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Ross S, Wood MA, Johns D, Murphy J, Baird R, Alford B. Understanding Engagement With Forensic Smartphone Apps: The Service Design Engagement Model. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2024; 68:1106-1123. [PMID: 35730559 DOI: 10.1177/0306624x221106323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Justice services have begun to integrate the use of mobile applications into treatment, support, and rehabilitative programs for forensic clients. One such application that been adopted to support forensic clients is "eRecovery": a smartphone application that provides clients recovering from a substance addiction with support for managing relapse. In this article, we report on evaluation findings from a trial of eRecovery in an Australian Community Justice Centre, and reflect on several issues relating to fostering and sustaining client engagement with similar applications within forensic and justice settings. We propose the Service Design Engagement Model to organize, visualize, and describe the stages and factors important to adoption, appropriation, and on-going routine use of the software by forensic clients. The model recognizes the role of contextual and environmental factors in supporting users through the early stages of engagement, and the importance of user agency in longer-term engagement with therapeutic apps.
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Affiliation(s)
| | | | | | - John Murphy
- Design4Use Pty. Ltd., Melbourne, VIC, Australia
| | - Ron Baird
- Victoria University, Melbourne, Australia
| | - Brooke Alford
- Neighbourhood Justice Centre, Collingwood, VIC, Australia
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Ware OD, Cano MT, Dalal Safa M, Garza N, Martinez S, Salloum I. Availability of substance use disorder treatment in Spanish: Associations with state-level proportions of Spanish speakers and treatment facility characteristics in the United States. Am J Addict 2024; 33:400-408. [PMID: 38264804 DOI: 10.1111/ajad.13520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 12/07/2023] [Accepted: 01/01/2024] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Spanish is the second most spoken language in the United States. Not all substance use disorder (SUD) treatment facilities provide treatment in Spanish. This study examined factors associated with SUD treatment facilities having counselors that provide treatment in Spanish. METHODS State-level estimates of Spanish-speaking individuals were derived from the American Community Survey 2019. SUD treatment facility characteristics were captured from the National Survey of Substance Abuse Treatment Services 2020. We examined a sample of 15,246 facilities which included 12,798 outpatient, 3554 nonhospital residential, and 1106 with both outpatient and residential programs. Binary logistic regression models were used to observe state-level proportions of Spanish speakers and facility-level characteristics as factors associated with a facility having counselors that provide treatment in Spanish. RESULTS Approximately 23.3% of facilities had counselors able to provide treatment in Spanish. Among outpatient or nonhospital residential SUD facilities, those in a state with a larger proportion of Spanish-speaking individuals, facilities with pay assistance, facilities that accept Medicaid, and facilities that engage in community outreach had higher odds of having counselors that provide treatment in Spanish. CONCLUSIONS Considering that less than a quarter of facilities provide treatment in Spanish, increasing the availability of linguistically appropriate and culturally responsive services for SUD is imperative. SCIENTIFIC SIGNIFICANCE This national study is the first of its kind to examine associations between estimates of Spanish speakers and treatment facility characteristics associated with counselors that provide treatment in Spanish in outpatient and nonhospital residential SUD treatment.
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Affiliation(s)
- Orrin D Ware
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Monique T Cano
- Department of Psychological Science, University of Texas Rio Grande Valley, Edinburg, Texas, USA
| | - M Dalal Safa
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Noe Garza
- Institute of Neuroscience, University of Texas Rio Grande Valley, Edinburg, Texas, USA
| | - Suky Martinez
- Division on Substance Use Disorders, Columbia University Irving Medical Center & New York State Psychiatric Institute, New York, New York, USA
| | - Ihsan Salloum
- Institute of Neuroscience, University of Texas Rio Grande Valley, Edinburg, Texas, USA
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Wilde JA, Zawislak K, Sawyer-Morris G, Hulsey J, Molfenter T, Taxman FS. The adoption and sustainability of digital therapeutics in justice systems: A pilot feasibility study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 116:104024. [PMID: 37086698 DOI: 10.1016/j.drugpo.2023.104024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 03/28/2023] [Accepted: 03/29/2023] [Indexed: 04/24/2023]
Abstract
BACKGROUND This study explored whether participants with substance use disorder (SUD) would adopt and use a smart-phone app with a cognitive behavioral therapy program, weekly Brief Addiction Monitor (BAM) assessments, daily check-ins, tools to track sobriety and treatment, and other patient-centered resources. In addition, participants with SUD could access a social worker and peer support specialists. METHODS The study sought participants from two groups: those referred by a justice-related agency and participants who responded to outreach from the Addiction Policy Forum (APF). The Connections smart-phone app was offered to both groups. The study examined use of the app and social worker/peer recovery support services by participants who downloaded and used the app; those referred by a justice-related agency and those who self-referred through APF. The app provided primary data, including socio-demographics, referral status, dates of use, activities completed, and BAM scores. RESULTS The app was offered to 1973 participants, 40% of whom downloaded it. Three groups emerged from among the 350 who used the app: those who used only the cognitive behavioral aspects of the app, those who used only the recovery support services offered, and those who used both the app and recovery support services. Looking at the two referral groups, the justice-referred group preferred telehealth recovery support services with the social worker; the self-referred group used the app and the app plus the recovery support services equally. Scores on the BAM improved across time. Justice-referred participants' protective behaviors improved more than those of the self-referred participants while self-referred participants' risk behaviors improved more than those of justice-referred participants. Older participants were more likely to use the app, and to report fewer risky behaviors, as measured by the BAM. CONCLUSIONS Use of a digital therapeutic appears to support recovery of participants with SUD although many clients need and want the integration of social worker-driven recovery support services. Basically, the app can be an extension to personal services, but many people with SUD (particularly during COVID-19) crave human interaction. It also appears that those who seek assistance on their own, rather than being referred by a justice-related agency, may be more likely to benefit from digital therapeutics such as the Connections app.
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Affiliation(s)
- Judith A Wilde
- Schar School of Policy and Government, George Mason University, Van Metre Hall, Fifth Floor, 3351 Fairfax Drive, MS 3B1, Arlington, VA 22201, United States.
| | - Kayla Zawislak
- Addiction Policy Forum, 4701 Sangamore Rd, Suite 100N, Bethesda, MD 20816, United States.
| | - Ginnie Sawyer-Morris
- Addiction Policy Forum, 4701 Sangamore Rd, Suite 100N, Bethesda, MD 20816, United States.
| | - Jessica Hulsey
- Addiction Policy Forum, 4701 Sangamore Rd, Suite 100N, Bethesda, MD 20816, United States.
| | - Todd Molfenter
- College of Engineering, University of Wisconsin, 1513 University Ave., 4103 Mechanical Engineering Building, Madison, WI 53706, United States.
| | - Faye S Taxman
- Schar School of Policy and Government, George Mason University, Van Metre Hall, Fifth Floor, 3351 Fairfax Drive, MS 3B1, Arlington, VA 22201, United States.
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Sharma AK, Shadakshari D, Chand P, Murthy P. Design, development and pilot testing of 'Quest', a smartphone-based relapse prevention app for patients with alcohol dependence. Asian J Psychiatr 2023; 83:103572. [PMID: 37019043 DOI: 10.1016/j.ajp.2023.103572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 03/15/2023] [Accepted: 03/25/2023] [Indexed: 04/07/2023]
Abstract
OBJECTIVE To design, develop and pilot the 'Quest' app for smartphone-based relapse prevention for patients diagnosed with alcohol dependence syndrome (ADS). METHODS Principles of relapse prevention and motivation enhancement were used to develop the Quest App. Four addiction psychiatrists reviewed the app using the "app evaluation framework". Thirty patients (> 18 yrs age) diagnosed with ADS, who had an Android smartphone, were fluent in writing and reading English and agreed to use the app regularly for the next three months were enrolled in this study. After initial treatment for intoxication/withdrawal and with written consent, patients in the study group (TAUQ) were requested to download the Quest application from a downloadable installation file. The usability and acceptability of Quest App amongst TAUQ patients was evaluated using the usability section of the mHealth App Usability Questionnaire (MAUQ). The short-term effectiveness at the end of three months was compared between TAUQ and comparison group who received Treatment as Usual (TAU). RESULTS Both acceptability (65 %) and usability (5.8 out of 7) of the app were high. The patient groups (with or without Quest app) showed a significant reduction in drinking at 30, 60, and 90 days follow-up compared with their baseline number of drinking days. There was no significant difference between the two groups (with or without Quest App) in the median number of lapses and the median number of days of heavy drinking. CONCLUSIONS This is the first attempt to develop a smartphone app and test its feasibility in preventing relapse among patients with ADS in the Indian population. Further validation of the app after incorporating feedback and testing on a larger sample size and multiple languages is required.
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Affiliation(s)
- Abhishek Kumar Sharma
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore 560029, India
| | - Darshan Shadakshari
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore 560029, India
| | - Prabhat Chand
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore 560029, India.
| | - Pratima Murthy
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore 560029, India
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Sweeney MM, Holtyn AF, Stitzer ML, Gastfriend DR. Practical Technology for Expanding and Improving Substance Use Disorder Treatment: Telehealth, Remote Monitoring, and Digital Health Interventions. Psychiatr Clin North Am 2022; 45:515-528. [PMID: 36055736 PMCID: PMC9352538 DOI: 10.1016/j.psc.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The US opioid crisis and the COVID-19 pandemic have sparked innovation in substance use disorder (SUD) treatment such that telehealth, remote monitoring, and digital health interventions are increasingly feasible and effective. These technologies can increase SUD treatment access and acceptability, even for nontreatment seeking, remote, and underserved populations, and can be used to reduce health disparities. Overall, digital tools will likely overcome many barriers to delivery of evidence-based behavioral treatments such as cognitive behavioral therapy and contingency management, that, along with appropriate medications, constitute the foundation of treatment of SUDs.
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Affiliation(s)
- Mary M Sweeney
- Department of Psychiatry and Behavioral Sciences, Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD 21224, USA
| | - August F Holtyn
- Department of Psychiatry and Behavioral Sciences, Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD 21224, USA
| | - Maxine L Stitzer
- Department of Psychiatry and Behavioral Sciences, Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD 21224, USA; Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD 21201, USA
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Flickinger TE, Waselewski M, Tabackman A, Huynh J, Hodges J, Otero K, Schorling K, Ingersoll K, Tiouririne NAD, Dillingham R. Communication between patients, peers, and care providers through a mobile health intervention supporting medication-assisted treatment for opioid use disorder. PATIENT EDUCATION AND COUNSELING 2022; 105:2110-2115. [PMID: 35260260 PMCID: PMC10112280 DOI: 10.1016/j.pec.2022.02.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 02/08/2022] [Accepted: 02/21/2022] [Indexed: 05/02/2023]
Abstract
INTRODUCTION Our team developed the HOPE app as a clinic-based platform to support patients receiving medication assisted treatment (MAT) for opioid use disorder. We investigated the app's two communication features: an anonymous community message board (CMB) and secure messaging between patients and their clinic team. METHODS The HOPE (Heal Overcome Persist Endure) app was piloted with patients and MAT providers. Text from the CMB and messaging were downloaded and de-identified. Content analysis was performed using iteratively developed codebooks with team consensus. RESULTS The pilot study enrolled 28 participants; 25 were "members" (patients) and 3 were providers (physician, nurse, social worker). Of member-generated CMB posts, 45% described the poster's state of mind, including positive and negative emotions, 47% conveyed support and 8% asked for support. Members' secure messages to the team included 52% medical, 45% app-related, and 8% social topics. Provider's messages contained information exchange (90%) and relationship-building (36%). DISCUSSION Through the CMB, members shared emotions and social support with their peers. Through secure messaging, members addressed medical and social needs with their care team, used primarily for information exchange but also relationship-building. PRACTICE IMPLICATIONS The HOPE app addresses communication needs for patients in MAT and can support them in recovery.
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Affiliation(s)
- Tabor E Flickinger
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA.
| | - Marika Waselewski
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Alexa Tabackman
- University of Virginia School of Medicine, Charlottesville, VA, USA
| | | | - Jacqueline Hodges
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Kori Otero
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Kelly Schorling
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Karen Ingersoll
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Nassima Ait-Daoud Tiouririne
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Rebecca Dillingham
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
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McKay JR, Gustafson DH, Ivey M, P-Romashko K, Curtis B, Thomas T, Oslin DA, Polsky D, Quanbeck A, Lynch KG. Efficacy and comparative effectiveness of telephone and smartphone remote continuing care interventions for alcohol use disorder: a randomized controlled trial. Addiction 2022; 117:1326-1337. [PMID: 34859519 PMCID: PMC10600977 DOI: 10.1111/add.15771] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 11/05/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND AND AIMS Management of alcohol use disorder (AUD) could be enhanced by effective remote treatments. This study tested whether supplementing intensive outpatient programs (IOPs) with continuing care delivered via (1) telephone, (2) smartphone or (3) their combination improves outcomes relative to (4) IOP only. Continuing care conditions were also compared. DESIGN Randomized controlled trial of four groups with 3-, 6-, 9-, 12- and 18-month follow-ups. SETTING University research center in Philadelphia, PA, USA. PARTICIPANTS Participants (n = 262) met DSM-V criteria for AUD, were largely male (71%) and African American (82%). INTERVENTIONS AND COMPARATOR Telephone monitoring and counseling (TMC; n = 59), addiction comprehensive health enhancement support system (ACHESS; n = 68) and TMC + ACHESS (n = 70) provided for 12 months. The control condition received IOP only (TAU; n = 65). MEASUREMENT The primary outcome was percentage of days heavy drinking (PDHD) in months 1-12. Secondary outcomes were any drinking, any drug use, drinking consequences and quality of life. FINDINGS Mean PDHD in months 1-12 was 10.29 in TAU, 5.41 in TMC, 6.80 in ACHESS and 5.99 in TMC + ACHESS. PDHD was lower in TMC [Cohen's d = 0.35, P = 0.018, 95% confidence interval (CI) = (-1.42, -0.20)], ACHESS [d = 0.31, P = 0.031, 95% CI = (-1.27, -0.06)] and TMC + ACHESS [d = 0.36, P = 0.009, 95% CI = (-1.40, -0.20)] than in TAU. Differences between TMC + ACHESS, TMC and ACHESS were small (d ≤ 0.06) and non-significant. Findings were inconclusive as to whether or not the treatment conditions differed on PDHD at 18 months. A significant effect was obtained on any drinking, which was higher in months 1-12 in TAU than in TMC [odds ratio (OR) = 3.02, standard error (SE) = 0.43, 95% CI = (1.30, 6.99), P = 0.01] and TMC + ACHESS [OR = 2.43, SE = 0.39, 95% CI = (1.12, 5.27), P = 0.025). No other significant effects were obtained on other secondary outcomes during or after treatment. CONCLUSIONS A telephone-delivered intervention and a smartphone-delivered intervention, alone and in combination, provided effective remote continuing care for alcohol use disorder. The combination of both interventions was not superior to either alone and effects did not persist post-treatment.
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Affiliation(s)
- James R. McKay
- Center for Studies of Addiction, Perelman School of Medicine. University of Pennsylvania, 3535 Market St., Suite 500, Philadelphia, PA 19104
- Crescenz VAMC, 3900 Woodland Ave, Philadelphia, PA 19104
| | - David H. Gustafson
- Center for Health Enhancement System Studies, University of Wisconsin-Madison, 4109 Mechanical Engineering Building, 1513 University Ave., Madison, WI 53706
| | - Megan Ivey
- Center for Studies of Addiction, Perelman School of Medicine. University of Pennsylvania, 3535 Market St., Suite 500, Philadelphia, PA 19104
| | - Klaren P-Romashko
- Center for Health Enhancement System Studies, University of Wisconsin-Madison, 4109 Mechanical Engineering Building, 1513 University Ave., Madison, WI 53706
| | - Brenda Curtis
- Technology and Translational Research Unit, National Institute on Drug Abuse National Institute of Health, Biomedical Research Center, 251 Bayview Blvd, Suite 200, Baltimore, MD 21224
| | - Tyrone Thomas
- Center for Studies of Addiction, Perelman School of Medicine. University of Pennsylvania, 3535 Market St., Suite 500, Philadelphia, PA 19104
| | - David A. Oslin
- Center for Studies of Addiction, Perelman School of Medicine. University of Pennsylvania, 3535 Market St., Suite 500, Philadelphia, PA 19104
- Crescenz VAMC, 3900 Woodland Ave, Philadelphia, PA 19104
| | - Daniel Polsky
- Department of Health Policy and Management, Bloomberg School of Public Health Carey Business School, Johns Hopkins University, 624 N. Broadway, Room 661, Baltimore, MD
| | - Andrew Quanbeck
- Department of Family Medicine & Community Health, University of Wisconsin-Madison, 800 University Bay Drive, Madison, WI 53705
| | - Kevin G. Lynch
- Center for Studies of Addiction, Perelman School of Medicine. University of Pennsylvania, 3535 Market St., Suite 500, Philadelphia, PA 19104
- Crescenz VAMC, 3900 Woodland Ave, Philadelphia, PA 19104
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Hodges J, Waselewski M, Harrington W, Franklin T, Schorling K, Huynh J, Tabackman A, Otero K, Ingersoll K, Tiouririne NAD, Flickinger T, Dillingham R. Six-month outcomes of the HOPE smartphone application designed to support treatment with medications for opioid use disorder and piloted during an early statewide COVID-19 lockdown. Addict Sci Clin Pract 2022; 17:16. [PMID: 35255965 PMCID: PMC8899792 DOI: 10.1186/s13722-022-00296-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 02/07/2022] [Indexed: 02/20/2023] Open
Abstract
Background Morbidity and mortality related to opioid use disorder (OUD) in the U.S. is at an all-time high. Innovative approaches are needed to address gaps in retention in treatment with medications for opioid use disorder (MOUD). Mobile health (mHealth) approaches have shown improvement in engagement in care and associated clinical outcomes for a variety of chronic diseases, but mHealth tools designed specifically to support patients treated with MOUD are limited. Methods Following user-centered development and testing phases, a multi-feature smartphone application called HOPE (Heal. Overcome. Persist. Endure) was piloted in a small cohort of patients receiving MOUD and at high risk of disengagement in care at an office-based opioid treatment (OBOT) clinic in Central Virginia. Outcomes were tracked over a six-month period following patient enrollment. They included retention in care at the OBOT clinic, usage of various features of the application, and self-rated measures of mental health, substance use, treatment and recovery. Results Of the 25 participants in the HOPE pilot study, a majority were retained in care at 6 months (56%). Uptake of bi-directional features including messaging with providers and daily check-ins of mood, stress and medication adherence peaked at one month, and usage persisted through the sixth month. Patients who reported that distance to clinic was a problem at baseline had higher loss to follow up compared to those without distance as a reported barrier (67% vs 23%, p = 0.03). Patients lost to in-person clinic follow up continued to engage with one or more app features, indicating that mHealth approaches may bridge barriers to clinic visit attendance. Participants surveyed at baseline and 6 months (N = 16) scored higher on scales related to overall self-control and self-efficacy related to drug abstinence. Conclusions A pilot study of a novel multi-feature smartphone application to support OUD treatment showed acceptable retention in care and patient usage at 6 months. Further study within a larger population is needed to characterize ‘real world’ uptake and association with outcomes related to retention in care, relapse prevention, and opioid-associated mortality. Supplementary Information The online version contains supplementary material available at 10.1186/s13722-022-00296-4.
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Affiliation(s)
- Jacqueline Hodges
- Division of Infectious Diseases and International Health, University of Virginia, PO Box 801340, Charlottesville, VA, 22908-1340, USA.
| | - Marika Waselewski
- University of Michigan Medical School, 7300 Medical Science Building I - A Wing, 1301 Catherine St., Ann Arbor, MI, 48109-5624, USA
| | - William Harrington
- University of Virginia School of Medicine, 1215 Lee St, Charlottesville, VA, 22903, USA
| | - Taylor Franklin
- University of Virginia School of Medicine, 1215 Lee St, Charlottesville, VA, 22903, USA
| | - Kelly Schorling
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, 1300 Jefferson Park Ave., Charlottesville, VA, 22903, USA
| | - Jacqueline Huynh
- University of Virginia School of Medicine, 1215 Lee St, Charlottesville, VA, 22903, USA
| | - Alexa Tabackman
- University of Virginia School of Medicine, 1215 Lee St, Charlottesville, VA, 22903, USA
| | - Kori Otero
- Division of Infectious Diseases and International Health, University of Virginia, PO Box 801340, Charlottesville, VA, 22908-1340, USA
| | - Karen Ingersoll
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, 1300 Jefferson Park Ave., Charlottesville, VA, 22903, USA
| | - Nassima Ait-Daoud Tiouririne
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, 1300 Jefferson Park Ave., Charlottesville, VA, 22903, USA
| | - Tabor Flickinger
- Department of Medicine, University of Virginia, 1215 Lee St, Charlottesville, VA, 22903, USA
| | - Rebecca Dillingham
- Division of Infectious Diseases and International Health, University of Virginia, PO Box 801340, Charlottesville, VA, 22908-1340, USA
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Venner K, Hernandez-Vallant A, Hirchak KA, Herron J. A scoping review of cultural adaptations of substance use disorder treatments across Latinx communities: Guidance for future research and practice. J Subst Abuse Treat 2022; 137:108716. [DOI: 10.1016/j.jsat.2021.108716] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 10/26/2021] [Accepted: 12/14/2021] [Indexed: 11/24/2022]
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Menon R, Meyer J, Nippak P, Begum H. Smartphone Alcohol Use Disorder Recovery Apps: a Survey of Behavioral Intention to Use (Preprint). JMIR Hum Factors 2021; 9:e33493. [PMID: 35363145 PMCID: PMC9015776 DOI: 10.2196/33493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 12/22/2021] [Accepted: 02/14/2022] [Indexed: 11/24/2022] Open
Abstract
Background Alcohol use disorder (AUD) carries a huge health and economic cost to society. Effective interventions exist but numerous challenges limit their adoption, especially in a pandemic context. AUD recovery apps (AUDRA) have emerged as a potential complement to in-person interventions. They are easy to access and show promising results in terms of efficacy. However, they rely on individual adoption decisions and remain underused. Objective The aim of this survey study is to explore the beliefs that determine the intention to use AUDRA. Methods We conducted a cross-sectional survey study of people with AUD. We used the Unified Theory of Acceptance and Use of Technology, which predicts use and behavioral intention to use based on performance expectancy, effort expectancy, social influence, and facilitating conditions. Participants were recruited directly from 2 sources; first, respondents at addiction treatment facilities in Ontario, Canada, were contacted in person, and they filled a paper form; second, members from AUD recovery support groups on social media were contacted and invited to fill an internet-based survey. The survey was conducted between October 2019 and June 2020. Results The final sample comprised 159 participants (124 involved in the web-based survey and 35 in the paper-based survey) self-identifying somewhat or very much with AUD. Most participants (n=136, 85.5%) were aware of AUDRA and those participants scored higher on performance expectancy, effort expectancy, and social influence. Overall, the model explains 35.4% of the variance in the behavioral intention to use AUDRA and 11.1% of the variance in use. Social influence (P=.31), especially for women (P=.23), and effort expectancy (P=.25) were key antecedents of behavioral intention. Facilitating conditions were not significant overall but were moderated by age (P=.23), suggesting that it matters for older participants. Performance expectancy did not predict behavioral intention, which is unlike many other technologies but confirms other findings associated with mobile health (mHealth). Open-ended questions suggest that privacy concerns may significantly influence the use of AUDRA. Conclusions This study suggests that unlike many other technologies, the adoption of AUDRA is not mainly determined by utilitarian factors such as performance expectancy. Rather, effort expectancy and social influence play a key role in determining the intention to use AUDRA.
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Affiliation(s)
- Rijuta Menon
- School of Health Services Management, Ted Rogers School of Management, Ryerson University, Toronto, ON, Canada
| | - Julien Meyer
- School of Health Services Management, Ted Rogers School of Management, Ryerson University, Toronto, ON, Canada
| | - Pria Nippak
- School of Health Services Management, Ted Rogers School of Management, Ryerson University, Toronto, ON, Canada
| | - Housne Begum
- School of Health Services Management, Ted Rogers School of Management, Ryerson University, Toronto, ON, Canada
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Spanhel K, Balci S, Feldhahn F, Bengel J, Baumeister H, Sander LB. Cultural adaptation of internet- and mobile-based interventions for mental disorders: a systematic review. NPJ Digit Med 2021; 4:128. [PMID: 34433875 PMCID: PMC8387403 DOI: 10.1038/s41746-021-00498-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 08/03/2021] [Indexed: 02/07/2023] Open
Abstract
Providing accessible and effective healthcare solutions for people living in low- and middle-income countries, migrants, and indigenous people is central to reduce the global mental health treatment gap. Internet- and mobile-based interventions (IMI) are considered scalable psychological interventions to reduce the burden of mental disorders and are culturally adapted for implementation in these target groups. In October 2020, the databases PsycInfo, MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Web of Science were systematically searched for studies that culturally adapted IMI for mental disorders. Among 9438 screened records, we identified 55 eligible articles. We extracted 17 content, methodological, and procedural components of culturally adapting IMI, aiming to consider specific situations and perspectives of the target populations. Adherence and effectiveness of the adapted IMI seemed similar to the original IMI; yet, no included study conducted a direct comparison. The presented taxonomy of cultural adaptation of IMI for mental disorders provides a basis for future studies investigating the relevance and necessity of their cultural adaptation.PROSPERO registration number: CRD42019142320.
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Affiliation(s)
- Kerstin Spanhel
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg, Germany.
| | - Sumeyye Balci
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Felicitas Feldhahn
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg, Germany
| | - Juergen Bengel
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg, Germany
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Lasse B Sander
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg, Germany
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12
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Uribe ALM, Rudt HG, Leak TM. Stakeholders' Views on Mobile Applications to Deliver Infant and Toddler Feeding Education to Latina Mothers of Low Socioeconomic Status. Nutrients 2021; 13:2569. [PMID: 34444738 PMCID: PMC8398137 DOI: 10.3390/nu13082569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 07/07/2021] [Accepted: 07/23/2021] [Indexed: 12/02/2022] Open
Abstract
Infant- and toddler-feeding (ITF) practices are critical to long-term health and chronic disease prevention. Using mobile applications (apps) to promote desirable ITF practices shows promise for overcoming challenges of in-person education. However, the viability of ITF apps for Latina mothers of low-socioeconomic status (SES) remains unclear. The objective of this study was to characterize stakeholders' views on Latina mothers' capability, motivation, and barriers to using ITF apps. New York City-based health professionals who frequently engage with Latina mothers of low SES completed in-depth interviews. Directed content analysis was used to identify themes through theoretical and inductive codes. Participants included dietitians, nutrition educators, and physicians (n = 17). The following themes were identified: (1) Most Latina mothers of low-SES are tech-savvy (i.e., high capability and experience using smartphones and apps); (2) Apps are an appealing way to deliver ITF education; (3) There are challenges to using apps that must be carefully considered for ITF education development. Overall, ITF apps are a viable option as skills and use appear high among Latina mothers. Key considerations for app development include targeted app promotion; detailed instructions for obtaining and using app; more visuals, less text for low literacy and multiple dialects; making key features available offline.
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Affiliation(s)
- Alexandra L. MacMillan Uribe
- Division of Nutritional Sciences, Cornell University, 244 Garden Avenue, Ithaca, NY 14853, USA; (H.G.R.); (T.M.L.)
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13
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Gonzalez C, Early J, Gordon-Dseagu V, Mata T, Nieto C. Promoting Culturally Tailored mHealth: A Scoping Review of Mobile Health Interventions in Latinx Communities. J Immigr Minor Health 2021; 23:1065-1077. [PMID: 33988789 PMCID: PMC8120499 DOI: 10.1007/s10903-021-01209-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2021] [Indexed: 12/14/2022]
Abstract
This scoping review of mHealth research focuses on intervention studies that utilize mobile technologies to promote behavior change and improve health outcomes in U.S. Latinx communities. 342 mHealth articles were reviewed using PRIMSA protocols; most did not include a majority Latinx study population or did not report on an intervention. The final sample resulted in 23 articles published between 2012 and 2020. Reviewed interventions focused on conditions such as: diabetes, depression, substance abuse, obesity, hypertension, maternal health, and farmworker safety. About one-third of mHealth interventions included mobile applications, the rest were limited to texting programs. Text message reminders can help improve medication adherence and care access, especially when coupled with support from community health workers. Bi-directional text message interventions with feedback loops and personalized treatment options can build user agency. Additionally, multi-modal applications that combine texting with self-guided interactive content show promise for culturally tailored mHealth.
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Affiliation(s)
- Carmen Gonzalez
- Department of Communication, University of Washington, Communications Building 101, Seattle, WA, 98195, USA.
| | - Jody Early
- School of Nursing and Health Studies, University of Washington Bothell, Bothell, USA
| | - Vanessa Gordon-Dseagu
- School of Nursing and Health Studies, University of Washington Bothell, Bothell, USA
| | - Teresa Mata
- Fielding School of Public Health, University of California Los Angeles, Los Angeles, USA
| | - Carolina Nieto
- Department of Communication, University of Washington, Communications Building 101, Seattle, WA, 98195, USA
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14
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Thonon F, Perrot S, Yergolkar AV, Rousset-Torrente O, Griffith JW, Chassany O, Duracinsky M. Electronic Tools to Bridge the Language Gap in Health Care for People Who Have Migrated: Systematic Review. J Med Internet Res 2021; 23:e25131. [PMID: 33955837 PMCID: PMC8138704 DOI: 10.2196/25131] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 03/05/2021] [Accepted: 03/16/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND People who have migrated or with a language barrier may face significant hurdles in accessing health care. Some apps have been specifically developed to facilitate the dialogue between health care professionals and people who have migrated who have low-level language proficiency or to promote health among people who have migrated. OBJECTIVE We conducted a systematic review to investigate development, acceptability, and effectiveness of these types of apps. METHODS We conducted a search of PubMed, Scopus, and Embase databases. We included all study designs (qualitative, quantitative, mixed) reporting development, evaluation of efficacy, or acceptability of apps facilitating dialogue with a health professional or promoting health for people who have migrated, minorities, or tourists with a language barrier, using any outcome. Two researchers selected the studies independently. We collected general information about the app, information about health literacy and cultural adaptation, information about the development of the app, evidence on acceptability or efficacy, and information on app use. Data were collected by 2 researchers independently and results were reviewed to verify agreement and reported according to PRISMA (Preferred Reporting Items for Systematic Review and Meta-analysis). RESULTS Positive results for translation apps included better communication, but with possible limitations, and reduced consultation time. Positive results for health promotion apps included improved quality of life and better management of chronic illnesses. CONCLUSIONS Overall, the apps had good levels of acceptability, though only half had their efficacy evaluated. In those evaluations, the endpoints were mostly related to reported behavior change and knowledge improvement, which is common for evaluations of health promotion programs. In the future, as more health apps are created, it is essential that apps that claim to have a public health objective undergo a rigorous evaluation of their acceptability, efficacy, and actual use. Indicators of outcomes beyond changes in behavior and knowledge should be reported; change in health status or access to care should also be reported. This systematic review has helped us note the characteristics associated with improved acceptability and efficacy, which can be helpful for the development of future apps.
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Affiliation(s)
- Frédérique Thonon
- Patient-Reported Outcomes Unit (PROQOL), UMR 1123, Université de Paris, INSERM, F-75004, Paris, France
- Unité de Recherche Clinique en Economie de la Santé (URC-ECO), AP-HP, Hôpital Hôtel-Dieu, F-75004, Paris, France
| | - Swati Perrot
- Patient-Reported Outcomes Unit (PROQOL), UMR 1123, Université de Paris, INSERM, F-75004, Paris, France
| | | | - Olivia Rousset-Torrente
- Patient-Reported Outcomes Unit (PROQOL), UMR 1123, Université de Paris, INSERM, F-75004, Paris, France
- Unité de Recherche Clinique en Economie de la Santé (URC-ECO), AP-HP, Hôpital Hôtel-Dieu, F-75004, Paris, France
| | - James W Griffith
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Olivier Chassany
- Patient-Reported Outcomes Unit (PROQOL), UMR 1123, Université de Paris, INSERM, F-75004, Paris, France
- Unité de Recherche Clinique en Economie de la Santé (URC-ECO), AP-HP, Hôpital Hôtel-Dieu, F-75004, Paris, France
| | - Martin Duracinsky
- Patient-Reported Outcomes Unit (PROQOL), UMR 1123, Université de Paris, INSERM, F-75004, Paris, France
- Unité de Recherche Clinique en Economie de la Santé (URC-ECO), AP-HP, Hôpital Hôtel-Dieu, F-75004, Paris, France
- Service de Médecine Interne et d'Immunologie Clinique, Hôpital Bicêtre, F94270, Le Kremlin Bicêtre, France
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Muñoz AO, Camacho E, Torous J. Marketplace and Literature Review of Spanish Language Mental Health Apps. Front Digit Health 2021; 3:615366. [PMID: 34713093 PMCID: PMC8521936 DOI: 10.3389/fdgth.2021.615366] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 01/15/2021] [Indexed: 12/12/2022] Open
Abstract
Language differences between patients and providers remains a barrier to accessing health care, especially mental health services. One potential solution to reduce inequities for patients that speak different languages and improve their access to care is through the delivery of healthcare through mobile technology. Given that the Latinx community serves as the largest ethnic minority in the United States, this two-phased review examines Spanish app development, feasibility and efficacy. Phase 1 explored the commercial marketplace for apps available in Spanish, while phase 2 involved a literature review of published research centered around the creation, functions, and usability of these apps using the PubMed and Google Scholar electronic databases. Of the apps available on the database, only 14.5% of them had Spanish operability. The literature search uncovered 629 results, of which 12 research articles that tested or described 10 apps met the inclusion criteria. Of the 10 apps studied in this literature review, only four apps were translated to Spanish. Our study reveals that despite increasing interest in Spanish-language apps to address mental health, the commercial marketplace is not currently meeting the demand.
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Affiliation(s)
| | - Erica Camacho
- Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - John Torous
- Harvard Medical School, Boston, MA, United States
- Beth Israel Deaconess Medical Center, Boston, MA, United States
- *Correspondence: John Torous
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White VM, Molfenter T, Gustafson DH, Horst J, Greller R, Gustafson DH, Kim JS, Preuss E, Cody O, Pisitthakarm P, Toy A. NIATx-TI versus typical product training on e-health technology implementation: a clustered randomized controlled trial study protocol. Implement Sci 2020; 15:94. [PMID: 33097097 PMCID: PMC7582427 DOI: 10.1186/s13012-020-01053-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 10/12/2020] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Substance use disorders (SUDs) lead to tens-of-thousands of overdose deaths and other forms of preventable deaths in the USA each year. This results in over $500 billion per year in societal and economic costs as well as a considerable amount of grief for loved ones of affected individuals. Despite these health and societal consequences, only a small percentage of people seek treatment for SUDs, and the majority of those that seek help fail to achieve long-term sobriety. E-health applications in healthcare have proven to be effective at sustaining treatment and reaching patients traditional treatment pathways would have missed. However, e-health adoption and sustainment rates in healthcare are poor, especially in the SUD treatment sector. Implementation engineering can address this gap in the e-health field by augmenting existing implementation models, which explain organizational and individual e-health behaviors retrospectively, with prospective resources that can guide implementation. METHODS This cluster randomized control trial is designed to test two implementation strategies at adopting an evidence-based mobile e-health technology for SUD treatment. The proposed e-health implementation model is the Network for the Improvement of Addiction Treatment-Technology Implementation (NIATx-TI) Framework. This project, based in Iowa, will compare a control condition (using a typical software product training approach that includes in-person staff training followed by access to on-line support) to software implementation utilizing NIATx-TI, which includes change management training, followed by coaching on how to implement and use the mobile application. While e-health spans many modalities and health disciplines, this project will focus on implementing the Addiction Comprehensive Health Enhancement Support System (A-CHESS), an evidence-based SUD treatment recovery app framework. This trial will be conducted in Iowa at 46 organizational sites within 12 SUD treatment agencies. The control arm consists of 23 individual treatment sites based at five organizations, and the intervention arm consists of 23 individual SUD treatment sites based at seven organizations DISCUSSION: This study addresses an issue of substantial public health significance: enhancing the uptake of the growing inventory of patient-centered evidence-based addiction treatment e-health technologies. TRIAL REGISTRATION ClinicalTrials.gov , NCT03954184 . Posted 17 May 2019.
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Affiliation(s)
- Veronica M White
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 1513 University Ave, Madison, WI, 53706, USA.
| | - Todd Molfenter
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 1513 University Ave, Madison, WI, 53706, USA
| | - David H Gustafson
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 1513 University Ave, Madison, WI, 53706, USA
| | - Julie Horst
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 1513 University Ave, Madison, WI, 53706, USA
| | - Rachelle Greller
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 1513 University Ave, Madison, WI, 53706, USA
| | - David H Gustafson
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 1513 University Ave, Madison, WI, 53706, USA
| | - Jee-Seon Kim
- Department of Educational Psychology, University of Wisconsin-Madison, Educational Sciences, 1025 West Johnson St, Madison, WI, 53706-1706, USA
| | - Eric Preuss
- Division of Behavioral Health, Iowa Department of Public Health, Lucas State Office Building, 321 E. 12th Street, Des Moines, IA, 50319-0075, USA
| | - Olivia Cody
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 1513 University Ave, Madison, WI, 53706, USA
| | - Praan Pisitthakarm
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 1513 University Ave, Madison, WI, 53706, USA
| | - Alexander Toy
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 1513 University Ave, Madison, WI, 53706, USA
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Colbert S, Thornton L, Richmond R. Smartphone apps for managing alcohol consumption: a literature review. Addict Sci Clin Pract 2020; 15:17. [PMID: 32381062 PMCID: PMC7206704 DOI: 10.1186/s13722-020-00190-x] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 04/27/2020] [Indexed: 01/01/2023] Open
Abstract
Background Smartphone applications (apps) designed to assist users to reduce hazardous and harmful alcohol consumption show potential as an inexpensive alternative to traditional brief intervention in primary care. The aim of this paper is to provide an overview of the literature on alcohol reduction apps and the availability of evidenced-based apps on top commercial app stores. Methods We reviewed literature through to December 2019 using the databases PubMed, MEDLINE, PsycINFO and Google Scholar and keyword search terms smartphone/mobile/phone AND application/app AND alcohol. Articles were included if the primary intervention was a smartphone app and the study measured participant changes in frequency or volume of alcohol consumption. Results 21 relevant articles were identified that evaluated 19 unique smartphone apps. Of the 19 unique apps, seven were designed for use among youth and 12 in adult populations. The available evidence for the efficacy of alcohol reduction apps among youth is inconclusive, with results from these evaluations not showing a clear benefit in reducing alcohol consumption compared to control groups. The results of apps designed for adult populations appears more promising, but results are still mixed. Of the 19 alcohol reduction apps that have been evaluated only eight of these are currently publicly available in commercial app stores. Of these eight apps, only four were demonstrated in the literature to assist with reducing alcohol consumption. Conclusion The evidence for alcohol reduction apps is promising but inconclusive. Few apps that have been evaluated in the scientific literature are currently available for download in commercial app stores.
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Affiliation(s)
- Stephanie Colbert
- School Public Health and Community Medicine, University of New South Wales, Kensington, Australia
| | - Louise Thornton
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Sydney, Australia
| | - Robyn Richmond
- School Public Health and Community Medicine, University of New South Wales, Kensington, Australia.
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