Adapting an evidence-based e-learning CBT program into a mobile app for people experiencing gambling-related problems: A Formative Study

Applying the Just-In-Time Adaptive Intervention Framework to the Development of Gambling Interventions

Just-In-Time Adaptive Interventions (JITAIs) are emerging "push" mHealth interventions that provide the right type, timing, and amount of support to address the dynamically-changing needs for each individual. Although JITAIs are well-suited to the delivery of interventions for the addictions, few are available to support gambling behaviour change. We therefore developed GamblingLess: In-The-Moment and Gambling Habit Hacker, two smartphone-delivered JITAIs that differ with respect to their target populations, theoretical underpinnings, and decision rules. We aim to describe the decisions, methods, and tools we used to design these two treatments, with a view to providing guidance to addiction researchers who wish to develop JITAIs in the future. Specifically, we describe how we applied a comprehensive, organising scientific framework to define the problem, define just-in-time in the context of the identified problem, and formulate the adaptation strategies. While JITAIs appear to be a promising design in addiction intervention science, we describe several key challenges that arose during development, particularly in relation to applying micro-randomised trials to their evaluation, and offer recommendations for future research. Issues including evaluation considerations, integrating on-demand intervention content, intervention optimisation, combining active and passive assessments, incorporating human facilitation, adding cost-effectiveness evaluations, and redevelopment as transdiagnostic interventions are discussed.

Smartphone Apps for Problem Gambling: A Review of Content and Quality

Purpose of review

Problem gambling can have profound consequences for affected individuals, yet only a small proportion of people with problem gambling seek treatment. Mobile phone applications (apps) may provide an effective and scalable therapeutic option. The purpose of this study was to evaluate publicly available mobile apps aimed at improving problematic gambling behavior.

Recent findings

To date, there are no published studies that have evaluated the quality of publicly available smartphone apps for problem gambling in the US. There is thus a significant gap in knowledge of existing apps for addressing problem gambling.

Summary

This study included a review of 14 problem-gambling-specific apps. Apps that incorporated cognitive-behavioral therapy concepts and in-app communities were associated with better aesthetics and information quality scores. Additionally, in-app communities were associated with better engagement scores. Our results highlight the importance of evidence-based and engaging features in apps designed to help people with problem gambling.

Development, acceptability, and perceived effectiveness of a trauma-informed adolescent self-regulation intervention

Youth who have experienced trauma often face challenges with self-regulation and can have diminished health outcomes, including those related to sexual and reproductive health. We developed a 12-session blended e-learning intervention for youth involved in juvenile justice systems to encourage healthy sexual decision-making by improving self-regulation skills. This paper describes the development of the program, e-Practice Self-Regulation, as well as an assessment of program acceptability and perceived effectiveness among youth participants. Data were collected using a feedback survey from youth who both completed (n = 95) and did not complete (n = 80) the intervention. Program acceptability was high among all participants, and over 70 % of both completers and non-completers would recommend e-Practice Self-Regulation to peers. Youth reported positive interactions with facilitators and described sessions as helpful, interesting, and educational. The most common criticism was online session length. A majority in both groups reported perceived effectiveness related to sexual health and self-regulation, which increased with more sessions completed. Results suggest e-Practice Self-Regulation is acceptable to youth participants, who reported learning skills necessary for self-regulation and sexual health and intended to use these skills to avoid unplanned pregnancy.

Scoping review of telehealth use by Indigenous populations from Australia, Canada, New Zealand, and the United States

INTRODUCTION

Telehealth has the potential to address health disparities experienced by Indigenous people, especially in remote areas. This scoping review aims to map and characterize the existing evidence on telehealth use by Indigenous people and explore the key concepts for effective use, cultural safety, and building therapeutic relationships.

METHODS

A search for published and gray literature, written in English, and published between 2000 and 2022 was completed in 17 electronic databases. Two reviewers independently screened retrieved records for eligibility. For included articles, data were extracted, categorized, and analyzed. Synthesis of findings was performed narratively.

RESULTS

A total of 321 studies were included. The most popular type of telehealth used was mHealth (44%), and the most common health focuses of the telehealth interventions were mental health (26%) and diabetes/diabetic retinopathy (13%). Frequently described barriers to effective telehealth use included concerns about privacy/confidentiality and limited internet availability; meanwhile, telehealth-usage facilitators included cultural relevance and community engagement. Although working in collaboration with Indigenous communities was the most frequently reported way to achieve cultural safety, 40% of the studies did not report Indigenous involvement. Finally, difficulty to establish trusting therapeutic relationships was a major concern raised about telehealth, and evidence suggests that having the first visit-in-person is a potential way to address this issue.

CONCLUSION

This comprehensive review identified critical factors to guide the development of culturally-informed telehealth services to meet the needs of Indigenous people and to achieve equitable access and positive health outcomes.

GAMBLINGLESS IN-THE-MOMENT: Protocol for a micro-randomised trial of a gambling Just-In-Time Adaptive Intervention (Preprint)

Background

The presence of discrete but fluctuating precipitants, in combination with the dynamic nature of gambling episodes, calls for the development of tailored interventions delivered in real time, such as just-in-time adaptive interventions (JITAIs). JITAIs leverage mobile and wireless technologies to address dynamically changing individual needs by providing the type and amount of support required at the right time and only when needed. They have the added benefit of reaching underserved populations by providing accessible, convenient, and low-burden support. Despite these benefits, few JITAIs targeting gambling behavior are available.

Objective

This study aims to redress this gap in service provision by developing and evaluating a theoretically informed and evidence-based JITAI for people who want to reduce their gambling. Delivered via a smartphone app, GamblingLess: In-The-Moment provides tailored cognitive-behavioral and third-wave interventions targeting cognitive processes explicated by the relapse prevention model (cravings, self-efficacy, and positive outcome expectancies). It aims to reduce gambling symptom severity (distal outcome) through short-term reductions in the likelihood of gambling episodes (primary proximal outcome) by improving craving intensity, self-efficacy, or expectancies (secondary proximal outcomes). The primary aim is to explore the degree to which the delivery of a tailored intervention at a time of cognitive vulnerability reduces the probability of a subsequent gambling episode.

Methods

GamblingLess: In-The-Moment interventions are delivered to gamblers who are in a state of receptivity (available for treatment) and report a state of cognitive vulnerability via ecological momentary assessments 3 times a day. The JITAI will tailor the type, timing, and amount of support for individual needs. Using a microrandomized trial, a form of sequential factorial design, each eligible participant will be randomized to a tailored intervention condition or no intervention control condition at each ecological momentary assessment across a 28-day period. The microrandomized trial will be supplemented by a 6-month within-group follow-up evaluation to explore long-term effects on primary (gambling symptom severity) and secondary (gambling behavior, craving severity, self-efficacy, and expectancies) outcomes and an acceptability evaluation via postintervention surveys, app use and engagement indices, and semistructured interviews. In all, 200 participants will be recruited from Australia and New Zealand.

Results

The project was funded in June 2019, with approval from the Deakin University Human Research Ethics Committee (2020-304). Stakeholder user testing revealed high acceptability scores. The trial began on March 29, 2022, and 84 participants have been recruited (as of June 24, 2022). Results are expected to be published mid-2024.

Conclusions

GamblingLess: In-The-Moment forms part of a suite of theoretically informed and evidence-based web-based and mobile gambling interventions. This trial will provide important empirical data that can be used to facilitate the JITAI’s optimization to make it a more effective, efficient, and scalable tailored intervention.

Trial Registration

Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12622000490774; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380757&isClinicalTrial=False

International Registered Report Identifier (IRRID)

PRR1-10.2196/38958