1
|
Malte CA, Dulin PL, Baer JS, Fortney JC, Danner AN, Lott AMK, Hawkins EJ. Usability and Acceptability of a Mobile App for the Self-Management of Alcohol Misuse Among Veterans (Step Away): Pilot Cohort Study. JMIR Mhealth Uhealth 2021; 9:e25927. [PMID: 33830064 PMCID: PMC8063094 DOI: 10.2196/25927] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 02/02/2021] [Accepted: 03/10/2021] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Alcohol misuse is common among Operation Enduring Freedom and Operation Iraqi Freedom veterans, yet barriers limit treatment participation. Mobile apps hold promise as means to deliver alcohol interventions to veterans who prefer to remain anonymous, have little time for conventional treatments, or live too far away to attend treatment in person. OBJECTIVE This pilot study evaluated the usability and acceptability of Step Away, a mobile app designed to reduce alcohol-related risks, and explored pre-post changes on alcohol use, psychological distress, and quality of life. METHODS This single-arm pilot study recruited Operation Enduring Freedom and Operation Iraqi Freedom veterans aged 18 to 55 years who exceeded National Institute on Alcohol Abuse and Alcoholism drinking guidelines and owned an iPhone. Enrolled veterans (N=55) completed baseline and 1-, 3-, and 6-month assessments. The System Usability Scale (scaled 1-100, ≥70 indicating acceptable usability) assessed the effectiveness, efficiency, and satisfaction dimensions of usability, while a single item (scaled 1-9) measured the attractiveness of 10 screenshots. Learnability was assessed by app use during week 1. App engagement (proportion of participants using Step Away, episodes of use, and minutes per episode per week) over 6 months measured acceptability. Secondary outcomes included pre-post change on heavy drinking days (men: ≥5 drinks per day; women: ≥4 drinks per day) and Short Inventory of Problems-Revised, Kessler-10, and brief World Health Organization Quality of Life Questionnaire scores. RESULTS Among the 55 veterans enrolled in the study, the mean age was 37.4 (SD 7.6), 16% (9/55) were women, 82% (45/55) were White, and 82% (45/55) had an alcohol use disorder. Step Away was used by 96% (53/55) of participants in week 1, 55% (30/55) in week 4, and 36% (20/55) in week 24. Step Away use averaged 55.1 minutes (SD 57.6) in week 1 and <15 minutes per week in weeks 2 through 24. Mean System Usability Scale scores were 69.3 (SD 19.7) and 71.9 (SD 15.8) at 1 and 3 months, respectively. Median attractiveness scores ranged from 5 to 8, with lower ratings for text-laden screens. Heavy drinking days decreased from 29.4% (95% CI 23.4%-35.4%) at baseline to 16.2% (95% CI 9.9%-22.4%) at 6 months (P<.001). Likewise, over 6 months, Short Inventory of Problems-Revised scores decreased from 6.3 (95% CI 5.1-7.5) to 3.6 (95% CI 2.4-4.9) (P<.001) and Kessler-10 scores decreased from 18.8 (95% CI 17.4-20.1) to 17.3 (95% CI 15.8-18.7) (P=.046). Changes were not detected on quality of life scores. CONCLUSIONS Operation Enduring Freedom and Operation Iraqi Freedom veterans found the usability of Step Away to be acceptable and engaged in the app over the 6-month study. Reductions were seen in heavy drinking days, alcohol-related problems, and Kessler-10 scores. A larger randomized trial is warranted to confirm our findings.
Collapse
Affiliation(s)
- Carol A Malte
- Center of Excellence in Substance Addiction Treatment and Education (CESATE), Veterans Affairs Puget Sound Health Care System, Seattle, WA, United States
- Health Services Research & Development Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, WA, United States
| | - Patrick L Dulin
- Department of Psychology, University of Alaska Anchorage, Anchorage, AK, United States
| | - John S Baer
- Center of Excellence in Substance Addiction Treatment and Education (CESATE), Veterans Affairs Puget Sound Health Care System, Seattle, WA, United States
- Health Services Research & Development Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, WA, United States
- Department of Psychology, University of Washington, Seattle, WA, United States
| | - John C Fortney
- Health Services Research & Development Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, WA, United States
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Anissa N Danner
- Center of Excellence in Substance Addiction Treatment and Education (CESATE), Veterans Affairs Puget Sound Health Care System, Seattle, WA, United States
- Health Services Research & Development Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, WA, United States
| | - Aline M K Lott
- Center of Excellence in Substance Addiction Treatment and Education (CESATE), Veterans Affairs Puget Sound Health Care System, Seattle, WA, United States
- Health Services Research & Development Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, WA, United States
| | - Eric J Hawkins
- Center of Excellence in Substance Addiction Treatment and Education (CESATE), Veterans Affairs Puget Sound Health Care System, Seattle, WA, United States
- Health Services Research & Development Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, WA, United States
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| |
Collapse
|
2
|
File D, Bőthe B, Kapitány-Fövény M, Demetrovics Z. Efficacy of a complex smartphone application for reducing hazardous alcohol consumption: Study protocol for a randomized controlled trial with analysis of in-app user behavior in relation to outcome. Int J Methods Psychiatr Res 2020; 29:1-10. [PMID: 32896955 PMCID: PMC7723194 DOI: 10.1002/mpr.1848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 07/08/2020] [Accepted: 07/28/2020] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE The efficacy of alcohol reduction applications is variable, and the underlying factors are largely unknown. The aim of this study is threefold: evaluate the relationship between user engagement and intervention efficacy, investigate the efficacy of the different functions applied, and investigate the efficacy of the intervention application compared to control groups. METHODS A randomized controlled trial will be conducted to determine the efficacy of a newly developed smartphone application compared to the controls in reducing alcohol consumption at a 30, 60, 90, 120, 150, and 180 days follow-up. Hazardous drinkers, aged 18 years or older, will be recruited through web articles and will be randomized (blinded to their allocation), to receive one of the two versions of the application (educational or control application) for 30 days, or will be allocated to a wait-list control group. Function usage times will be recorded on a single-user level to determine the association between application usage and efficacy. RESULTS Data collection will be completed by July 2020, and follow-up will be completed by January 2021. CONCLUSIONS The evaluation of intervention efficacy as a function of user behavior will hopefully contribute to the science of developing more efficient alcohol intervention applications in the future.
Collapse
Affiliation(s)
- Domonkos File
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
| | - Beáta Bőthe
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary.,Département de Psychologie, Université de Montréal, Montreal, Canada
| | - Máté Kapitány-Fövény
- Department of Addiction, Semmelweis University Faculty of Health Sciences, Budapest, Hungary.,Drug Outpatient Centre, Nyírő Gyula National Institute of Psychiatry and Addictions, Budapest, Hungary
| | - Zsolt Demetrovics
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
| |
Collapse
|
3
|
McPhee MD, Keough MT, Rundle S, Heath LM, Wardell JD, Hendershot CS. Depression, Environmental Reward, Coping Motives and Alcohol Consumption During the COVID-19 Pandemic. Front Psychiatry 2020; 11:574676. [PMID: 33192708 PMCID: PMC7661794 DOI: 10.3389/fpsyt.2020.574676] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 09/28/2020] [Indexed: 12/21/2022] Open
Abstract
Background: Increases in the incidence of psychological distress and alcohol use during the COVID-19 pandemic have been predicted. Behavioral theories of depression and alcohol self-medication theories suggest that greater social/environmental constraints and increased psychological distress during COVID-19 could result in increases in depression and drinking to cope with negative affect. The current study had two goals: (1) to examine self-reported changes in alcohol use and related outcomes after the introduction of COVID-19 social distancing requirements, and; (2) to test hypothesized mediation models to explain individual differences in self-reported changes in depression and alcohol use during the early weeks of the COVID-19 pandemic. Methods: Participants (n = 833) were U.S. residents recruited for participation in a single online survey. The cross-sectional survey included questions assessing environmental reward, depression, COVID-19-related distress, drinking motives, and alcohol use outcomes. Outcomes were assessed via retrospective self-report for two timeframes in the single survey: the 30 days prior to state-mandated social distancing ("pre-social-distancing"), and the 30 days after the start of state-mandated social distancing ("post-social-distancing"). Results: Depression severity, coping motives, and some indices of alcohol consumption (e.g., frequency of binge drinking, and frequency of solitary drinking) were significantly greater post-social-distancing relative to pre-social-distancing. Conversely, environmental reward and other drinking motives (social, enhancement, and conformity) were significantly lower post-social distancing compared to pre-social-distancing. Behavioral economic indices (alcohol demand) were variable with regard to change. Mediation analyses suggested a significant indirect effect of reduced environmental reward with drinking quantity/frequency via increased depressive symptoms and coping motives, and a significant indirect effect of COVID-related distress with alcohol quantity/frequency via coping motives for drinking. Discussion: Results provide early cross-sectional evidence regarding the relation of environmental reward, depression, and COVID-19-related psychological distress with alcohol consumption and coping motives during the early weeks of the COVID-19 pandemic. Results are largely consistent with predictions from behavioral theories of depression and alcohol self-medication frameworks. Future research is needed to study prospective associations among these outcomes.
Collapse
Affiliation(s)
- Matthew D. McPhee
- Department of Psychology, University of Toronto, Toronto, ON, Canada
| | | | - Samantha Rundle
- Department of Psychology, University of Toronto, Toronto, ON, Canada
| | - Laura M. Heath
- Department of Psychology, University of Toronto, Toronto, ON, Canada
| | - Jeffrey D. Wardell
- Department of Psychology, York University, Toronto, ON, Canada
- Institute for Mental Health Policy Research and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Christian S. Hendershot
- Department of Psychology, University of Toronto, Toronto, ON, Canada
- Institute for Mental Health Policy Research and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
4
|
Blonigen DM, Harris-Olenak B, Kuhn E, Timko C, Humphreys K, Smith JS, Dulin P. Using peers to increase veterans' engagement in a smartphone application for unhealthy alcohol use: A pilot study of acceptability and utility. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2020; 35:829-839. [PMID: 32597665 DOI: 10.1037/adb0000598] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Mobile apps can only increase access to alcohol treatment if patients actively engage with them. Peers may be able to facilitate such engagement by providing supportive accountability and instruction and encouragement for app use. We developed a protocol for peers to support engagement in the Stand Down app for unhealthy alcohol use in veterans and tested the acceptability and utility of the protocol. Thirty-one veteran primary care patients who screened positive for unhealthy alcohol use and were not currently in addiction treatment were given access to Stand Down for four weeks and concurrently received weekly phone support from a Department of Veterans Affairs peer specialist to facilitate engagement with the app. App usage was extracted daily, and pre/post treatment assessments measured changes in drinking patterns, via the Timeline Followback interview, and satisfaction with care, via quantitative and qualitative approaches. A priori benchmarks for acceptability were surpassed: time spent in the app (M = 93.89 min, SD = 92.1), days of app use (M = 14.05, SD = 8.0), and number of daily interviews completed for tracking progress toward a drinking goal (M = 12.64, SD = 9.7). Global satisfaction, per the Client Satisfaction Questionnaire, was high (M = 26.4 out of 32, SD = 4.5). Pre to post, total standard drinks in the prior 30 days (MPre = 142.7, MPost = 85.6), Drinks Per Drinking Day (MPre = 5.4, MPost = 4.0), and Percent Heavy Drinking Days (MPre = 35.3%, MPost = 20.1%) decreased significantly (ps < .05). Findings indicate that Peer-Supported Stand Down is highly acceptable to veteran primary care patients and may help reduce drinking in this population. A larger controlled trial of this intervention is warranted. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
Collapse
Affiliation(s)
- Daniel M Blonigen
- Center for Innovation to Implementation, VA Palo Alto Health Care System
| | | | - Eric Kuhn
- National Center for PTSD, Dissemination and Training Division, VA Palo Alto Health Care System
| | - Christine Timko
- Center for Innovation to Implementation, VA Palo Alto Health Care System
| | - Keith Humphreys
- Center for Innovation to Implementation, VA Palo Alto Health Care System
| | - Jennifer S Smith
- Center for Innovation to Implementation, VA Palo Alto Health Care System
| | - Patrick Dulin
- Department of Clinical and Community Psychology, University of Alaska Anchorage
| |
Collapse
|
5
|
Mitchell MM, Mendelson J, Gryczynski J, Carswell SB, Schwartz RP. A novel telehealth platform for alcohol use disorder treatment: preliminary evidence of reductions in drinking. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2020; 46:297-303. [PMID: 31596648 DOI: 10.1080/00952990.2019.1658197] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Alcohol use disorder (AUD) treatment remains greatly underutilized. Innovative strategies are needed to improve AUD treatment access and patient engagement. The Ria Treatment Platform (RTP) is a patient-centered telemedicine AUD treatment program accessed through a smartphone application (app) that includes a package of physician visits (with AUD prescriptions as appropriate), text- and phone-based support from a recovery coach, video monitoring of medication adherence, and Bluetooth-linked breathalyzer tracking of alcohol intake. OBJECTIVES The purpose of the current study is to examine changes in alcohol use among patients utilizing the RTP. METHODS This study examines daily breathalyzer blood alcohol content (BAC) readings collected from 77 adult patients (50.7% male) over the first 90 days in treatment with the RTP. Data were analyzed using dynamic structural equation modeling. RESULTS The treatment retention rate at 90 days was 55%. The best fit for the BAC data was given by a cubic curve, which showed that among patients who remained engaged for 90 days average BAC levels declined approximately 50% (from .091 to .045) from baseline to day 90. CONCLUSION This study provides preliminary evidence of substantial alcohol use reductions among patients utilizing the RTP, an innovative telemedicine program accessed via smartphone. Although other alcohol-reduction apps have shown promise from scientific evaluations, the RTP appears to be the only app that incorporates physician-prescribed medication and a recovery coach. Research incorporating random assignment and meaningful comparison groups is needed to further evaluate this promising strategy.
Collapse
|
6
|
Blonigen D, Harris-Olenak B, Kuhn E, Humphreys K, Timko C, Dulin P. From "Step Away" to "Stand Down": Tailoring a Smartphone App for Self-Management of Hazardous Drinking for Veterans. JMIR Mhealth Uhealth 2020; 8:e16062. [PMID: 32053118 PMCID: PMC7055774 DOI: 10.2196/16062] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 11/11/2019] [Accepted: 11/14/2019] [Indexed: 11/15/2022] Open
Abstract
Background US military veterans who screen positive for hazardous drinking during primary care visits may benefit from a mobile app. Step Away is an evidence-based mobile intervention system for the self-management of hazardous drinking. However, Step Away was not designed for veterans, and differences between veterans and civilians could limit the reach and effectiveness of the app with this population. Objective The primary objective of this study was to repurpose Step Away to address the needs and preferences of the veteran primary care population. The Method for Program Adaptation through Community Engagement (M-PACE) model was used to guide the adaptation process. This model can serve as a generalizable approach that other researchers and intervention developers can follow to systematically tailor mobile health tools for a new population. Methods Veteran patients who screened positive for hazardous drinking during a primary care visit (n=12) and peer providers employed by the US Veterans Health Administration (n=11) were recruited to systematically review Step Away and provide feedback on its content and presentation via Web-based surveys and a semistructured interview. Participant feedback was reviewed through an iterative process by key stakeholders who adjudicated which suggested modifications to the app could enhance engagement and effectiveness with veterans while maintaining program integrity. Results Usability ratings of the individual modules of Step Away were uniformly positive across patients and peers, as was the perceived utility of the app overall. Personalized feedback on the health consequences and costs of drinking, options for customization, and the measurement-based care capabilities of the app were viewed as facilitators of engagement. Conversely, lengthy text, small font, and a lack of interactive features were viewed as potential barriers with the older primary care population. Modifications to create a veteran version of the app (Stand Down: Think Before You Drink) included altering the appearance of the app to incorporate more veteran-centric content, adding links and options for resources and activities for veterans, and reducing the amount of text and adding veteran-specific references and common concerns and triggers for drinking in this population. Conclusions The M-PACE model provided a systematic approach to repurpose Step Away to fit the needs and preferences of veteran primary care patients who engage in hazardous drinking. Stand Down may serve as an innovative, low-cost means of expanding access to care for veterans who engage in hazardous drinking.
Collapse
Affiliation(s)
- Daniel Blonigen
- Department of Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, United States
| | - Brooke Harris-Olenak
- Department of Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, United States
| | - Eric Kuhn
- Department of Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, United States
| | - Keith Humphreys
- Department of Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, United States
| | - Christine Timko
- Department of Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, United States
| | - Patrick Dulin
- University of Alaska-Anchorage, Anchorage, AK, United States
| |
Collapse
|
7
|
Prevention, screening, and treatment for heavy drinking and alcohol use disorder. Lancet Psychiatry 2019; 6:1054-1067. [PMID: 31630982 PMCID: PMC6883141 DOI: 10.1016/s2215-0366(19)30213-5] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 05/15/2019] [Accepted: 05/16/2019] [Indexed: 12/21/2022]
Abstract
Heavy drinking and alcohol use disorder are major public health problems. Practitioners not specialising in alcohol treatment are often unaware of the guidelines for preventing, identifying, and treating heavy drinking and alcohol use disorder. However, a consensus exists that clinically useful and valuable tools are available to address these issues. Here, we review existing information and developments from the past 5 years in these areas. We also include information on heavy drinking and alcohol use disorder among individuals with co-occurring psychiatric disorders, including drug use disorders. Areas covered include prevention; screening, brief intervention, and referral for treatment; evidence-based behavioural interventions; medication-assisted treatment; technology-based interventions (eHealth and mHealth); and population-level interventions. We also discuss the key topics for future research.
Collapse
|
8
|
Azarang A, Pakyurek M, Giroux C, Nordahl TE, Yellowlees P. Information Technologies: An Augmentation to Post-Traumatic Stress Disorder Treatment Among Trauma Survivors. Telemed J E Health 2019; 25:263-271. [DOI: 10.1089/tmj.2018.0068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Affiliation(s)
- Atoosa Azarang
- MIND Institute, University of California-Davis Medical Center, Sacramento, California
| | - Murat Pakyurek
- Department of Psychiatry and Behavioral Sciences, University of California-Davis, School of Medicine, Sacramento, California
| | - Caroline Giroux
- Department of Psychiatry and Behavioral Sciences, University of California-Davis, School of Medicine, Sacramento, California
| | - Thomas E. Nordahl
- Department of Psychiatry and Behavioral Sciences, University of California-Davis, School of Medicine, Sacramento, California
| | - Peter Yellowlees
- Department of Psychiatry and Behavioral Sciences, University of California-Davis, School of Medicine, Sacramento, California
| |
Collapse
|
9
|
Garnett C, Crane D, West R, Brown J, Michie S. The development of Drink Less: an alcohol reduction smartphone app for excessive drinkers. Transl Behav Med 2019; 9:296-307. [PMID: 29733406 PMCID: PMC6417151 DOI: 10.1093/tbm/iby043] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Excessive alcohol consumption poses a serious problem for public health. Digital behavior change interventions have the potential to help users reduce their drinking. In accordance with Open Science principles, this paper describes the development of a smartphone app to help individuals who drink excessively to reduce their alcohol consumption. Following the UK Medical Research Council's guidance and the Multiphase Optimization Strategy, development consisted of two phases: (i) selection of intervention components and (ii) design and development work to implement the chosen components into modules to be evaluated further for inclusion in the app. Phase 1 involved a scoping literature review, expert consensus study and content analysis of existing alcohol apps. Findings were integrated within a broad model of behavior change (Capability, Opportunity, Motivation-Behavior). Phase 2 involved a highly iterative process and used the "Person-Based" approach to promote engagement. From Phase 1, five intervention components were selected: (i) Normative Feedback, (ii) Cognitive Bias Re-training, (iii) Self-monitoring and Feedback, (iv) Action Planning, and (v) Identity Change. Phase 2 indicated that each of these components presented different challenges for implementation as app modules; all required multiple iterations and design changes to arrive at versions that would be suitable for inclusion in a subsequent evaluation study. The development of the Drink Less app involved a thorough process of component identification with a scoping literature review, expert consensus, and review of other apps. Translation of the components into app modules required a highly iterative process involving user testing and design modification.
Collapse
Affiliation(s)
- Claire Garnett
- Research Department of Behavioural Science and Health, UCL, London, UK
| | - David Crane
- Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
| | - Robert West
- Research Department of Behavioural Science and Health, UCL, London, UK
| | - Jamie Brown
- Research Department of Behavioural Science and Health, UCL, London, UK
- Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
| | - Susan Michie
- Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
| |
Collapse
|
10
|
Liu HYT, Chia RM, Setiawan IMA, Crytzer TM, Ding D. Development of "My Wheelchair Guide" app: a qualitative study. Disabil Rehabil Assist Technol 2018; 14:839-848. [PMID: 30451540 DOI: 10.1080/17483107.2018.1499140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: The smartphone app "My Wheelchair Guide" is designed to provide essential information about wheelchair use and service delivery for new wheelchair users. It aims to empower wheelchair users in taking ownership in acquiring appropriate wheelchairs, and guiding them to use their wheelchairs in a safe and effective manner.Objective: This paper describes the development of the "My Wheelchair Guide" app and the usability evaluation of one of the app sections "Use a Wheelchair".Method: Ten manual wheelchair users and four seating/mobility professionals completed a survey on the ease of use and perceived usefulness of the app, and a semi-structured interview. Wheelchair users used checklists in the app to self-assess their wheelchairs' fit and set-up, and their wheelchair skills. Two investigators independently conducted content analysis of the interview transcripts and identified salient themes.Results: All participants perceived the app to be easy to use. Both wheelchair users and wheelchair seating professionals recognized that the "Use a Wheelchair" section would be very beneficial for new wheelchair users. Self-assessment checklists facilitated participants to review their wheelchair set-up and skills. Participants also provided several suggestions and recommendations to revise and refine the app section.Conclusion: The app section was perceived to be a useful and easy-to-use educational tool by most of the study participants. Participants' feedback will be used to guide the app revision for a better user experience. Further studies could be conducted to assess the app effectiveness on improving wheelchair users' knowledge and facilitating self-advocacy for appropriate wheelchairs.Implications for rehabilitationSmartphone apps designed to support patient education and self-management regarding wheelchair use are perceived beneficial by both wheelchair users and clinical professionals.Smartphone apps support multimedia information presentation and user interaction, and can potentially create an effective learning environment for wheelchair users and their families to learn about their everyday devices.Users of educational apps prefer reduced text-based content and care about app aesthetics.
Collapse
Affiliation(s)
- Hsin-Yi Tanya Liu
- Department of Rehabilitation Sciences and Technology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Rui-Min Chia
- Department of Rehabilitation Sciences and Technology, University of Pittsburgh, Pittsburgh, PA, USA
| | - I Made Agus Setiawan
- Department of Health Information Management, University of Pittsburgh, Pittsburgh, PA, USA
| | - Theresa Marie Crytzer
- Department of Rehabilitation Sciences and Technology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Dan Ding
- Department of Rehabilitation Sciences and Technology, University of Pittsburgh, Pittsburgh, PA, USA
| |
Collapse
|
11
|
Watkins LE, Sprang K. An Overview of Internet- and Smartphone-Delivered Interventions for Alcohol and Substance Use Disorders. FOCUS: JOURNAL OF LIFE LONG LEARNING IN PSYCHIATRY 2018; 16:376-383. [PMID: 31975929 DOI: 10.1176/appi.focus.20180016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Substance use disorders are a serious public health concern that affect approximately one in 12 individuals 12 years and older. Despite the high need for effective treatments for substance use disorders, the underutilization of services is well documented. One potential method of increasing access to care is through the use of technology. Treatment through the Internet or smartphone provides attractive solutions for those who are ambivalent to seeking treatment, because these treatments are easy to access from almost anywhere, self-paced, low commitment, and anonymous. The purpose of this review is to summarize the literature on Internet and smartphone interventions for substance use disorders that were developed on the basis of evidence-based treatments. The authors discuss these interventions within two broad categories: brief motivational or feedback-oriented interventions, which typically include one or two sessions, and longer interventions, which include multiple modules and are based on cognitive-behavior therapy, relapse prevention, contingency management, or a community reinforcement approach. These therapeutic adaptations through new technologies allow for increased access to substance use treatments and appear to yield overall positive results in adjusting norms about substance use, decreasing and ceasing substance use, and improving confidence to manage substance use.
Collapse
Affiliation(s)
- Laura E Watkins
- Dr. Watkins and Dr. Sprang are with the Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta
| | - Kelsey Sprang
- Dr. Watkins and Dr. Sprang are with the Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta
| |
Collapse
|
12
|
Tofighi B, Abrantes A, Stein MD. The Role of Technology-Based Interventions for Substance Use Disorders in Primary Care: A Review of the Literature. Med Clin North Am 2018; 102:715-731. [PMID: 29933825 PMCID: PMC6563611 DOI: 10.1016/j.mcna.2018.02.011] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The burden of alcohol and drug use disorders (substance use disorders [SUDs]) has intensified efforts to expand access to cost-effective psychosocial interventions and pharmacotherapies. This article provides an overview of technology-based interventions (eg, computer-based and Web-based interventions, text messaging, interactive voice recognition, smartphone apps, and emerging technologies) that are extending the reach of effective addiction treatments both in substance use treatment and primary care settings. It discusses the efficacy of existing technology-based interventions for SUDs, prospects for emerging technologies, and special considerations when integrating technologies in primary care (eg, privacy and regulatory protocols) to enhance the management of SUDs.
Collapse
Affiliation(s)
- Babak Tofighi
- Department of Population Health, New York University School of Medicine, 227 East 30th Street 7th Floor, New York, NY 10016, USA; Division of General Internal Medicine, New York University School of Medicine, New York, NY 10016, USA.
| | - Ana Abrantes
- Butler Hospital, Department of Psychiatry and Human Behavior, Behavioral Medicine and Addictions Research, Butler, PA, USA; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Michael D Stein
- Department of Health Law, Policy, and Medicine, Boston University, Boston, MA 02118, USA
| |
Collapse
|
13
|
Garnett C, Crane D, West R, Michie S, Brown J, Winstock A. User characteristics of a smartphone app to reduce alcohol consumption. Transl Behav Med 2017; 7:845-853. [PMID: 28315201 PMCID: PMC5684066 DOI: 10.1007/s13142-017-0477-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Digital interventions are available to help people reduce their alcohol consumption, but it is not known who uses these interventions and how this treatment-seeking group compares with the general population of drinkers. The study objective was to compare the socio-demographic and drinking characteristics of users of the 'Drinks Meter' smartphone app with the general population of drinkers in England and website users of the same intervention. Data were used from the Drinks Meter app and website, and a nationally representative cross-sectional survey in England (Alcohol Toolkit Study). Participants were drinkers aged 16+ in England. Data were collected on participants' age, gender, region, sexual orientation, social grade and AUDIT score. Regression analyses were conducted to assess differences in socio-demographic and drinking characteristics between samples. Drinks Meter app users, compared with drinkers of the general population, were younger, more likely to be from the South, not heterosexual, less likely to be of a lower social grade and had a higher mean AUDIT score. Drinks Meter app users were younger than website users and reported greater alcohol consumption and related harms. Drinkers using the Drinks Meter app are more likely to be younger and report greater alcohol consumption and related harms compared with the general population of drinkers in England and website users of the same intervention. Apps that provide feedback on drinking appear to be reaching those who report greater alcohol consumption and related harms.
Collapse
Affiliation(s)
- Claire Garnett
- Research Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK.
| | - David Crane
- Research Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Robert West
- Cancer Research UK Health Behaviour Research Centre, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Susan Michie
- Research Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Jamie Brown
- Research Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
- Cancer Research UK Health Behaviour Research Centre, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Adam Winstock
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
- Institute of Psychiatry, National Addiction Centre, King's College London, 4 Windsor Walk, Denmark Hill, London, SE5 8BB, UK
| |
Collapse
|
14
|
Hoeppner BB, Schick MR, Kelly LM, Hoeppner SS, Bergman B, Kelly JF. There is an app for that - Or is there? A content analysis of publicly available smartphone apps for managing alcohol use. J Subst Abuse Treat 2017; 82:67-73. [PMID: 29021117 DOI: 10.1016/j.jsat.2017.09.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 09/08/2017] [Accepted: 09/08/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Smartphone apps are emerging as a promising tool to support recovery from and prevention of problematic alcohol use, yet it is unclear what type of apps are currently available in the public domain, and to what degree these apps use interactive tailoring or other dynamic features to meet users' specific needs. METHODS We conducted a content analysis of Android apps for managing drinking available on Google Play (n=266), downloaded between November 21, 2014 and June 25, 2015. We recorded app popularity (>10,000 downloads) and user-rated quality (number of stars) from Google Play, and coded the apps on three domains (basic descriptors, functionality, use of dynamic features). RESULTS In total, the reviewed 266 apps were downloaded at least 2,793,567 times altogether. The most common types of app were BAC calculators (37%), information provision apps (37%), tracking calendars (24%), and motivational tools (21%). Most apps were free (65%) or low in cost (mean=$3.76; SD=$5.80). Many apps provided at least some level of tailored feedback (60%), but the extent of tailoring was limited. Use of other dynamic features (i.e., push notifications, passive data collection) was largely absent. Univariate models predicting app popularity (i.e., >10,000 downloads vs. not) and user-rated quality (i.e., star rating) indicated that tailoring was positively related to popularity (OR=2.41 [1.30-4.46]), and the existence of time-based tailoring (e.g., tracking) was related to quality (b=0.48 [0.19-0.77]). CONCLUSIONS These apps have a wide public health reach with >2.7 million total combined downloads to date. A wide variety of apps exist, allowing persons interested in using apps to help them manage their drinking to choose from numerous types of supports. Tailoring, while related favorably to an app's popularity and user-rated quality, is limited in publicly available apps.
Collapse
Affiliation(s)
- Bettina B Hoeppner
- Recovery Research Institute and Center for Addiction Medicine, Massachusetts General Hospital, Harvard Medical School, United States; Psychiatry Department, Massachusetts General Hospital, Harvard Medical School, United States.
| | - Melissa R Schick
- Recovery Research Institute and Center for Addiction Medicine, Massachusetts General Hospital, Harvard Medical School, United States
| | - Lourah M Kelly
- Recovery Research Institute and Center for Addiction Medicine, Massachusetts General Hospital, Harvard Medical School, United States; Suffolk University, Psychology Department, 73 Tremont Street, 8th Floor, MA 02114, United States
| | - Susanne S Hoeppner
- Psychiatry Department, Massachusetts General Hospital, Harvard Medical School, United States
| | - Brandon Bergman
- Recovery Research Institute and Center for Addiction Medicine, Massachusetts General Hospital, Harvard Medical School, United States; Psychiatry Department, Massachusetts General Hospital, Harvard Medical School, United States
| | - John F Kelly
- Recovery Research Institute and Center for Addiction Medicine, Massachusetts General Hospital, Harvard Medical School, United States; Psychiatry Department, Massachusetts General Hospital, Harvard Medical School, United States
| |
Collapse
|
15
|
Dulin PL, Gonzalez VM. Smartphone-based, momentary intervention for alcohol cravings amongst individuals with an alcohol use disorder. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2017; 31:601-607. [PMID: 28703611 DOI: 10.1037/adb0000292] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Smartphone-based alcohol interventions represent an innovative strategy for providing in-the-moment intervention to individuals with an alcohol use disorder. While early research into their overall effectiveness is promising, little is known about the efficacy of specific intervention tools in reducing drinking subsequent to a cued craving. This study examined the influence of smartphone-delivered in-the-moment coping strategies on drinking after experiencing a craving among participants utilizing the Location-Based Monitoring and Intervention for Alcohol Use Disorders (LBMI-A). The LBMI-A was utilized by 28 adults (18 to 45 years old) who met criteria for an alcohol use disorder and were interested in changing their drinking. Participants utilized the system for 6 weeks and responded to a daily interview of craving, type of LBMI-A coping strategy utilized in response, and whether or not they subsequently drank. Mixed model analyses of 744 total observations revealed that craving cue type, craving strength, and coping strategies were significantly related to drinking in response to a craving. Results suggested that coping strategies delivered by the LBMI-A (i.e., listening to an urge surfing audio file, viewing reasons for changing drinking) were superior to using a non-LBMI-A strategy. Simple contrast analyses indicated that cues related to being around alcohol and time of day were the most potent elicitors of subsequent drinking. Results suggest smartphone-delivered coping strategies for alcohol cravings are effective in reducing craving cued drinking and that craving cues related to drinking environments and drinking times of day represent fruitful areas of intervention focus. (PsycINFO Database Record
Collapse
|
16
|
Barrio P, Ortega L, López H, Gual A. Self-management and Shared Decision-Making in Alcohol Dependence via a Mobile App: a Pilot Study. Int J Behav Med 2017; 24:722-727. [DOI: 10.1007/s12529-017-9643-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
17
|
Dulin PL, Alvarado CE, Fitterling JM, Gonzalez VM. Comparisons of Alcohol Consumption by Time-Line Follow Back vs. Smartphone-Based Daily Interviews. ADDICTION RESEARCH & THEORY 2016; 25:195-200. [PMID: 29170622 PMCID: PMC5695707 DOI: 10.1080/16066359.2016.1239081] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 09/15/2016] [Accepted: 09/16/2016] [Indexed: 06/07/2023]
Abstract
This study compared alcohol consumption data collected through daily interviews on a smartphone with data collected via the Timeline Follow-Back (TLFB) during a 6-week pilot study of a smartphone-based alcohol intervention system. The focus of the study was to assess for discrepancies between the two measurement methodologies on commonly utilized alcohol outcome variables. Twenty-five participants between 22 and 45 years of age and were drinking heavily at study incipience completed a 6-week alcohol intervention delivered by a smartphone application that monitored drinking through a daily interview. Participants also completed a TLFB of their alcohol consumption during the intervention period. Difference scores were calculated by subtracting the average weekly outcome variables derived from the smartphone daily interview from the average weekly outcome variables derived from the TLFB which yielded six discrepancy scores for each of the 25 participants and resulted in 150 observations. Heirarchical linear modeling indicated that the TLFB and smartphone daily interview methods did not produce significant discrepancies over the 6-week interval when examining percent of heavy drinking days and percent of days abstinent. However, discrepancies on drinks per drinking day increased substantially over time, suggesting that it is susceptible to recall bias when assessed by the TLFB. Results also indicated that participants under-reported their drinking on the TLFB compared to the daily smartphone-based assessment. Results indicate that outside of assessing for extreme drinking (binge or no drinking), the TLFB should be used cautiously and that smartphone apps represent a promising method for accurately assessing alcohol consumption over time.
Collapse
|
18
|
Yellowlees P, Richard Chan S, Burke Parish M. The hybrid doctor-patient relationship in the age of technology - Telepsychiatry consultations and the use of virtual space. Int Rev Psychiatry 2016; 27:476-89. [PMID: 26493089 DOI: 10.3109/09540261.2015.1082987] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The doctor-patient relationship is evolving and changing through the impact of many technological, social and environmental factors. These factors will be examined, especially the impact of changing attitudes among younger generations of physicians and patients who live in an information-driven networked world. Telepsychiatry is already over 50 years old and has a strong evidence base which suggests that it is a better form of practice compared with the traditional in-person consultation for certain patient groups. In particular, telepsychiatry encourages intimacy in relationships through the use of the 'virtual space' in the consultation, better collaboration between psychiatrists and primary care physicians, and improved patient satisfaction. The practice of psychiatry will change through the use of mobile devices, asynchronous consultations, and the opportunities that automated interpretation and translation bring to work across cultures. The future will likely bring many psychiatrists working increasingly in a hybrid model, both in-person, and online, using the strengths of both approaches to improve patient care.
Collapse
Affiliation(s)
- Peter Yellowlees
- a Department of Psychiatry , University of California , Davis , California and
| | - Steven Richard Chan
- a Department of Psychiatry , University of California , Davis , California and
| | - Michelle Burke Parish
- a Department of Psychiatry , University of California , Davis , California and.,b Betty Irene More School of Nursing , University of California , Davis , California , USA
| |
Collapse
|
19
|
Realising the technological promise of smartphones in addiction research and treatment: An ethical review. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2016; 36:47-57. [PMID: 27455467 DOI: 10.1016/j.drugpo.2016.05.013] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Revised: 05/25/2016] [Accepted: 05/25/2016] [Indexed: 01/20/2023]
Abstract
BACKGROUND Smartphone technologies and mHealth applications (or apps) promise unprecedented scope for data collection, treatment intervention, and relapse prevention when used in the field of substance abuse and addiction. This potential also raises new ethical challenges that researchers, clinicians, and software developers must address. AIMS This paper aims to identify ethical issues in the current uses of smartphones in addiction research and treatment. METHODS A search of three databases (PubMed, Web of Science and PsycInfo) identified 33 studies involving smartphones or mHealth applications for use in the research and treatment of substance abuse and addiction. A content analysis was conducted to identify how smartphones are being used in these fields and to highlight the ethical issues raised by these studies. RESULTS Smartphones are being used to collect large amounts of sensitive information, including personal information, geo-location, physiological activity, self-reports of mood and cravings, and the consumption of illicit drugs, alcohol and nicotine. Given that detailed information is being collected about potentially illegal behaviour, we identified the following ethical considerations: protecting user privacy, maximising equity in access, ensuring informed consent, providing participants with adequate clinical resources, communicating clinically relevant results to individuals, and the urgent need to demonstrate evidence of safety and efficacy of the technologies. CONCLUSIONS mHealth technology offers the possibility to collect large amounts of valuable personal information that may enhance research and treatment of substance abuse and addiction. To realise this potential researchers, clinicians and app-developers must address these ethical concerns to maximise the benefits and minimise risks of harm to users.
Collapse
|
20
|
Barrio P, Ortega L, Bona X, Gual A. Development, Validation, and Implementation of an Innovative Mobile App for Alcohol Dependence Management: Protocol for the SIDEAL Trial. JMIR Res Protoc 2016; 5:e27. [PMID: 26888196 PMCID: PMC4776025 DOI: 10.2196/resprot.5002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 11/03/2015] [Accepted: 11/29/2015] [Indexed: 11/24/2022] Open
Abstract
Background Information and communication technologies (ICT) have become one of the main pathways to the new paradigm of increased self-management of chronic conditions such as alcohol dependence. Validation of some mobile phone apps has begun, while validation of many others is forthcoming. Objective To describe the protocol for validation of a new app called SIDEAL (an acronym of the Spanish name “Soporte Innovador a la persona con DEpendencia del ALcohol,” or innovative support for people with alcohol dependence). Methods The project consists of 3 complementary, consecutive studies, including a pilot feasibility study, a qualitative study using focus groups, and, finally, a randomized controlled trial where patients will be randomized to standard treatment or standard treatment plus SIDEAL. During the pilot study, feasibility, usability, and acceptance by users will be the main outcomes explored. An electronic questionnaire will be sent to patients asking for their opinions. Focus groups will be the next step, after which improvements and refinements will be implemented in the app. During the final phase, consumption variables (heavy drinking days per month, mean standard drinks per day) will be investigated, in order to test app efficacy. Results Because of the encouraging results with previous similar apps, we expect patients to widely accept and incorporate SIDEAL into their therapeutic options. Significant reductions in drinking-related variables are also expected. The pilot study has concluded with the inclusion of 29 patients. Results are expected to be available soon (expected mid-2016). Conclusions SIDEAL may represent a useful, reliable, effective, and efficient tool to complement therapeutic options available to both patients and professionals.
Collapse
Affiliation(s)
- Pablo Barrio
- Addictions Unit, Clinical Neuroscience Institute, Hospital Clinic of Barcelona, Barcelona, Spain.
| | | | | | | |
Collapse
|
21
|
Goodwin J, Cummins J, Behan L, O’Brien SM. Development of a mental health smartphone app: perspectives of mental health service users. J Ment Health 2016; 25:434-440. [DOI: 10.3109/09638237.2015.1124392] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- John Goodwin
- Department of Nursing and Midwifery, University of Cork, Cork, Republic of Ireland,
- St. Michaels Unit, North Lee Mental Health Services, Cork, Republic of Ireland,
| | - John Cummins
- Department of Nursing and Midwifery, University of Cork, Cork, Republic of Ireland,
- Community Mental Health Team, North Lee Mental Health Services, Cork, Republic of Ireland,
| | - Laura Behan
- Department of Allied Psychology, University of Cork, Cork, Republic of Ireland,
| | - Sinead M. O’Brien
- Home Based Crisis Team, North Lee Mental Health Services, Cork, Republic of Ireland, and
- Department of Psychiatry, University of Cork, Cork, Republic of Ireland
| |
Collapse
|
22
|
Meredith SE, Alessi SM, Petry NM. Smartphone applications to reduce alcohol consumption and help patients with alcohol use disorder: a state-of-the-art review. ACTA ACUST UNITED AC 2015; 1:47-54. [PMID: 27478863 PMCID: PMC4963021 DOI: 10.2147/ahct.s65791] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Hazardous drinking and alcohol use disorder (AUD) are substantial contributors to USA and global morbidity and mortality. Patient self-management and continuing care are needed to combat these public health threats. However, services are rarely provided to patients outside of clinic settings or following brief intervention. Smartphone applications (“apps”) may help narrow the divide between traditional health care and patient needs. The purpose of this review is to identify and summarize smartphone apps to reduce alcohol consumption or treat AUD that have been evaluated for feasibility, acceptability, and/or efficacy. We searched two research databases for peer-reviewed journal articles published in English that evaluated smartphone apps to decrease alcohol consumption or treat AUD. We identified six apps. Two of these apps (A-CHESS and LBMI-A) promoted self-reported reductions in alcohol use, two (Promillekoll and PartyPlanner) failed to promote self-reported reductions in alcohol use, and two (HealthCall-S and Chimpshop) require further evaluation and testing before any conclusions regarding efficacy can be made. In summary, few evaluations of smartphone apps to reduce alcohol consumption or treat AUD have been reported in the scientific literature. Although advances in smartphone technology hold promise for disseminating interventions among hazardous drinkers and individuals with AUD, more systematic evaluations are necessary to ensure that smartphone apps are clinically useful.
Collapse
Affiliation(s)
- Steven E Meredith
- Calhoun Cardiology Center, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Sheila M Alessi
- Calhoun Cardiology Center, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Nancy M Petry
- Calhoun Cardiology Center, University of Connecticut School of Medicine, Farmington, CT, USA
| |
Collapse
|
23
|
Ford JH, Alagoz E, Dinauer S, Johnson KA, Pe-Romashko K, Gustafson DH. Successful Organizational Strategies to Sustain Use of A-CHESS: A Mobile Intervention for Individuals With Alcohol Use Disorders. J Med Internet Res 2015; 17:e201. [PMID: 26286257 PMCID: PMC4642385 DOI: 10.2196/jmir.3965] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 06/08/2015] [Accepted: 07/16/2015] [Indexed: 02/03/2023] Open
Abstract
Background Mobile health (mHealth) services are growing in importance in health care research with the advancement of wireless networks, tablets, and mobile phone technologies. These technologies offer a wide range of applications that cover the spectrum of health care delivery. Although preliminary experiments in mHealth demonstrate promising results, more robust real-world evidence is needed for widespread adoption and sustainment of these technologies. Objective Our aim was to identify the problems/challenges associated with sustained use of an mHealth addiction recovery support app and to determine strategies used by agencies that successfully sustained client use of A-CHESS. Methods Qualitative inquiry assessed staff perceptions about organizational attributes and strategies associated with sustained use of the mobile app, A-CHESS. A total of 73 interviews of clinicians and administrators were conducted. The initial interviews (n=36) occurred at the implementation of A-CHESS. Follow-up interviews (n=37) occurred approximately 12 and 24 months later. A coding scheme was developed and Multiuser NVivo was used to manage and analyze the blinded interview data. Results Successful strategies used by treatment providers to sustain A-CHESS included (1) strong leadership support, (2) use of client feedback reports to follow up on non-engaged clients, (3) identify passionate staff and incorporate A-CHESS discussions in weekly meetings, (4) develop A-CHESS guidelines related to client use, (5) establish internal work groups to engage clients, and (6) establish a financial strategy to sustain A-CHESS use. The study also identified attributes of A-CHESS that enhanced as well as inhibited its sustainability. Conclusions Mobile apps can play an important role in health care delivery. However, providers will need to develop strategies for engaging both staff and patients in ongoing use of the apps. They will also need to rework business processes to accommodate the changes in communication frequency and style, learn to use app data for decision making, and identify financing mechanisms for supporting these changes.
Collapse
Affiliation(s)
- James H Ford
- University of Wisconsin - Madison, Center for Health Systems Research and Analysis, Madison, WI, United States.
| | | | | | | | | | | |
Collapse
|
24
|
Dulin PL, Gonzalez VM, Campbell K. Results of a pilot test of a self-administered smartphone-based treatment system for alcohol use disorders: usability and early outcomes. Subst Abus 2015; 35:168-75. [PMID: 24821354 DOI: 10.1080/08897077.2013.821437] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND This paper provides results from a pilot study focused on assessing early-stage effectiveness and usability of a smartphone-based intervention system that provides a stand-alone, self-administered intervention option, the Location-Based Monitoring and Intervention for Alcohol Use Disorders (LBMI-A). The LBMI-A provided numerous features for intervening with ongoing drinking, craving, connection with supportive others, managing life problems, high-risk location alerting, and activity scheduling. METHODS Twenty-eight participants, ranging in age from 22 to 45, who met criteria for an alcohol use disorder used an LBMI-A-enabled smartphone for 6 weeks. RESULTS Participants indicated the LBMI-A intervention modules were helpful in highlighting alcohol use patterns. Tools related to managing alcohol craving, monitoring consumption, and identifying triggers to drink were rated by participants as particularly helpful. Participants also demonstrated significant reductions in hazardous alcohol use while using the system (56% of days spent hazardously drinking at baseline vs. 25% while using the LBMI-A) and drinks per day diminished by 52%. CONCLUSIONS Implications for system improvement as well as suggestions for designing ecological momentary assessment and intervention systems for substance use disorders are discussed.
Collapse
Affiliation(s)
- Patrick L Dulin
- a Department of Psychology, University of Alaska, Anchorage , Anchorage , Alaska , USA
| | | | | |
Collapse
|
25
|
Gonzalez VM, Dulin PL. Comparison of a smartphone app for alcohol use disorders with an Internet-based intervention plus bibliotherapy: A pilot study. J Consult Clin Psychol 2015; 83:335-45. [PMID: 25622202 DOI: 10.1037/a0038620] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To date, no research has evaluated the efficacy of a stand-alone, smartphone-based intervention for individuals with an alcohol use disorder. The current pilot study evaluated the short-term outcomes of a smartphone-based intervention for alcohol use disorders compared with an Internet-based brief motivational intervention plus bibliotherapy. METHOD Adults (18 to 45 years old) with an alcohol use disorder received either the Location-Based Monitoring and Intervention for Alcohol Use Disorders (LBMI-A; n = 28), a smartphone-based intervention, or the online Drinker's Check-up plus bibliotherapy (DCU + bib; n = 26). These groups were compared using the Timeline Followback interview for percent days abstinent (PDA), percent heavy drinking days (PHDD), and drinks per week (DPW) from baseline to 6 weeks after the introduction of the interventions. RESULTS Multilevel models revealed that the LBMI-A resulted in a significant increase in PDA over the course of the study, whereas the DCU + bib did not. Effect sizes for change from baseline for PDA suggest that the DCU + bib resulted in moderate a decrease, whereas the LBMI-A resulted in a large increase in PDA. Both interventions resulted in significant decreases in PHDD and DPW. The LBMI-A produced larger reductions in the first 3 to 4 weeks after the intervention was introduced than the DCU + bib. On weeks with greater LBMI-A usage, participants reported less DPW and PHDD. CONCLUSIONS Both interventions resulted in significant decreases in alcohol use over the 6-week trial, which is promising for stand-alone technology-based intervention systems aimed at individuals with an alcohol use disorder. (PsycINFO Database Record
Collapse
|
26
|
Giroux D, Bacon S, King DK, Dulin P, Gonzalez V. Examining perceptions of a smartphone-based intervention system for alcohol use disorders. Telemed J E Health 2014; 20:923-9. [PMID: 25243480 DOI: 10.1089/tmj.2013.0222] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND This study presents results from qualitative interviews conducted with participants in a study on the effectiveness of the Location-Based Monitoring and Intervention System for Alcohol Use Disorders (LBMI-A), a smartphone-based, stand-alone intervention application (app) for adults with alcohol use disorders. MATERIALS AND METHODS Participants were provided an LBMI-A-enabled smartphone to use during a 6-week pilot study. The LBMI-A was composed of psychoeducational modules, assessment and feedback of alcohol use patterns, geographic high-risk location monitoring and alerts, and in vivo assessment and intervention for alcohol cravings and help with managing psychological distress. Semistructured interviews were conducted with all participants following 6 weeks of interacting with the LBMI-A app (n=26). Interviews explored user perceptions of the ease and utility of LBMI-A features, module helpfulness, barriers to use, and recommendations for improvements to the program. Researchers applied a systematic qualitative coding process to transcripts that included both a priori themes identified as important by the research team and new themes that emerged during the coding process. RESULTS AND CONCLUSIONS Narrative analysis found the emergence of five main themes identified by LBMI-A users as the most helpful functions of the phone: (1) Awareness, (2) Accountability, (3) Skill Transference, (4) Tracking Progress, and (5) Prompts. These themes are explored, and implications of these findings for future smartphone-based interventions are discussed.
Collapse
Affiliation(s)
- Danielle Giroux
- Department of Psychology, University of Alaska , Anchorage, Anchorage, Alaska
| | | | | | | | | |
Collapse
|
27
|
Cheatle MD, Barker C. Improving opioid prescription practices and reducing patient risk in the primary care setting. J Pain Res 2014; 7:301-11. [PMID: 24966692 PMCID: PMC4062552 DOI: 10.2147/jpr.s37306] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Chronic pain is complex, and the patient suffering from chronic pain frequently experiences concomitant medical and psychiatric disorders, including mood and anxiety disorders, and in some cases substance use disorders. Ideally these patients would be referred to an interdisciplinary pain program staffed by pain medicine, behavioral health, and addiction specialists. In practice, the majority of patients with chronic pain are managed in the primary care setting. The primary care clinician typically has limited time, training, or access to resources to effectively and efficiently evaluate, treat, and monitor these patients, particularly when there is the added potential liability of prescribing opioids. This paper reviews the role of opioids in managing chronic noncancer pain, including efficacy and risk for misuse, abuse, and addiction, and discusses several models employing novel technologies and health delivery systems for risk assessment, intervention, and monitoring of patients receiving opioids in a primary care setting.
Collapse
Affiliation(s)
- Martin D Cheatle
- Center for Studies of Addiction, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Cody Barker
- Center for Studies of Addiction, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
28
|
Morgenstern J, Kuerbis A, Muench F. Ecological Momentary Assessment and Alcohol Use Disorder Treatment. Alcohol Res 2014; 36:101-9. [PMID: 26259004 PMCID: PMC4432849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
The ability to capture real-time data on human behavior inexpensively, efficiently, and accurately holds promise to transform and broaden our understanding of many areas of health science. One approach to acquiring this type of real-time data is ecological momentary assessment (EMA).This method has been used to collect data in many domains of addiction research, including research on the treatment of alcohol use disorders (AUDs). Empirical evidence supports the hypothesis that use of EMA can improve the quality of AUD treatment research when compared with standard assessment methods because it provides more accurate reporting, allows investigators to examine the dynamic unfolding of the behavior change process at an individual level, and can be used to augment and improve clinical assessment and treatment. Overall, the existing literature provides strong support for the advantages of EMA when combined with standard assessment of addictive behaviors in general. Nevertheless, use of EMA in AUD treatment research thus far has been limited, especially in the area of research on mechanisms of behavior change. Existing research indicates, however, that EMA can be used to deliver tailored feed- back as a novel and potentially transformative approach to improving AUD treatment. This research area clearly warrants additional future efforts.
Collapse
|
29
|
Quanbeck A, Chih MY, Isham A, Johnson R, Gustafson D. Mobile Delivery of Treatment for Alcohol Use Disorders: A Review of the Literature. Alcohol Res 2014; 36:111-22. [PMID: 26259005 PMCID: PMC4432850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Several systems for treating alcohol-use disorders (AUDs) exist that operate on mobile phones. These systems are categorized into four groups: text-messaging monitoring and reminder systems, text-messaging intervention systems, comprehensive recovery management systems, and game-based systems. Text-messaging monitoring and reminder systems deliver reminders and prompt reporting of alcohol consumption, enabling continuous monitoring of alcohol use. Text-messaging intervention systems additionally deliver text messages designed to promote abstinence and recovery. Comprehensive recovery management systems use the capabilities of smart-phones to provide a variety of tools and services that can be tailored to individuals, including in-the-moment assessments and access to peer discussion groups. Game-based systems engage the user using video games. Although many commercial applications for treatment of AUDs exist, few (if any) have empirical evidence of effectiveness. The available evidence suggests that although texting-based applications may have beneficial effects, they are probably insufficient as interventions for AUDs. Comprehensive recovery management systems have the strongest theoretical base and have yielded the strongest and longest-lasting effects, but challenges remain, including cost, understanding which features account for effects, and keeping up with technological advances.
Collapse
|