concentration, and improves

mood, resulting in a cheerful feeling that typically

lasts around half an hour (POUCHES.EU, 2020).

Additionally, snus use is associated with certain

beliefs and cognitive distortions that also contribute

to addiction. These include the notion that snus

relieves stress and the belief that it is necessary for

coping with challenging emotions. Cognitive biases,

such as underestimating the health risks of snus and

Citoler, A. P., Lee, J. and Lee, E.

ExSnus: A Persuasive Mobile Health Application for Snus Cessation.

DOI: 10.5220/0013398100003911

Paper published under CC license (CC BY-NC-ND 4.0)

In Proceedings of the 18th International Joint Conference on Biomedical Engineering Systems and Technologies (BIOSTEC 2025) - Volume 1, pages 1105-1116

ISBN: 978-989-758-731-3; ISSN: 2184-4305

1105

overestimating its benefits, further reinforce these

addictive behaviours (Cognitive Behavioral Therapy

Los Angeles, 2020). Other factors influencing snus

use include its perception as a less risky alternative to

cigarettes or as an aid during smoking cessation

(Ramström et al., 2016), as well as its cultural

importance in Sweden (Pele et al., 2023).

However, several studies have shown that snus

use can lead to overall morbidity and mortality

(Byhamre et al., 2020; France-Presse, 2023), which

motivates people to stop using it. A study conducted

among young people found that nearly half of daily

snus users were willing to quit (Danielsson et al.,

2023). The study also demonstrated that awareness of

the health risks associated with snus and receiving

advice to quit had a positive impact on individuals’

motivation to stop using it.

Another study conducted among Swedish

smokers aged 16-84, who used snus as a method to

quit smoking, identified additional reasons for

quitting snus (Sohlberg & Wennberg, 2020). These

reasons included health problems such as high blood

pressure and dental problems, economic concerns

because of the high price of snus, negative effects on

relationships due to complaints related to the smell,

and the perception of the habit as disgusting.

Interestingly, some cited the difficulty of shipping

and purchasing snus abroad as a reason to quit.

1.3 Cessation Consequences and

Established Treatments

Despite the initial motivations, quitting snus is a

challenging process due to the associated withdrawal

symptoms that emerge when snus is no longer used.

These negative symptoms occur because the body has

become dependent on nicotine, a highly addictive

substance present in snus that influences

neurotransmitters in the brain's reward system. Since

cigarettes and snus share this nicotine content, the

withdrawal symptoms that occur when quitting snus

are similar to those encountered when quitting

smoking (Ashford, 2016). These withdrawal

symptoms typically include intense cravings and

mood changes such as anxiety, irritability, and

difficulty concentrating and sleeping (Maana;

Snusforumet, 2022). It is crucial for people who want

to quit snus to be aware of these symptoms and when

they are likely to occur. Understanding that these

symptoms are only temporary can help them stay

motivated throughout the cessation journey

(Smokefree Veterans, 2021).

Over the years, different treatments have been

developed to aid smoking cessation efforts, which can

also be applied to quit snus given the shared nicotine

content between the two products. Nicotine

Replacement Therapy (NRT) is the most common

smoking cessation method, using products that

administer controlled doses of nicotine to alleviate

cravings and withdrawal symptoms (Smokefree

Veterans, 2021). The effectiveness of these

treatments is enhanced when complemented with

guidance or counselling, usually provided by

healthcare professionals (National Cancer Institute,

2022; Smokefree Veterans, 2021). This counselling

often involves cognitive approaches to help people

change their attitudes towards tobacco and snus use,

with Cognitive Behavioural Therapy (CBT) being

one of the most established methods for managing

nicotine withdrawal (Vinci, 2020). CBT focuses on

identifying maladaptive thoughts and behaviours to

then alter them (Cognitive Behavioral Therapy Los

Angeles, 2020). Furthermore, CBT emphasizes the

value of setting achievable goals and creating a

realistic quit plan to prevent relapse, along with other

strategies such as self-reminders of the reasons for

quitting and rewards for resisting cravings (Jenlmat,

2018; Nicotine Pouches with Gum Protection, 2024).

However, accessing professional counselling can

be tedious, especially for young people who might

lack the motivation or economical means. As

technology advances, new and more accessible

alternatives for advice and counseling are emerging,

including mHealth technologies. mHealth

applications provide an opportunity to deliver

continuous support, such as the previously mentioned

cognitive therapies, making them readily available for

people seeking to overcome addictive behaviours.

1.4 Aim of the Project

The increasing popularity of snus among Swedish

youth, coupled with the mounting evidence of its

associated health risks, is becoming a critical public

health issue. To address this issue, mHealth

applications have the potential to serve as powerful

allies, providing accessible counselling to help

individuals overcome addictions. This project focuses

on designing a mHealth application tailored to aid

university students in Sweden with snus cessation.

The design of the application will follow a service

design process and incorporate a persuasive

technology framework to ensure that it addresses the

users’ needs and effectively influences their

behaviour changes towards snus use.

The main research questions guiding this project

are:

DEMS 2025 - Special Session on Design and Evaluation of Monitoring Systems

1106

a) What are the key factors that contribute to the

use of snus?

b) How can a mobile snus cessation application

can be designed to address these factors and

incorporate a persuasive technology framework?

To answer these questions, the project will first

identify the main drivers of snus use and then

determine how a mobile application can effectively

counteract them by following some persuasive

technology principles.

2 THEORETICAL

FRAMEWORKS

This section provides an in-depth presentation of the

foundational theories and methodologies guiding the

design of the mobile application. It delves into

approaches such as Service Design, Persuasive

Technology, and User Interface Design, explaining

why they were selected. Furthermore, the integration

of Artificial Intelligence counselling into the

application is examined, highlighting its potential to

enhance accessibility and personalization.

2.1 Adapted Design Approaches

This sub-section offers an overview of the theoretical

foundation behind the approaches used in designing

the mobile application for this study.

Service Design (SD) is rooted in design thinking,

which focuses on understanding the users’ needs to

create products and services that improve user

experiences (Stickdorn et al., 2020). SD has been

already employed to develop several mHealth

applications (Farao et al., 2020; Koumpouros, 2022;

Woods et al., 2017). It was selected for this project

based on evidence showing that mHeatlh applications

designed without sufficient input from users and

clinicians often fail to achieve high quality (Farao et

al., 2020; Koumpouros, 2022).

Persuasive Technology (PT) uses non-coercive

methods to alter user behaviours or attitudes

(Wenker, 2022). In the health field, persuasive health

technology (PHT) targets health-related behaviours

to improve a person’s health status (McLean, 2020;

Orji et al., 2016). For this project, PHT aimed at

tobacco cessation is particularly relevant. This type of

PHT uses cognitive strategies to change users’

attitudes towards tobacco use (Wenker, 2022), being

CBT one of the most well-established methods. The

Persuasive Systems Design (PSD) framework acts as

a guideline for designing these persuasive

technologies through four main areas: Primary Task

Support, Computer-Human Dialogue Support,

System Credibility Support, and Social Support

(McLean, 2020).

Nevertheless, effective mHealth applications

require both the right functionalities and an interface

that is easy to use. User Interface (UI) design focuses

on creating such interfaces (The Interaction Design

Foundation, 2024) by defining a clear navigational

structure and keeping the number of functionalities

offered on each screen simple (Shokurova, 2020).

2.2 Artificial Intelligence Counseling in

Health

The use of Artificial Intelligence (AI) based

counseling is becoming popular in health-related

applications (Espejo et al., 2023). AI-powered

chatbots such as QuitBot (Fred Hutch Cancer Center,

2024) provide personalized support for smoking

cessation by combining evidence-based content with

natural language processing and machine learning.

These chatbots offer users real-time guidance

throughout the quitting process, making them more

accessible and adaptable than traditional counseling

methods (Fiske et al., 2019). Although AI holds

promise for mental and physical health interventions,

ethical considerations and ongoing research are

essential to ensure these tools complement

professional care effectively (Bendotti et al., 2023;

He et al., 2022; Whittaker et al., 2022).

3 METHODS

Table 1 presents the methods employed across four

phases of an adapted SD process: research, ideation,

prototyping and validation, as depicted in Figure 1.

The State-of-the-Art (SOTA), and user interview and

its analysis were employed during the research phase.

For the ideation phase, persona and use cases were

created to represent the application’s functionalities.

Then, sketching, wireframing and interactive click

modelling were used to create the digital prototype of

the application. Finally, usability testing coupled with

usability interview completed the validation phase. In

this way, these methods were used to create this

project’s application, which was called ExSnus and

will be referred to as such from now on.

In the initial research phase, SOTA was conducted

to understand the current snus cessation methods.

Existing smoking cessation strategies and mHealth

applications for snus cessation were reviewed to

assess their strengths, weaknesses, and potential gaps

ExSnus: A Persuasive Mobile Health Application for Snus Cessation

1107

Table 1: Methods Employed in This Study.

Methods

Research topic

State-of-the-

Art

(SOTA)

Existing mHealth applications for snus

cessation

User interview

Relationship of college students with snus

Document and

thematic

analysis

Identifying key user needs for snus

cessation from the SOTA and the

interviews

Persona and

use cases

Representing a potential end-user and

defining the functionalities to address the

identified user needs by implementing a

persuasive technology framework

Sketching

Translating defined functionalities into

visual elements

Wireframing

Converting sketches into digital designs,

establishing connections between the

application’s screens

Interactive

click modelling

Giving more realism and aesthetic to the

digital screens following UI guidelines,

making them functional

Usability

testing

Moderated in-person testing where

participants completed tasks in the

interactive click prototype to evaluate its

functionalities

Usability

Interview

Use of AI counselling and preferred

functionalities from the designed prototype

to address snus addiction

that ExSnus could address (Beck et al., 2016).

Additionally, current trends in mobile application

design were studied to ensure ExSnus meets user

expectations.

In parallel, user interviews in the form of semi-

structured interview (Lazar et al., 2017) were

conducted with five students at Chalmers University

of Technology who use snus. The goal was to explore

their motivations, experiences, and attitudes towards

snus. The interview questions covered topics such as

their snus habits and perspectives on quitting, like

“Do you feel snus helps you in some way?” and

“What do you think you need to help yourself to quit

snus?”. The answers were analysed using thematic

analysis (Braun et al., 2006) to identify key themes

that informed the design of ExSnus, ensuring that it

addresses the needs users face when quitting snus.

In this way, the knowledge obtained in the

research phase allowed the identification of necessary

functionalities to be included in ExSnus during the

ideation phase. Based on the collected and analysed

data, a persona (Method Library - This is Service

Design Doing, 2020) was created to represent the

needs of potential users of ExSnus. Then, the

functionalities of ExSnus were defined to address

Figma: The Collaborative Interface Design Tool

these needs, based on existing mHealth applications

for snus cessation and following the principles of the

PSD model. These functionalities are represented

through use cases and a use case diagram, which

illustrate how users interact with the application,

describing their goals, actions, and system responses

(Indeed Editorial Team, 2023).

Subsequently, mock-ups were created to visually

represent the defined features of ExSnus during the

prototyping phase. The prototyping process began

with rough sketches, which were later translated into

wireframes that focused on structure and layout,

omitting visual design details such as content and

colour schemes (Osman, 2023). Finally, a more

detailed and interactive prototype of the main screens

was developed from the wireframe. The project used

the Figma

software to create both the wireframes and

the final interactive prototype.

Lastly, the interactive prototype underwent

usability testing to assess how intuitive and user-

friendly it was (Maze, 2023). In this project, a

moderated in-person approach was used, combining

qualitative and quantitative methods. Five

participants of the usability testing, who were from

the target audience of college students, were given

tasks to explore the main functionalities of the

ExSnus prototype while verbalizing their thoughts

using the Think Aloud protocol. This helped identify

any confusing or frustrating elements of the screens

(Bil et al., 2022). After completing the tasks,

participants had a brief usability interview where they

answered questions related to which part of the

application they found most helpful for quitting snus,

and their thoughts on the social and AI functionalities.

They also completed the System Usability Scale

(SUS) questionnaire to quantify their perception of

the application’s usability (Thomas, 2019). Their

feedback could be used in future steps to refine the

ExSnus prototype, ensuring it is user-friendly and

effective before development begins.

4 RESULTS

This section presents the key findings from the design

and validation of the ExSnus application. It delves

into how theoretical frameworks such as SD and PT

were applied during the design process to ensure that

the application effectively addresses user needs.

Then, it presents the innovative features incorporated

into the application through user personas and use

cases that are translated into visual design elements.

DEMS 2025 - Special Session on Design and Evaluation of Monitoring Systems

1108

Finally, it summarizes user feedback gathered

through usability.

4.1 Application of the Theoretical

Framework

The design process for ExSnus was based on both the

SD methodology and the PT framework. This dual

approach ensured that ExSnus correctly addressed

users’ needs while also increasing user engagement

and effectively influencing their behavior.

Additionally, the visual design of ExSnus followed

UI principles to ensure that the user experience was

both intuitive and aesthetically pleasing.

An adapted SD process was followed in the design

of ExSnus through the research, ideation, prototyping

and validation phases to create and validate the

application’s functionalities. Tools such as user

personas and use cases were employed to understand

and meet user needs.

The PT framework was employed to define the

functionalities of ExSnus so that it motivated users to

quit snus (Vinci, 2020). Particular attention was paid

to social support because interpersonal relationships

and community influence are crucial for sustaining

behavior changes (Oinas-Kukkonen et al., 2009;

Soulakova et al., 2018). Various studies have shown

that a supportive social environment enhances the

success of quitting smoking (Creswell et al., 2015;

Sorensen et al., 2002). This social support was

integrated through different functionalities in

ExSnus, such as allowing users to observe others

performing similar behaviors and comparing their

progress, which creates a sense of belonging (Fogg,

1998).

Finally, the UI guidelines introduced by

Shokurova (2020) were followed to create a simple

and intuitive interface. The layout was designed with

calming colors and health-specific icons to provide a

visually soothing experience.

4.2 Existing mHealth Applications for

Snus Cessation: State-of-the-Art

(SOTA)

While there are numerous mobile applications to help

quit smoking, mobile applications focused on snus

cessation are limited and relatively unknown. The

found applications that are available either for

Android or iPhone systems were Snus Stop, Quit

Snus, DipQuit, Snuskollen, Snusfri and Slutta. The

most common features across them focus on tracking

progress through visual graphs or statistics, mainly on

snus spared and money saved. Motivation is usually

enhanced by reaching milestones related to days

without consuming snus. It is also worth noting that,

although some of the available applications provide

information on health regained by quitting snus, this

information often lacks scientific support, a limitation

observed in smoking cessation applications as well.

For instance, Haskins et al. (2017) found that only 2

out of 50 mobile applications directed to smoking

cessation had scientific backing.

After SOTA, some of these found features were

included when designing ExSnus, such as tracking

money saved and snus use statistics. Nevertheless,

this project goes further by including social features,

an AI chatbot, and scientifically backed information

on withdrawal symptoms and available therapies.

Additionally, ExSnus provides deeper insights into

users’ triggers for cravings and offers tips to address

them.

While research has been conducted on the

effectiveness of smoking cessation applications

(Haskins et al., 2017; Regmi et al., 2017; Scott-

Sheldon et al., 2016; Whittaker et al., 2016), similar

studies for snus cessation are lacking. The collective

findings regarding smoking cessation mobile

applications suggest that they are helpful, both

independently and combined with face-to-face

support or online programs, particularly in high-

income countries that have established tobacco

control measures. Reported quit rates for smoking

cessation applications range from 12.5% to 51.5%

(Barroso-Hurtado et al., 2021), with their success

largely attributed to their ability to reach a wide

audience at minimal cost, making them more

accessible than other cessation interventions.

4.3 Interviews Analysis

The analysis of the interviews with five college

student snus users in Sweden revealed several core

themes related to their behaviors and perceptions

about snus. These themes highlight user’s needs that

must be addressed when designing ExSnus.

4.3.1 Social and Cultural Influence

Snus use is deeply ingrained in Swedish culture, often

introduced in social situations such as parties and

considered a normal behaviour. This social

acceptance creates a supportive environment to

continue its use, making it difficult to find social

support when trying to quit, which highlights the

importance of including social support on the

application.

ExSnus: A Persuasive Mobile Health Application for Snus Cessation

1109

Figure 1: Project steps followed in the application design based on the adapted SD process (Stickdorn et al., 2020).

4.3.2 Addiction and Use of Snus

Many users exhibit physical and psychological

dependency, using snus right after waking up and

managing stress or focusing on tasks. Addressing

these perceived functional benefits is essential to

encourage quitting.

4.3.3 Health Concerns and Motivations for

Cessation

Although interviewees were somewhat aware that

snus could pose health risks, they lacked detailed

knowledge about its contents and specific dangers.

Health concerns, along with financial costs, were

strong motivators for quitting, highlighting the

importance of including health education and

monetary incentives as key features of ExSnus.

4.3.4 Cessation Support and Technology

Scepticism

The interviewees had varied opinions on how a

mobile application could help them quit, with some

suggesting features like managing triggers or sharing

progress with friends.

4.4 Persona

A persona was designed based on insights from the

literature study, SOTA and the interviews’ analysis,

presented in Figure 2 in our previously published

paper (Puyuelo-Citoler et al., 2024). This persona

represents a Swedish university student and serves as

a typical model for potential users of ExSnus. His

objectives, preferences, and challenges were

considered when designing the use cases that shape

the application’s features.

4.5 Use Cases and UML Case Diagram

The created use cases cover the encountered user’s

needs through ExSnus. Then, a UML use case

diagram was designed to represent the main

functionalities depicted in the use cases and the

interactions between the potential end-users and the

ExSnus system, as shown in Figure 2. The defined

uses cases are the following ones:

1. Create Profile: Enables users to create a

personalized profile by completing a

questionnaire to assess their addiction level

and setting a quit date and motivations (e.g.,

monetary savings). This tailored profile helps

the app provide customized support based on

user-specific needs and preferences.

2. Record Snus Use: Allows users to log each

instance of snus use, including their emotional

state and activity at the time, helping them

identify patterns and triggers.

3. Record Craving Overcame: Enables users to

log instances when they successfully resist a

craving, including details about their

emotions, activities, and the methods used to

overcome the craving. This supports habit

change toward healthier behaviors.

4. Visualize Dashboard: Provides a visual

summary of the user's quitting progress,

including data on snus usage, emotional

triggers, money saved, and health benefits

achieved, offering insights to guide and

motivate the user.

5. Visualize Timeline: Displays a timeline of the

quitting journey, showing snus usage,

cravings overcome, and milestones achieved.

It also highlights expected health

improvements and withdrawal symptoms

based on scientific data to educate and prepare

the user.

6. Engage with Social Features: Allows users to

share their quitting progress and achievements

on social media or within a community forum

within the app, fostering social support and

engagement.

7. Chat with AI Counsellor: Provides instant

support through an AI-driven chat feature,

offering advice, motivational messages, and

DEMS 2025 - Special Session on Design and Evaluation of Monitoring Systems

1110

answers on questions related to the quitting

journey.

8. Receive Notifications: Sends timely

notifications about milestones, progress

updates, social engagement, and reminders of

quit dates or financial goals, helping users stay

motivated.

9. Profile Management: Allows users to manage

their profile settings, such as updating their

quit date, financial goals, motivational

messages, avatar, and notification preferences.

4.6 Application Design

After defining the functionalities of ExSnus through

the use cases presented in the previous sub-section,

they were translated into visual elements across

various screens. Initially, hand-drawn sketches

captured the essential features to ensure that all the

functionalities were included in the designed screens.

These sketches were then converted into a digital

wireframe, which connected all screens in low-level

detail, including buttons, main text, image

placements, and different screen statuses like error

messages. The wireframe shows the logic of how the

application’s screens are connected. During the

design of the wireframe, guidelines were employed to

correctly place navigation elements on the screens

(Lazard et al., 2021) and display specific elements

such as error messages (Santiago, 2020) so that the

user experience is enhanced. Screens for the timeline,

forum, and settings were inspired by existing designs

found online using the key search words “Timeline

mobile app design”, “Forum mobile app design”, and

“App settings design”.

After the wireframe was completed, a more

detailed design was created for the main screens,

incorporating visual elements such as calming colors,

readable fonts, and a clear visual hierarchy for text

and images, following healthcare applications’ design

principles (Mundia, 2023; Shapovalova, 2023;

Shokurova, 2020). Most visual elements, such as font

type and color, were chosen based on UI tips for

accessibility and aesthetic appeal (Heryanta, 2024;

Malik, 2023), ensuring that ExSnus provides a user-

friendly and engaging experience.

Due to content limitations, only a few examples

of the wireframe and final prototype are shown in

Figure 3 and Figure 4. However, the full set of

wireframes and prototypes can be accessed at

Wireframe

and Interactive Click Model

respectively.

Figure 2: UML case diagram representing a summary of the use cases and the interaction with the system.

Figma Wireframe

Figma Interactive Click Model

ExSnus: A Persuasive Mobile Health Application for Snus Cessation

1111

4.7 Usability Test Analysis

This sub-section presents an analysis of the usability

testing conducted to assess ExSnus’ functionality and

ease of use. The analysis is based on the feedback

collected from participants through the Think Aloud

process and interviews, as well as the results from the

SUS questionnaire. The insights gained from this

testing phase highlight both the strengths and areas

for improvement in the design of ExSnus.

4.7.1 Results from the Think Aloud Process

and the Usability Interview

Usability testing for ExSnus involved six university

students in Sweden, aged 23 to 28. Most participants

had prior experience using health applications and AI

chatbots, and some had previously tried to change

unhealthy habits, either independently or with

professional help. Key insights from the Think Aloud

process revealed that users appreciated the initial

questions about their addiction level when setting

their profile, because it made them feel the

application was personalized to their individual cases.

They also preferred multiple-choice questions rather

than having to type responses. Additionally, users

considered the dashboard the most useful screen, as it

allowed them to track their progress. On this screen,

the goal reminders were also welcomed, particularly

those related to monetary savings. Another notable

finding was the varied preferences regarding the

frequency and number of notifications to be received.

Figure 3: Wireframe showing the screens for recording snus usage and cravings overcome, as specified in the second and

third use cases.

DEMS 2025 - Special Session on Design and Evaluation of Monitoring Systems

1112

Figure 4: Example of some main screens from the application final design. From left to right: Dashboard, Timeline, Forum,

and AI chatbot.

Figure 5: Usability Evaluation of ExSnus using the SUS.

4.7.2 Results from the SUS Questionnaire

The responses to the SUS questionnaire generally

indicate that the system has strong usability, as shown

in Figure 5. In the left plot, most SUS scores are

concentrated in the high 80s, suggesting that users

found the system very usable. The scores fall within

the ‘Best Imaginable’ and ‘Excellent’ categories on

the color-coded chart, indicating a positive user

interface experience. The steep curve around the 70-

80 score range reflects significantly better

performance than typical SUS assessments. Most

responses were positive, particularly regarding ease

of use and the need for minimal prior knowledge or

assistance. However, there was more variability in

responses to questions related to how frequently users

would use the system, how well functionalities are

integrated, and whether others would find the system

easy to use, pointing to potential areas for

improvement.

ExSnus: A Persuasive Mobile Health Application for Snus Cessation

1113

5 DISCUSSION AND

CONCLUSION

The design of ExSnus was guided by the application

of the PT principles to address key factors driving

snus use, including stress relief, cognitive biases, and

social normalization, identified from the user

interviews. Knowing that the nicotine content of snus

provides relaxation, focus and mood enhancement to

its users, ExSnus offers strategies to replace these

benefits and manage withdrawal symptoms.

During the research phase, one of the critical

factors discovered for the success of quitting snus was

social support, as users highlighted the lack of it when

attempting to quit. To address this, ExSnus enables

users to share achievements and progress within a

supportive community forum, fostering a sense of

belonging and leveraging social influence to motivate

them throughout their cessation journey. These are

features included in the PT framework.

Self-monitoring features are another key element

from the PT framework, allowing users to track their

snus consumption, cravings, and progress over time.

This aligns with CBT principles by enabling users to

identify triggers, monitor their behavior patterns, and

adopt effective strategies. Financial tracking of

savings further reinforces motivation.

Educational content plays an essential role in

addressing cognitive biases, such as the belief that

snus is less harmful than smoking. Scientifically

validated information on health risks and the benefit

of quitting is delivered through features like the AI

chatbot and the timeline. By increasing awareness

and correcting misconceptions, ExSnus helps users to

make informed decisions about their health.

Usability testing revealed that users appreciated

personalized features, such as tailored questions and

progress reminders, especially those related to

financial savings. The dashboard was well-received

for tracking progress, though mixed feedback on

notifications and timeline displays, suggesting areas

for improvement. Overall, the design of ExSnus

successfully addresses user needs, demonstrating the

potential of the adapted SD framework and the PT

framework in mHealth applications.

Beyond its focus on snus cessation, ExSnus'

functionalities, such as the AI chatbot and self-

monitoring features, can be adapted to support

individuals tackling other addictions, such as caffeine

dependence or excessive gaming among teenagers.

Furthermore, ExSnus could promote behavioral

change beyond its primary target group of students by

adapting the design to reach older generations.

In conclusion, ExSnus shows the potential of the

PT framework in mHealth applications to assist with

behaviour change. While its primary focus is on snus

cessation, its adaptable design offers opportunities to

address a wide range of addictive behaviours and

health challenges. By expanding its current

functionalities, its applicability to other addictions

could be explored. In this way, our research has the

potential to make a meaningful contribution to public

health and behavioural change on a larger scale.

Future research should prioritize evaluating ExSnus

through randomized controlled trials to measure its

effectiveness in reducing snus consumption and

explore its scalability.

ACKNOWLEDGEMENTS

I would like to express my sincere gratitude to my

supervisor, Eunji Lee, and my co-supervisor, Jungna

Lee, for their invaluable knowledge, time, and

guidance throughout this project. I also thank the

participants who participated in this project.

REFERENCES

Ashford, K. (2016). Snus: What you should know about this

smokeless tobacco. WebMD. Retrieved from

https://www.webmd.com/smoking-cessation/features/

snus-tobacco-health-risks

Barroso-Hurtado, M., Suárez-Castro, D., Martínez-Vispo,

C., Becoña, E., & López-Durán, A. (2021). Smoking

cessation apps: A systematic review of format,

outcomes, and features. International Journal of

Environmental Research and Public Health, 18(21),

11664. https://doi.org/10.3390/ijerph182111664

Beck, J., & Stolterman, E. (2016). Examining practical,

everyday theory use in design research. She Ji: The

Journal of Design, Economics, and Innovation, 2(2),

125–140. https://doi.org/10.1016/j.sheji.2016.01.010

Bendotti, H., Lawler, S., Chan, G. C., Gartner, C., Ireland,

D., & Marshall, H. M. (2023, January). Conversational

artificial intelligence interventions to support smoking

cessation: A systematic review and meta-analysis.

DIGITAL HEALTH, 9. Retrieved from

https://doi.org/10.1177/20552076231211634

Bil, A., & Dumowski, D. (2022). What is a thinking aloud

protocol and how can it improve your understanding of

a product? BOLDARE. Retrieved March, from

https://www.boldare.com

Braun, V., & Clarke, V. (2006). Using thematic analysis in

psychology. Qualitative Research in Psychology, 3(2),

77–101. Retrieved from

https://doi.org/10.1191/1478088706qp063oa

DEMS 2025 - Special Session on Design and Evaluation of Monitoring Systems

1114

Byhamre, M. L., Araghi, M., Alfredsson, L., Bellocco, R.,

Engström, G., Eriksson, M., Galanti, M. R., Jansson, J.-

H., Lager, A., Lundberg, M., et al. (2020). Swedish snus

use is associated with mortality: A pooled analysis of

eight prospective studies. International Journal of

Epidemiology, 49(6), 2041–2050.

https://doi.org/10.1093/ije/dyaa197

Clarke, E., Thompson, K., Weaver, S., Thompson, J., &

O’Connell, G. (2019). Snus: A compelling harm

reduction alternative to cigarettes. Harm Reduction

Journal, 16(1), Article 62.

https://doi.org/10.1186/s12954-019-0335-1

Cognitive Behavioral Therapy Los Angeles. (2020). Quit

smoking Los Angeles. Retrieved from

https://cogbtherapy.com/quit-smoking-los-angeles

Creswell, K. G., Cheng, Y., & Levine, M. D. (2015). A test

of the stress-buffering model of social support in

smoking cessation: Is the relationship between social

support and time to relapse mediated by reduced

withdrawal symptoms? Nicotine & Tobacco Research,

17(5), 566–571. https://doi.org/10.1093/ntr/ntu192

Danielsson, M., Lammi, A., Siitonen, S., Ollgren, J.,

Pylkkänen, L., & Vasankari, T. (2023). Factors

predicting willingness to quit snus and cigarette use

among young males. Scientific Reports, 13(1).

https://doi.org/10.1038/s41598-023-42233-8

Espejo, G., Reiner, W., & Wenzinger, M. (2023,

September). Exploring the role of artificial intelligence

in mental healthcare: Progress, pitfalls, and promises.

Cureus. Retrieved from

https://doi.org/10.7759/cureus.44748

Farao, J., Malila, B., Conrad, N., Mutsvangwa, T.,

Rangaka, M. X., & Douglas, T. S. (2020). A user-

centred design framework for mHealth. PLOS ONE,

15(8). https://doi.org/10.1371/journal.pone.0237910

The Public Health Agency of Sweden. (2023). Ungas bruk

av tobaks- och nikotinprodukter. Retrieved from

https://www.folkhalsomyndigheten.se/livsvillkor-

levnadsvanor/andts/andts-anvandning-och-ohalsa/

anvandning/anvandning-av-tobaks-och-

nikotinprodukter/ungas-bruk-av-tobaks--och-

nikotinprodukter/

Fogg, B. J. (1998). Persuasive computers: Perspectives and

research directions. In Proceedings of the CHI 98

Conference on Human Factors in Computing Systems

(pp. 225–232). Los Angeles: ACM Press/Addison-

Wesley Publishing Co.

France-Presse, A. (2023). Why Sweden going smoke-free

may not be such good “snus”. Retrieved November,

from https://www.voanews.com/a/7345050.html

Fred Hutch Cancer Center. (2024). Fred Hutch launches free

AI-powered chatbot app to help people quit smoking.

Retrieved from https://www.fredhutch.org/en/news/

releases/2024/01/fred-hutch-launches-free-ai-powered-

chatbot-app-to-help-people-q.html

Haskins, B. L., Lesperance, D., Gibbons, P., & Boudreaux,

E. D. (2017). A systematic review of smartphone

applications for smoking cessation. Translational

Behavioral Medicine, 7(2), 292–299.

https://doi.org/10.1007/s13142-017-0492-2

He, L., Basar, E., Wiers, R. W., Antheunis, M. L., &

Krahmer, E. (2022, April). Can chatbots help to

motivate smoking cessation? A study on the

effectiveness of motivational interviewing on

engagement and therapeutic alliance. BMC Public

Health, 22(1). Retrieved from

https://doi.org/10.1186/s12889-022-13115-x

Heryanta, J. (2024). Never use pure black in typography.

Medium. UX Planet. Retrieved April, from

https://uxplanet.org/basicdesign-never-use-pure-black-

in-typography-36138a3327a6

Indeed Editorial Team. (2023). List of use cases examples.

Indeed. Retrieved March, from

https://www.indeed.com/career-advice/career-

development/list-of-use-cases-examples

Fiske, A., Henningsen, P., & Buyx, A. (2019, May). Your

robot therapist will see you now: Ethical implications

of embodied artificial intelligence in psychiatry,

psychology, and psychotherapy. Journal of Medical

Internet Research, 21(5). Retrieved from

https://doi.org/10.2196/13216

Jenlmat. (2018). Smokeless tobacco. Rogel Cancer Center |

University of Michigan. Retrieved November, from

https://www.rogelcancercenter.org/breaking-habits-

beating-us/smokeless-tobacco

Koumpouros, Y. (2022). User-centric design methodology

for mHealth apps: The PAINAPP paradigm for chronic

pain. Technologies, 10(1), 25.

https://doi.org/10.3390/technologies10010025

Lazar, J., Feng, J. H., & Hochheiser, H. (2017). Interview

strategies. In Research methods in human-computer

interaction (pp. 198–199). Elsevier. ISBN:

9780128053904

Lazard, A. J., Babwah Brennen, J. S., & Belina, S. P.

(2021). App designs and interactive features to increase

mHealth adoption: User expectation survey and

experiment. JMIR mHealth and uHealth, 9(11).

https://doi.org/10.2196/29815

Maana. Sluta snusa. Retrieved from https://www.maana.se/

alkohol-droger/snus/sluta-snusa/

Malik, R. (2023) Leading global UI/UX design agency.

Onething Design Studio. Retrieved from

https://www.onething.design/blogs/triadic-color-scheme

Maze. (2023). What is usability testing? How to evaluate

the user experience. Retrieved November, from

https://maze.co/guides/usability-testing/

McLean, A. (2020). mHealth apps as effective persuasive

health technology: Contextualizing the “necessary”

functionalities. JMIR Nursing, 3(1).

https://doi.org/10.2196/19302

Method Library - This is Service Design Doing. (2020).

Creating personas. Retrieved from

https://www.thisisservicedesigndoing.com/methods/cr

eating-personas-2

Mundia, B. (2023). Principles of visual hierarchy in UI

design. Medium. UX Planet. Retrieved August, from

https://uxplanet.org/principles-of-visual-hierarchy-in-

ui-design-fbcd31f88088

National Cancer Institute. (2022). Tips for coping with

nicotine withdrawal and triggers. Retrieved January,

ExSnus: A Persuasive Mobile Health Application for Snus Cessation

1115

from https://www.cancer.gov/about-cancer/causes-

prevention/risk/tobacco/withdrawal-fact-sheet

Nicotine Pouches with Gum Protection. (2024). How to quit

snus: A guide. Retrieved January, from

https://stingfreesnus.com/how-to-quit-snus-a-guide/

Norwegian Institute of Public Health. (2019). Health risks

from snus use. Retrieved from

https://www.fhi.no/en/publ/2019/health-risks-from-

snus-use2/

Oinas-Kukkonen, H., & Harjumaa, M. (2009). Persuasive

systems design: Key issues, process model, and system

features. Communications of the Association for

Information Systems, 24.

https://doi.org/10.17705/1cais.02428

Orji, R., & Moffatt, K. (2016). Persuasive technology for

health and wellness: State-of-the-art and emerging

trends. Health Informatics Journal, 24(1), 66–91.

https://doi.org/10.1177/1460458216650979

Osman, M. (2023). Website wireframe beginner’s guide:

Processes, tools, & examples. HubSpot Blog. Retrieved

November, from

https://blog.hubspot.com/website/website-wireframe

Pele, C., & Ritter, K. (2023). Sweden close to becoming first

“smoke-free” country in Europe as daily use of

cigarettes dwindles. Retrieved June, from

https://apnews.com/article/smoking-cigarettes-snus-

sweden-7e3744800a4714bdee4bcb1736983586

POUCHES.EU. (2020). Snus effect. Retrieved February,

from https://pouches.eu/en/blogs/nieuws/snus-effect

Puyuelo-Citoler, A., & Lee, E. (2024). Designing a social

snus cessation mobile application with an integrated AI

function. Studies in Health Technology and Informatics,

316, 532–533. https://doi.org/10.3233/SHTI240467

Ramström, L., Borland, R., & Wikmans, T. (2016).

Patterns of smoking and snus use in Sweden:

Implications for public health. International Journal of

Environmental Research and Public Health, 13(11),

1110. https://doi.org/10.3390/ijerph13111110

Regmi, K., Kassim, N., Ahmad, N., & Tuah, N. (2017).

Effectiveness of mobile apps for smoking cessation: A

review. Tobacco Prevention & Cessation, 3(April).

https://doi.org/10.18332/tpc/70088

Santiago, S. V. (2020). A comprehensive guide to

notification design. Toptal Design Blog. Toptal.

Retrieved June, from https://www.toptal.com/

designers/ux/notification-design

Scott-Sheldon, L. A., Lantini, R., Jennings, E. G., Thind,

H., Rosen, R. K., Salmoirago-Blotcher, E., & Bock, B.

C. (2016). Text messaging-based interventions for

smoking cessation: A systematic review and meta-

analysis. JMIR mHealth and uHealth, 4(2).

https://doi.org/10.2196/mhealth.5436

Shapovalova, M. (2023). Telemedicine website design: Top

5 tips for telehealth product design in 2023. Voypost.

Retrieved May, from https://www.voypost.com/blog/

telemedicine-website-design

Shokurova, K. (2020). How to build a healthcare app that

helps people. Shakuro. Retrieved September, from

https://shakuro.com/blog/how-to-design-a-healthcare-

app-that-makes-its-users-happier

Smokefree Veterans. (2021). Get help with medications.

Retrieved from https://veterans.smokefree.gov/quit-

smoking-vet/get-help-medications

Smokefree Veterans. (2021). How to quit dipping or

chewing tobacco. Retrieved from

https://veterans.smokefree.gov/quit-dip-

vapes/smokeless-tobacco/how-to-quit

Snusforumet. (2022). Snus and health. Retrieved

September, from https://snusforumet.se/en/snus-and-

health/

Sohlberg, T., & Wennberg, P. (2020). Snus cessation

patterns: A long-term follow-up of snus users in

Sweden. Harm Reduction Journal, 17(1).

https://doi.org/10.1186/s12954-020-00405-z

Sorensen, G., Emmons, K., Stoddard, A. M., Linnan, L., &

Avrunin, J. (2002). Do social influences contribute to

occupational differences in quitting smoking and

attitudes toward quitting? American Journal of Health

Promotion, 16(3), 135–141.

Soulakova, J. N., Tang, C.-Y., Leonardo, S. A., &

Taliaferro, L. A. (2018). Motivational benefits of social

support and behavioural interventions for smoking

cessation. Journal of Smoking Cessation, 13(4), 216–

226. https://doi.org/10.1017/jsc.2017.26

Stickdorn, M., Hormess, M. E., Lawrence, A., & Schneider,

J. (2020). This is service design doing: Applying service

design thinking in the real world. Sebastopol, CA:

O’Reilly Media.

The Interaction Design Foundation. (2024). Design thinking.

Retrieved February, from https://www.interaction-

design.org/literature/topics/design-thinking

Thomas, N. (2019). How to use the system usability scale

(SUS) to evaluate the usability of your website. Usability

Geek. Retrieved September, from

https://usabilitygeek.com/how-to-use-the-system-

usability-scale-sus-to-evaluate-the-usability-of-your-

website/

Vinci, C. (2020). Cognitive behavioral and mindfulness-

based interventions for smoking cessation: A review of

the recent literature. Current Oncology Reports, 22(6).

https://doi.org/10.1007/s11912-020-00915-w

Wenker, K. (2022). A systematic literature review on

persuasive technology at the workplace. Patterns, 3(8),

100545. https://doi.org/10.1016/j.patter.2022.100545

Whittaker, R., Dobson, R., & Garner, K. (2022,

September). Chatbots for smoking cessation: Scoping

review. Journal of Medical Internet Research, 24(9).

Retrieved from https://doi.org/10.2196/35556

Whittaker, R., McRobbie, H., Bullen, C., Rodgers, A., & Gu,

Y. (2016). Mobile phone-based interventions for

smoking cessation. Cochrane Database of Systematic

Reviews.

https://doi.org/10.1002/14651858.cd006611.pub4

Woods, L., Cummings, E., Duff, J., & Walker, K. (2017).

Design thinking for mHealth application co-design to

support heart failure self-management. Studies in

Health Technology and Informatics, 241, 97–102.

DEMS 2025 - Special Session on Design and Evaluation of Monitoring Systems

1116