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Boumparis N, Noroozi A, Naghizadeh E, Meyer A, Wenger A, Rahimi-Movaghar A, Schaub MP. Blended smartphone intervention for patients in opioid maintenance treatment in Iran: protocol for a randomized controlled trial. BMC Psychiatry 2023; 23:518. [PMID: 37464337 DOI: 10.1186/s12888-023-05007-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 07/06/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND The pattern of substance use in Iran is characterized by a high prevalence of opioid use and opioid use disorder (OUD). Although opioid maintenance therapy (OMT) has been introduced in Iran, approximately 50% of people with opioid use disorder remain unreached. Moreover, psychosocial treatment of OUD and common mental health symptoms during OMT is limited. Digital interventions have been shown to improve psychological distress, depression, anxiety, and post-traumatic stress disorder symptoms. In addition, providing psychoeducation and risk reduction counseling to prevent communicable diseases like HIV and infectious hepatitis is common via the Internet. However, despite these promising advances, no smartphone intervention in OMT has been investigated for the treatment of OUD and common comorbid mental health symptoms. OBJECTIVE We examine the effectiveness of adding a blended smartphone intervention based on community reinforcement approach, motivational interviewing- and cognitive behavioral therapy compared to OMT as usual that aims to improve OMT outcomes and addresses common mental health symptoms in OMT patients in Iran. METHOD Adults with opioid dependence entering 8 treatment centers in Tehran, Iran will be randomly assigned to receive either OMT plus a smartphone intervention or OMT as usual. The primary outcomes will be the percentage of negative urine tests for illicit, non-prescribed use of opioids (opium, heroin, tramadol) and treatment retention. Secondary outcomes will include the longest period of abstinence from the illicit, non-prescribed use of opioids (opium, heroin, and tramadol) confirmed by urine samples, changes in communicable disease risk-taking behaviors, changes in stress and common mental health symptoms, and client satisfaction. Data analysis will follow the intention-to-treat principle and employ (generalized) linear mixed models. DISCUSSION This study will provide substantial knowledge for designing effective blended interventions for OUD. Moreover, it will investigate if treatment retention and OMT-related outcomes and common mental health symptoms can be improved by adding a smartphone intervention to OMT. TRIAL REGISTRATION https://en.irct.ir/trial/53578 .
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Affiliation(s)
- Nikolaos Boumparis
- Swiss Research Institute for Public Health and Addiction, University of Zurich, Konradstrasse 32, 8005, Zurich, Switzerland.
| | - Alireza Noroozi
- Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
| | - Eisa Naghizadeh
- Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
| | - Andreas Meyer
- Swiss Research Institute for Public Health and Addiction, University of Zurich, Konradstrasse 32, 8005, Zurich, Switzerland
| | - Andreas Wenger
- Swiss Research Institute for Public Health and Addiction, University of Zurich, Konradstrasse 32, 8005, Zurich, Switzerland
| | - Afarin Rahimi-Movaghar
- Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
| | - Michael P Schaub
- Swiss Research Institute for Public Health and Addiction, University of Zurich, Konradstrasse 32, 8005, Zurich, Switzerland
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2
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Brezing CA, Levin FR. Applications of technology in the assessment and treatment of cannabis use disorder. Front Psychiatry 2022; 13:1035345. [PMID: 36339845 PMCID: PMC9626500 DOI: 10.3389/fpsyt.2022.1035345] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 09/30/2022] [Indexed: 11/30/2022] Open
Abstract
Cannabis use and Cannabis Use Disorder (CUD) have been increasing. There are no FDA approved medications and evidence-based psychotherapy is limited by insufficient providers, serving very few patients effectively. The lack of resources for prevention and treatment of CUD has resulted in a significant gap between the need for services and access to treatment. The creation of a scalable system to prevent, screen, refer and provide treatment for a chronic, relapsing diagnosis like CUD could be achieved through the application of technology. Many studies have utilized ecological momentary assessments (EMA) in treatment seeking and non-treatment seeking cannabis users. EMA allows for repeated, intensive, longitudinal data collection in vivo. EMA has been studied in cannabis use and its association with affect, craving, withdrawal, other substances, impulsivity, and interpersonal behaviors. EMA has the potential to serve as a valuable monitoring tool in prevention, screening, and treatment for CUD. Research has also focused on the development of internet and application-based treatments for CUD, including a currently available prescription digital therapeutic. Treatment options have expanded to more broadly incorporate telehealth as an option for CUD treatment with broad acceptance and change in regulation following the COVID-19 pandemic. While technology has limitations, including cost, privacy concerns, and issues with engagement, it will be a necessary medium to meet societal health needs as a consequence of an ever-changing cannabis regulatory landscape. Future work should focus on improving existing platforms while ethically incorporating other functions (e.g., sensors) to optimize a public and clinical health approach to CUD.
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Affiliation(s)
- Christina A Brezing
- Division on Substance Use Disorders, New York State Psychiatric Institute, New York, NY, United States.,Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, United States
| | - Frances R Levin
- Division on Substance Use Disorders, New York State Psychiatric Institute, New York, NY, United States.,Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, United States
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3
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Newton AS, March S, Gehring ND, Rowe AK, Radomski AD. Establishing a Working Definition of User Experience for eHealth Interventions of Self-reported User Experience Measures With eHealth Researchers and Adolescents: Scoping Review. J Med Internet Res 2021; 23:e25012. [PMID: 34860671 PMCID: PMC8686463 DOI: 10.2196/25012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 03/27/2021] [Accepted: 09/23/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Across eHealth intervention studies involving children, adolescents, and their parents, researchers have measured user experience to assist with intervention development, refinement, and evaluation. To date, no widely accepted definitions or measures of user experience exist to support a standardized approach for evaluation and comparison within or across interventions. OBJECTIVE We conduct a scoping review with subsequent Delphi consultation to identify how user experience is defined and measured in eHealth research studies, characterize the measurement tools used, and establish working definitions for domains of user experience that could be used in future eHealth evaluations. METHODS We systematically searched electronic databases for published and gray literature available from January 1, 2005, to April 11, 2019. We included studies assessing an eHealth intervention that targeted any health condition and was designed for use by children, adolescents, and their parents. eHealth interventions needed to be web-, computer-, or mobile-based, mediated by the internet with some degree of interactivity. We required studies to report the measurement of user experience as first-person experiences, involving cognitive and behavioral factors reported by intervention users. We appraised the quality of user experience measures in included studies using published criteria: well-established, approaching well-established, promising, or not yet established. We conducted a descriptive analysis of how user experience was defined and measured in each study. Review findings subsequently informed the survey questions used in the Delphi consultations with eHealth researchers and adolescent users for how user experience should be defined and measured. RESULTS Of the 8634 articles screened for eligibility, 129 articles and 1 erratum were included in the review. A total of 30 eHealth researchers and 27 adolescents participated in the Delphi consultations. On the basis of the literature and consultations, we proposed working definitions for 6 main user experience domains: acceptability, satisfaction, credibility, usability, user-reported adherence, and perceived impact. Although most studies incorporated a study-specific measure, we identified 10 well-established measures to quantify 5 of the 6 domains of user experience (all except for self-reported adherence). Our adolescent and researcher participants ranked perceived impact as one of the most important domains of user experience and usability as one of the least important domains. Rankings between adolescents and researchers diverged for other domains. CONCLUSIONS Findings highlight the various ways in which user experience has been defined and measured across studies and what aspects are most valued by researchers and adolescent users. We propose incorporating the working definitions and available measures of user experience to support consistent evaluation and reporting of outcomes across studies. Future studies can refine the definitions and measurement of user experience, explore how user experience relates to other eHealth outcomes, and inform the design and use of human-centered eHealth interventions.
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Affiliation(s)
- Amanda S Newton
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Sonja March
- School of Psychology and Counselling, Centre for Health Research, University of Southern Queensland, Springfield Central, Australia
| | - Nicole D Gehring
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Arlen K Rowe
- School of Psychology and Counselling, Centre for Health Research, University of Southern Queensland, Springfield Central, Australia
| | - Ashley D Radomski
- Knowledge Institute for Child and Youth Mental Health and Addictions, Ottawa, ON, Canada.,CHEO (Children's Hospital of Eastern Ontario) Research Institute, Ottawa, ON, Canada
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4
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Williamson A, Barbarin A, Campbell B, Campbell T, Franzen S, Reischl TM, Zimmerman M, Veinot TC. Uptake of and Engagement With an Online Sexual Health Intervention (HOPE eIntervention) Among African American Young Adults: Mixed Methods Study. J Med Internet Res 2021; 23:e22203. [PMID: 34269689 PMCID: PMC8325088 DOI: 10.2196/22203] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 04/16/2021] [Accepted: 05/16/2021] [Indexed: 01/30/2023] Open
Abstract
Background Regarding health technologies, African American young adults have low rates of uptake, ongoing usage, and engagement, which may widen sexual health inequalities. Objective We aimed to examine rates of uptake and ongoing usage, and factors influencing uptake, ongoing usage, and engagement for a consumer health informatics (CHI) intervention for HIV/sexually transmitted infection (STI) prevention among African American young adults, using the diffusion of innovation theory, trust-centered design framework, and O’Brien and Toms’ model of engagement. Methods This community-based participatory mixed methods study included surveys at four time points (n=315; 280 African American participants) among young adults aged 18 to 24 years involved in a blended offline/online HIV/STI prevention intervention (HIV Outreach, Prevention, and Education [HOPE] eIntervention), which was described as a “HOPE party.” Qualitative interviews were conducted with a subset of participants (n=19) after initial surveys and website server logs indicated low uptake and ongoing usage. A generalized linear mixed-effects model identified predictors of eIntervention uptake, server logs were summarized to describe use over time, and interview transcripts were coded and thematically analyzed to identify factors affecting uptake and engagement. Results Participants’ initial self-reported eIntervention uptake was low, but increased significantly over time, although uptake never reached expectations. The most frequent activity was visiting the website. Demographic factors and HOPE party social network characteristics were not significantly correlated with uptake, although participant education and party network gender homophily approached significance. According to interviews, one factor driving uptake was the desire to share HIV/STI prevention information with others. Survey and interview results showed that technology access, perceived time, and institutional and technological trust were necessary conditions for uptake. Interviews revealed that factors undermining uptake were insufficient promotion and awareness building, and the platform of the intervention, with social media being less appealing due to previous negative experiences concerning discussion of sexuality on social media. During the interaction with the eIntervention, interview data showed that factors driving initial engagement were audience-targeted website esthetics and appealing visuals. Ongoing usage was impeded by insufficiently frequent updates. Similarly, lack of novelty drove disengagement, although a social media contest for sharing intervention content resulted in some re-engagement. Conclusions To encourage uptake, CHI interventions for African American young adults can better leverage users’ desires to share information about HIV/STI prevention with others. Ensuring implementation through trusted organizations is also important, though vigorous promotion is needed. Visual appeal and targeted content foster engagement at first, but ongoing usage may require continual content changes. A thorough analysis of CHI intervention use can inform the development of future interventions to promote uptake and engagement. To guide future analyses, we present an expanded uptake and engagement model for CHI interventions targeting African American young adults based on our empirical results.
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Affiliation(s)
- Alicia Williamson
- School of Information, University of Michigan, Ann Arbor, MI, United States
| | | | | | - Terrance Campbell
- YOUR Center, Flint, MI, United States.,TigerLIFE, University of Memphis, Memphis, TN, United States
| | - Susan Franzen
- Prevention Research Center of Michigan, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Thomas M Reischl
- Prevention Research Center of Michigan, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Marc Zimmerman
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, United States.,Department of Psychology, University of Michigan, Ann Arbor, MI, United States
| | - Tiffany Christine Veinot
- School of Information, University of Michigan, Ann Arbor, MI, United States.,Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, United States
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5
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Kazemi S, Tavousi M, Zarei F. A mobile-based educational intervention on STI-related preventive behavior among Iranian women. HEALTH EDUCATION RESEARCH 2021; 36:212-223. [PMID: 33515025 DOI: 10.1093/her/cyaa054] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 12/23/2020] [Indexed: 06/12/2023]
Abstract
While rates of sexually transmitted infections (STIs) in Iran are alarming, little is known about preventive sexual behaviors. The purpose of this article was to assess the effect of a mobile-based educational program to promote preventive behaviors regarding STIs in Iranian women. Using Roger's protection motivation theory, the following measures were developed as the study's conceptual framework: STI knowledge, STI vulnerability, STI prevention self-efficacy and STI prevention intentions. These variables were measured by the Persian version of a valid Korean four-scale tool. Data from 76 women were analyzed: 37 women in the smartphone application (Experimental) group and 39 in the control group. Health Education Sexually Transmitted Infections Application was developed as a smartphone application training program. Participants were tested at three-time points: pre-test (baseline), post-test 1 (immediately after the program's completion) and post-test 2 (16 weeks after the program's completion). Significant group differences were found at different times in STI knowledge, vulnerability, prevention self-efficacy and prevention intentions. The smartphone application was effective in sustaining the effects of the educational program in the experimental group. The development of appropriate teaching materials on sensitive public health issues, such as STIs to promote individual self-learning skills is suggested.
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Affiliation(s)
- Sara Kazemi
- Faculty of Medical Sciences, Department of Health Education, Tarbiat Modares University, Tehran, Iran
| | - Mahmoud Tavousi
- Health Metrics Research Center, ACECR, Iranian Institute for Health Sciences Research, Tehran, Iran
| | - Fatemeh Zarei
- Department of Health Education & Health Promotion, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
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6
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Bailey JV, Wayal S, Aicken CR, Webster R, Mercer CH, Nazareth I, Rait G, Peacock R, Murray E. Interactive digital interventions for prevention of sexually transmitted HIV. AIDS 2021; 35:643-653. [PMID: 33259345 PMCID: PMC7924981 DOI: 10.1097/qad.0000000000002780] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 03/11/2020] [Accepted: 03/13/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Digital technology offers good opportunities for HIV prevention. This systematic review assesses the effectiveness of interactive digital interventions (IDIs) for prevention of sexually transmitted HIV. METHODS We conducted a systematic search for randomized controlled trials (RCTs) of IDIs for HIV prevention, defining 'interactive' as producing personally tailored material. We searched databases including the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, PsycINFO, grey literature, reference lists, and contacted authors if needed.Two authors screened abstracts, applied eligibility and quality criteria and extracted data. Meta-analyses used random-effects models with standardized mean differences (SMD) for continuous outcomes and odds ratios (OR) for binary outcomes, assessing heterogeneity using the I2 statistic. RESULTS We included 31 RCTs of IDIs for HIV prevention. Meta-analyses of 29 RCTs comparing IDIs with minimal interventions (e.g. leaflet, waiting list) showed a moderate increase in knowledge (SMD 0.56, 95% CI 0.33 to 0.80), no effect on self-efficacy (SMD 0.13, 95% CI 0.00 to 0.27), a small improvement in intention (SMD 0.16, 95% CI 0.06 to 0.26), improvement in HIV prevention behaviours (OR 1.28, 95% CI 1.04 to 1.57) and a possible increase in viral load, but this finding is unreliable.We found no evidence of difference between IDIs and face-to-face interventions for knowledge, self-efficacy, intention, or HIV-related behaviours in meta-analyses of five small RCTs. We found no health economic studies. CONCLUSION There is good evidence that IDIs have positive effects on knowledge, intention and HIV prevention behaviours. IDIs are appropriate for HIV prevention in a variety of settings.Supplementary Video Abstract, http://links.lww.com/QAD/B934.
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Affiliation(s)
- Julia V. Bailey
- e-Health Unit, Research Department of Primary Care and Population Health, University College London
| | - Sonali Wayal
- e-Health Unit, Research Department of Primary Care and Population Health, University College London
- Development Media International
- Centre for Population Research in Sexual Health and HIV, Institute for Global Health, University College London, London
| | - Catherine R.H. Aicken
- Centre for Population Research in Sexual Health and HIV, Institute for Global Health, University College London, London
- School of Health Sciences, University of Brighton, Falmer, Brighton
| | - Rosie Webster
- e-Health Unit, Research Department of Primary Care and Population Health, University College London
| | - Catherine H. Mercer
- Centre for Population Research in Sexual Health and HIV, Institute for Global Health, University College London, London
| | - Irwin Nazareth
- Research Department of Primary Care and Population Health, University College London
| | - Greta Rait
- Research Department of Primary Care and Population Health, University College London
| | - Richard Peacock
- Whittington Health Library, The Whittington Hospital, London, UK
| | - Elizabeth Murray
- e-Health Unit, Research Department of Primary Care and Population Health, University College London
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7
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Lameiras-Fernández M, Martínez-Román R, Carrera-Fernández MV, Rodríguez-Castro Y. Sex Education in the Spotlight: What Is Working? Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:2555. [PMID: 33806507 PMCID: PMC7967369 DOI: 10.3390/ijerph18052555] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/01/2021] [Accepted: 03/02/2021] [Indexed: 12/14/2022]
Abstract
Adolescence, a period of physical, social, cognitive and emotional development, represents a target population for sexual health promotion and education when it comes to achieving the 2030 Agenda goals for sustainable and equitable societies. The aim of this study is to provide an overview of what is known about the dissemination and effectiveness of sex education programs and thereby to inform better public policy making in this area. Methodology: We carried out a systematic review based on international scientific literature, in which only peer-reviewed papers were included. To identify reviews, we carried out an electronic search of the Cochrane Database Reviews, ERIC, Web of Science, PubMed, Medline, Scopus and PsycINFO. This paper provides a narrative review of reviews of the literature from 2015 to 2020. Results: 20 reviews met the inclusion criteria (10 in school settings, 9 using digital platforms and 1 blended learning program): they focused mainly on reducing risk behaviors (e.g., VIH/STIs and unwanted pregnancies), whilst obviating themes such as desire and pleasure, which were not included in outcome evaluations. The reviews with the lowest risk of bias are those carried out in school settings and are the ones that most question the effectiveness of sex education programs. Whilst the reviews of digital platforms and blended learning show greater effectiveness in terms of promoting sexual and reproductive health in adolescents (ASRH), they nevertheless also include greater risks of bias. Conclusion: A more rigorous assessment of the effectiveness of sexual education programs is necessary, especially regarding the opportunities offered by new technologies, which may lead to more cost-effective interventions than with in-person programs. Moreover, blended learning programs offer a promising way forward, as they combine the best of face-to-face and digital interventions, and may provide an excellent tool in the new context of the COVID-19 pandemic.
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Affiliation(s)
- María Lameiras-Fernández
- Faculty of Education and Social Work, University of Vigo, 32004 Ourense, Spain; (R.M.-R.); (M.V.C.-F.); (Y.R.-C.)
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8
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Hammond AS, Antoine DG, Stitzer ML, Strain EC. A Randomized and Controlled Acceptability Trial of an Internet-based Therapy among Inpatients with Co-occurring Substance Use and Other Psychiatric Disorders. J Dual Diagn 2020; 16:447-454. [PMID: 32701419 DOI: 10.1080/15504263.2020.1794094] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Technology-assisted treatment (TAT) holds promise for innovative assessment, prevention, and treatment of substance use disorders (SUD). The widespread access to TAT makes it a potentially cost-effective and inventive option available for delivery in multiple settings. This study assessed acceptability of the web-based Therapeutic Education System (TES) in hospitalized dual diagnosis patients with SUDs and other psychiatric disorders. Methods: Eligible participants were nonpsychotic, voluntary patients with self-reported drug or alcohol use in the 30 days prior to admission. They were randomly assigned to treatment as usual (TAU, n = 47) or TAU + TES (n = 48). Acceptability of this Internet-based intervention was assessed by observed utilization and self-report. Results: The TAU + TES group (# analyzed = 41) completed a mean total of 5.5 (SEM = 0.8) modules with about one module per day while hospitalized and rated TES highly on several constructs of acceptability, including novelty, usefulness and ease of understanding. Conclusions: These findings support further exploration of TAT for treatment expansion in a high acuity, dual diagnosis population and indicate the value of future research on efficacy. ClinicalTrials.gov Identifier: NCT02674477.
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Affiliation(s)
- Alexis S Hammond
- Behavioral Pharmacology Research Unit, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Denis G Antoine
- Behavioral Pharmacology Research Unit, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Maxine L Stitzer
- Behavioral Pharmacology Research Unit, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Friends Research Institute, Baltimore, Maryland, USA
| | - Eric C Strain
- Behavioral Pharmacology Research Unit, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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9
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Hochstatter KR, Hull SJ, Sethi AK, Burns ME, Mundt MP, Westergaard RP. Promoting Safe Injection Practices, Substance Use Reduction, Hepatitis C Testing, and Overdose Prevention Among Syringe Service Program Clients Using a Computer-Tailored Intervention: Pilot Randomized Controlled Trial. J Med Internet Res 2020; 22:e19703. [PMID: 32990630 PMCID: PMC7556373 DOI: 10.2196/19703] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 07/05/2020] [Accepted: 07/07/2020] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Syringe service programs (SSPs) are safe, highly effective programs for promoting health among people who inject drugs. However, resource limitations prevent the delivery of a full package of prevention services to many clients in need. Computer-tailored interventions may represent a promising approach for providing prevention information to people who inject drugs in resource-constrained settings. OBJECTIVE The aim of this paper is to assess the effect of a computer-tailored behavioral intervention, called Hep-Net, on safe injection practices, substance use reduction, overdose prevention, and hepatitis C virus (HCV) testing among SSP clients. METHODS Using a social network-based recruitment strategy, we recruited clients of an established SSP in Wisconsin and peers from their social networks. Participants completed a computerized baseline survey and were then randomly assigned to receive the Hep-Net intervention. Components of the intervention included an overall risk synthesis, participants' selection of a behavioral goal, and an individualized risk reduction exercise. Individuals were followed up 3 months later to assess their behavior change. The effect of Hep-Net on receiving an HCV screening test, undergoing Narcan training, reducing the frequency of drug use, and sharing drug equipment was assessed. The individual's readiness to change each behavior was also examined. RESULTS From 2014 to 2015, a total of 235 people who injected drugs enrolled into the Hep-Net study. Of these, 64.3% (151/235) completed the follow-up survey 3-6 months postenrollment. Compared with the control group, individuals who received the Hep-Net intervention were more likely to undergo HCV testing (odds ratio [OR] 2.23, 95% CI 1.05-4.74; P=.04) and receive Narcan training (OR 2.25, 95% CI 0.83-6.06; P=.11), and they shared drug equipment less frequently (OR 0.06, 95% CI 0.55-0.65; P<.001). Similarly, individuals who received the intervention were more likely to advance in their stage of readiness to change these 3 behaviors. However, intervention participants did not appear to reduce the frequency of drug use or increase their readiness to reduce drug use more than control participants, despite the fact that the majority of the intervention participants selected this as the primary goal to focus on after participation in the baseline survey. CONCLUSIONS Implementing computer-based risk reduction interventions in SSPs may reduce harms associated with the sharing of injection equipment and prevent overdose deaths; however, brief computerized interventions may not be robust enough to overcome the challenges associated with reducing and ceasing drug use when implemented in settings centered on the delivery of prevention services. TRIAL REGISTRATION ClinicalTrials.gov NCT02474043; https://clinicaltrials.gov/ct2/show/NCT02474043. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR1-10.2196/resprot.4830.
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Affiliation(s)
| | - Shawnika J Hull
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington DC, DC, United States
| | - Ajay K Sethi
- Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Marguerite E Burns
- Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Marlon P Mundt
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Ryan P Westergaard
- Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
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10
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Estrada Y, Lee TK, Wagstaff R, M Rojas L, Tapia MI, Velázquez MR, Sardinas K, Pantin H, Sutton MY, Prado G. eHealth Familias Unidas: Efficacy Trial of an Evidence-Based Intervention Adapted for Use on the Internet with Hispanic Families. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2020; 20:68-77. [PMID: 29748900 DOI: 10.1007/s11121-018-0905-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
While substance use and sexual risk behaviors among Hispanic youth continue to be public health concerns, few evidence-based preventive interventions are developed for and implemented with Hispanic/Latino youth. The objective of this study was to evaluate the efficacy of eHealth Familias Unidas, an Internet adaptation of an evidence-based family intervention for Hispanics. A randomized controlled trial design (n = 230) was used to evaluate intervention effects on substance use and condomless sex among a sample of Hispanic eighth graders with behavioral problems. Participants were randomized to eHealth Familias Unidas (n = 113) or prevention as usual (n = 117) and assessed at baseline and 3 and 12 months post baseline. We trained mental health school personnel and community mental health professionals to recruit and deliver the Internet-based intervention with Hispanic families. It was hypothesized that, over time, eHealth Familias Unidas would be more efficacious than prevention as usual in reducing drug use (marijuana, cocaine, inhalants, and other drugs), prescription drug use, cigarette use, alcohol use, and condomless sex and that these changes would be mediated by family functioning. Significant intervention effects were found across time for drug use, prescription drug use, and cigarette use. While eHealth Familias Unidas positively affected family functioning, mediation effects were not found. This study demonstrated that family-based eHealth interventions can be efficacious among Hispanic populations when delivered in community settings.
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Affiliation(s)
- Yannine Estrada
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, 1120 NW 14th Street, Miami, FL, 33136, USA.
| | - Tae Kyoung Lee
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, 1120 NW 14th Street, Miami, FL, 33136, USA
| | - Rachel Wagstaff
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, 1120 NW 14th Street, Miami, FL, 33136, USA
| | - Lourdes M Rojas
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, 1120 NW 14th Street, Miami, FL, 33136, USA
| | - Maria I Tapia
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, 1120 NW 14th Street, Miami, FL, 33136, USA
| | - Maria Rosa Velázquez
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, 1120 NW 14th Street, Miami, FL, 33136, USA
| | - Krystal Sardinas
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, 1120 NW 14th Street, Miami, FL, 33136, USA
| | - Hilda Pantin
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, 1120 NW 14th Street, Miami, FL, 33136, USA
| | - Madeline Y Sutton
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Guillermo Prado
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, 1120 NW 14th Street, Miami, FL, 33136, USA
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Dawson K, Nic Gabhainn S, MacNeela P. Toward a Model of Porn Literacy: Core Concepts, Rationales, and Approaches. JOURNAL OF SEX RESEARCH 2020; 57:1-15. [PMID: 30624090 DOI: 10.1080/00224499.2018.1556238] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Although some positive outcomes for pornography engagement have been highlighted, researchers and educators have also expressed concerns about youth pornography engagement and have called for porn literacy education to be incorporated into sex education programs. As yet, there is lack of agreement regarding intervention development. This study aimed to engage participants in the identification of relevant curriculum content. Participatory methods of data collection were used with 54 young adults aged 18 to 29 to generate core concepts for porn literacy education, and these concepts were subsequently explored in group interviews. Findings suggest that the proposed learning outcomes should focus on reducing shame regarding pornography engagement and improving critical thinking skills regarding the following sexual health topics: body image comparisons and dissatisfaction; sexual and gender-based violence; fetishising of gay and transgender communities; and setting unrealistic standards for sex. Methods of engagement for porn literacy, gendered differences, and important findings that are specific to lesbian, gay, bisexual, transgender, plus (LGBT+) persons are discussed, and recommendations regarding future research and intervention development are outlined.
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Affiliation(s)
- Kate Dawson
- School of Psychology, National University of Ireland
- School of Health Promotion, National University of Ireland
| | - Saoirse Nic Gabhainn
- School of Psychology, National University of Ireland
- School of Health Promotion, National University of Ireland
| | - Pádraig MacNeela
- School of Psychology, National University of Ireland
- School of Health Promotion, National University of Ireland
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12
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Coyle KK, Chambers BD, Anderson PM, Firpo-Triplett R, Waterman EA. Blended Learning for Sexual Health Education: Evidence Base, Promising Practices, and Potential Challenges. THE JOURNAL OF SCHOOL HEALTH 2019; 89:847-859. [PMID: 31397903 PMCID: PMC8644387 DOI: 10.1111/josh.12821] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 02/12/2018] [Accepted: 07/01/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Blended learning is a combination of online learning and face-to-face instruction, and is increasingly being used in K-12 settings. A meta-analysis conducted for the Department of Education suggests blended learning is more effective than either group-based or online learning alone, particularly in K-12 settings. METHODS This paper provides a narrative review of the literature from 2000 to 2017 on blended learning as it applies to sexual health education programs, and discusses outcomes, best practices and potential challenges of blended learning that may be important for practitioners and researchers considering this approach. RESULTS Blended learning approaches are being used successfully in sexual health education programs, including school-based programs, and have yielded positive behavioral and psychosocial changes. Similar to traditional group-based programs, not all outcomes tested in these programs showed positive impact. Designing blended learning programs can be challenging, but there is a large best-practice literature that can inform practitioners interested in using it. CONCLUSIONS Blended learning approaches are viable for sexual health education and offer numerous advantages to group-based only programs, such as confidential personalization and an instructional approach that is familiar and engaging for participants.
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Affiliation(s)
- Karin K Coyle
- ETR, 100 Enterprise Way, Suite G300, Scotts Valley, CA 95066
| | - Brittany D Chambers
- Preterm Birth Initiative-California, University of California, San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA 94158
| | | | | | - Emily A Waterman
- Prevention Research Centerm The Pennsylvania State University, 119 Health & Human Development, University Park, PA 16802
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13
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Murry VM, Kettrey HH, Berkel C, Inniss-Thompson MN. The Pathways for African American Success: Does Delivery Platform Matter in the Prevention of HIV Risk Vulnerability Among Youth? J Adolesc Health 2019; 65:255-261. [PMID: 31043346 DOI: 10.1016/j.jadohealth.2019.02.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 02/15/2019] [Accepted: 02/15/2019] [Indexed: 12/12/2022]
Abstract
PURPOSE Technology provides new possibilities for disseminating effective prevention programming to underserved families, such as those residing in rural communities. The present study is an evaluation of a technology-delivered HIV risk prevention program designed for rural African-American families, Pathways for African American Success (PAAS), to determine its promise for increasing access to evidence-based youth risk prevention programs among those in the greatest need. METHODS Four hundred and twelve parent/youth dyads were randomly assigned to one of three conditions: (1) in-person facilitator-led PAAS small group, (2) self-directed PAAS technology, or (3) a literature control with home-mailed educational materials. RESULTS Compared with families in the literature control condition, families assigned to the PAAS technology or small group conditions demonstrated significantly stronger intervention induced parent-child protective processes (e.g., enhanced discussion quality, clearly articulated norms, and parental expectations about risk engagement) and lower youth intentions to engage in risky behaviors 6 months postintervention. Although some important nuances were noted, this study suggests that the PAAS technology-delivered modality is just as efficacious as the in-person facilitator-led, small group modality in dissuading HIV-related risk behaviors among rural African-American youths. CONCLUSIONS Implications for having a menu of service delivery models that address the diverse needs and contexts of families are discussed, including the promise of technology as an alternative modality for reaching populations often characterized as difficult to reach and to engage in family-based preventive interventions.
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Affiliation(s)
- Velma McBride Murry
- Department of Human and Organizational Development, Peabody College, Vanderbilt University, Nashville, Tennessee.
| | - Heather Hensman Kettrey
- Department of Sociology, Anthropology & Criminal Justice, Clemson University, Clemson, South Carolina
| | - Cady Berkel
- REACH Institute (formerly the Prevention Research Center), Arizona State University, Tempe, Arizona
| | - Misha N Inniss-Thompson
- Department of Human and Organizational Development, Peabody College, Vanderbilt University, Nashville, Tennessee
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Celik R, Toruner EK. The Effect of Technology-Based Programmes on Changing Health Behaviours of Adolescents: Systematic Review. Compr Child Adolesc Nurs 2019; 43:92-110. [PMID: 31157992 DOI: 10.1080/24694193.2019.1599083] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Technology-based applications in the health field have been increasing in recent years. Since they attract adolescents' attention, technology-based applications can be used in health-promoting interventions. This systematic literature review was conducted to determine the effect of technology-based programmes in changing adolescent health behaviors. In the literature review, 16 randomized controlled empirical studies with full text published in English between 2011 and 2016 in the PubMed and Science Direct databases were investigated. The sample of the studies investigated under the scope of this study consisted of adolescents in the age range of 12-24 years. The intervention time was determined to be a minimum of two weeks and a maximum of 24 months. When the resulting studies were examined, the model was used in some of the studies. The intervention methods used for adolescents were generally presented as informing, counseling services, protection, behavioral change development, self-assessment, goal development and problem-solving. It was observed that the majority of the studies were Internet and computer-based, and some were mobile phone-based. In 56.25% of the studies, the development in the studied health behaviors was found to be significant. In addition, 62.5% of the adolescents stated that they were satisfied with technology-based programmes. In the studies, some of the difficulties in the use of technology included the participants' withdrawing from the research, their having difficulties in accessing the website, and other technical problems. The use of technology in health promotion is becoming widespread, especially among adolescents, which increases the success of behavioural change. However, further randomized controlled studies are needed in the field to increase evidence-based knowledge.
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Affiliation(s)
- Rukiye Celik
- Nursing Department, Gazi University Health Sciences Faculty , Ankara, Turkey
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Simmons J, Rajan S, Goldsamt LA, Elliott L. Implementation of Online Opioid Prevention, Recognition and Response Trainings for Laypeople: Year 1 Survey Results. Subst Use Misuse 2018; 53:1997-2002. [PMID: 29641944 PMCID: PMC6240473 DOI: 10.1080/10826084.2018.1451891] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND This article reports on the first implementation of an online opioid-overdose prevention, recognition and response training for laypeople. The training was disseminated nationally in November 2014. Between 2000 and 2014, U.S. opioid deaths increased by 200%. The importance of complementary approaches to reduce opioid overdose deaths, such as online training, cannot be overstated. OBJECTIVES A retrospective evaluation was conducted to assess perceived knowledge, skills to intervene in an overdose, confidence to intervene, and satisfaction with the training. MEASUREMENTS Descriptive statistics were used to report sample characteristics, compare experiences with overdose and/or naloxone between subgroups, and describe participants' satisfaction with the trainings. Z-ratios were used to compare independent proportions, and paired t-tests were used to compare participant responses to items pre- and posttraining, including perceived confidence to intervene and perceived knowledge and skills to intervene successfully. RESULTS Between January and October 2015, 2,450 laypeople took the online training; 1,464 (59.8%) agreed to be contacted. Of these, 311 (21.2% of those contacted) completed the survey. Over 80% reported high satisfaction with content, format and mode of delivery and high satisfaction with items related to confidence and overdose reversal preparedness. Notably, 89.0% of participants felt they had the knowledge and skills to intervene successfully posttraining compared to 20.3% pretraining (z = -17.2, p <.001). Similarly, posttraining, 87.8% of participants felt confident they could successfully intervene compared to 24.4% pretraining (z = -15.9, p <.001). CONCLUSIONS This study demonstrates the effectiveness of the GetNaloxoneNow.org online training for laypeople.
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Affiliation(s)
- Janie Simmons
- a National Development and Research Institutes , New York , New York , USA
| | - Sonali Rajan
- b Department of Health and Behavior Studies , Teacher's College, Columbia University , New York , New York , USA
| | - Lloyd A Goldsamt
- c Meyers College of Nursing, New York University , New York , New York , USA
| | - Luther Elliott
- a National Development and Research Institutes , New York , New York , USA
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Ismayilova L, Terlikbayeva A. Building Competencies to Prevent Youth Substance Use in Kazakhstan: Mixed Methods Findings From a Pilot Family-Focused Multimedia Trial. J Adolesc Health 2018; 63:301-312. [PMID: 30006027 PMCID: PMC6261260 DOI: 10.1016/j.jadohealth.2018.04.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 04/03/2018] [Accepted: 04/05/2018] [Indexed: 11/20/2022]
Abstract
PURPOSE The knowledge-based approach to substance use and HIV prevention, commonly used in Central Asia, does not equip at-risk adolescents with risk reduction skills. This pilot study aims to adapt and test the feasibility and estimate the effect size parameters of a skill-based and family-focused intervention for at-risk adolescents from communities affected by heroin trade and use in Kazakhstan, located on the major drug trafficking route from Afghanistan. METHODS This National Institute on Drug Abuse-funded pilot trial used a mixed-methods approach and included 181 adolescents (ages 14-17) that reported at least one risk factor (e.g., substance-using family members or friends and parental criminal history). In addition to the school-based health education program, intervention-arm adolescent-caregiver dyads received three computerized pilot sessions focusing on risk reduction self-efficacy, resistance to peer pressure, and strengthening of family relationships. Adolescents completed baseline, 3- and 6-month Audio Computer-Assisted Self-Interview surveys in Russian and treatment group adolescents (n = 12) also participated in postintervention focus groups. RESULTS Small size effects were observed for youth-level theoretical mediators associated with lower substance use. Compared to the control group, intervention-arm adolescents showed improvement in personal and social competencies such as assertiveness (Cohen's d = .21) and self-esteem (d = .22) at 3 months and increased engagement in prosocial activities at 6 months (d = .41). Adolescents from the intervention group also reported improved self-control skills helping alleviate emotional distress (an increase in anger and tension management d = .30 at 3 months and a reduction in temper d = -.27 at 6 months) along with a lower likelihood of binge drinking at 6 months (odds ratio = .18, p = .023). CONCLUSIONS In middle-income countries like Kazakhstan, an intervention that utilizes interactive technologies and combines an empirically tested skills-based approach with family involvement may be an engaging, acceptable, and culturally appropriate tool for preventing substance use among at-risk youth.
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Affiliation(s)
- Leyla Ismayilova
- University of Chicago, School of Social Service Administration, Chicago, Illinois.
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Getty CA, Subramaniam S, Holtyn AF, Jarvis BP, Rodewald A, Silverman K. Evaluation of a Computer-Based Training Program to Teach Adults at Risk for HIV About Pre-Exposure Prophylaxis. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2018; 30:287-300. [PMID: 30148669 PMCID: PMC6247787 DOI: 10.1521/aeap.2018.30.4.287] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This study developed a computer-based program to teach HIV prevention behaviors and raise awareness of pre-exposure prophylaxis (PrEP) among individuals at risk for HIV. The program was divided into modules containing educational material and multiple-choice questions. Participants received immediate feedback for responses and incentives for correct responses to multiple-choice questions. Participants trained on each module until they met speed and accuracy criteria. The modules were divided into: Course 1 (HIV), Course 2 (PrEP), and Course 3 (HIV risk behaviors). Tests of content from all three courses were delivered before and after participants completed each course. Test scores on the content delivered in the courses improved only after participants completed training on each course. HIV and PrEP knowledge was initially low and increased following completion of each part of the program. Computer-based training offers a convenient and effective approach to promoting HIV prevention knowledge, including use of PrEP.
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Affiliation(s)
- Carol-Ann Getty
- Ulster University, Psychology Department, Coleraine, Northern Ireland, UK
- Johns Hopkins University School of Medicine, Center for Learning and Health, Department of Psychiatry & Behavioral Sciences, Baltimore, USA
- King’s College London, Addictions Department, London, UK
| | - Shrinidhi Subramaniam
- Johns Hopkins University School of Medicine, Center for Learning and Health, Department of Psychiatry & Behavioral Sciences, Baltimore, USA
| | - August F. Holtyn
- Johns Hopkins University School of Medicine, Center for Learning and Health, Department of Psychiatry & Behavioral Sciences, Baltimore, USA
| | - Brantley P. Jarvis
- Johns Hopkins University School of Medicine, Center for Learning and Health, Department of Psychiatry & Behavioral Sciences, Baltimore, USA
| | - Andrew Rodewald
- Johns Hopkins University School of Medicine, Center for Learning and Health, Department of Psychiatry & Behavioral Sciences, Baltimore, USA
| | - Kenneth Silverman
- Johns Hopkins University School of Medicine, Center for Learning and Health, Department of Psychiatry & Behavioral Sciences, Baltimore, USA
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Campbell ANC, Montgomery L, Sanchez K, Pavlicova M, Hu M, Newville H, Weaver L, Nunes EV. Racial/ethnic subgroup differences in outcomes and acceptability of an Internet-delivered intervention for substance use disorders. J Ethn Subst Abuse 2017; 16:460-478. [PMID: 28368740 DOI: 10.1080/15332640.2017.1300550] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The Therapeutic Education System (TES), an Internet version of the Community Reinforcement Approach plus prize-based motivational incentives, is one of few empirically supported technology-based interventions. To date, however, there has not been a study exploring differences in substance use outcomes or acceptability of TES among racial/ethnic subgroups. This study uses data from a multisite (N = 10) effectiveness study of TES to explore whether race/ethnicity subgroups (White [n = 267], Black/African American [n = 112], and Hispanic/Latino [n = 55])moderate the effect of TES. Generalized linear mixed models were used to test whether abstinence, retention, social functioning, coping, craving, or acceptability differed by racial/ethnic subgroup. Findings demonstrated that race/ethnicity did not moderate the effect of TES versus TAU on abstinence, retention, social functioning, or craving. A three-way interaction (treatment, race/ethnicity, and abstinence status at study entry) showed that TES was associated with greater coping scores among nonabstinent White participants (p = .008) and among abstinent Black participants (p < .001). Acceptability of the TES intervention, although high overall, was significantly different by race/ethnicity subgroup with White participants reporting lower acceptability of TES compared to Black (p = .006) and Hispanic/Latino (p = .008) participants. TES appears to be a good candidate treatment among a diverse population of treatment-seeking individuals with substance use disorders.
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Affiliation(s)
- Aimee N C Campbell
- a Columbia University Medical Center , New York , New York.,b New York State Psychiatric Institute , New York , New York
| | - L Montgomery
- c Mental Health and Substance Abuse Counseling Program , University of Cincinnati, School of Human Services , Cincinnati , Ohio
| | - Katherine Sanchez
- d School of Social Work , University of Texas at Arlington , Arlington , Texas
| | - M Pavlicova
- e Columbia University, Mailman School of Public Health , New York , New York
| | - M Hu
- a Columbia University Medical Center , New York , New York
| | - H Newville
- f University of Washington , Seattle , Washington
| | - L Weaver
- g Icahn School of Medicine at Mount Sinai , New York , New York
| | - E V Nunes
- a Columbia University Medical Center , New York , New York
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Estrada Y, Molleda L, Murray A, Drumhiller K, Tapia M, Sardinas K, Rosen A, Pantin H, Perrino T, Sutton M, Cano MÁ, Dorcius D, Wendorf Muhamad J, Prado G. eHealth Familias Unidas: Pilot Study of an Internet Adaptation of an Evidence-Based Family Intervention to Reduce Drug Use and Sexual Risk Behaviors Among Hispanic Adolescents. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:E264. [PMID: 28273862 PMCID: PMC5369100 DOI: 10.3390/ijerph14030264] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 02/25/2017] [Accepted: 02/27/2017] [Indexed: 11/16/2022]
Abstract
This paper describes the Internet adaptation of an evidenced-based intervention for Hispanic families, eHealth Familias Unidas, and explores whether an Internet-based format is feasible and acceptable to Hispanic families. Core intervention components from the evidence-based intervention, Familias Unidas, were transposed into a video format and edited for content. Additionally, interactive exercises and a soap opera series were incorporated to reinforce intervention content and optimize participant engagement and retention. To understand the feasibility and acceptability of eHealth Familias Unidas, we conducted a pilot study and examined findings from: (1) session completion rates for both e-parent group sessions and family sessions (n = 23 families); and (2) qualitative data collected from Hispanic parents (n = 29) that received the eHealth intervention. Engagement and attendance in the intervention showed that 83% of families engaged in the intervention and that there was an overall session completion rate of 78%. Qualitative interviews were conducted mid and post intervention with a combined total of 29 participants. A general inductive approach was used to derive themes from the collected data. Overall, parents expressed positive feedback in regards to the intervention and stated that there were multiple lessons learned from participating in eHealth Familias Unidas. Findings indicate that an Internet-based family intervention is not only feasible and acceptable for Hispanic families, but also offers a viable option to ameliorate barriers to participation and implementation of preventive interventions.
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Affiliation(s)
- Yannine Estrada
- Department of Public Health Sciences, University of Miami, Miami, FL 33136, USA.
| | - Lourdes Molleda
- Department of Public Health Sciences, University of Miami, Miami, FL 33136, USA.
| | - Ashley Murray
- Division of HIV/AIDS Prevention, NCHHSTP, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
| | - Kathryn Drumhiller
- Division of HIV/AIDS Prevention, NCHHSTP, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
- Lifesource Biomedical, Herndon, VA 20170, USA.
| | - Maria Tapia
- Department of Public Health Sciences, University of Miami, Miami, FL 33136, USA.
| | - Krystal Sardinas
- Department of Pediatrics, University of Miami, Miami, FL 33136, USA.
| | | | - Hilda Pantin
- Department of Public Health Sciences, University of Miami, Miami, FL 33136, USA.
| | - Tatiana Perrino
- Department of Public Health Sciences, University of Miami, Miami, FL 33136, USA.
| | - Madeline Sutton
- Division of HIV/AIDS Prevention, NCHHSTP, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
| | - Miguel Ángel Cano
- Department of Epidemiology, Florida International University, Miami, FL 33199, USA.
| | - Daphney Dorcius
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA.
| | | | - Guillermo Prado
- Department of Public Health Sciences, University of Miami, Miami, FL 33136, USA.
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Simmons J, Rajan S, Goldsamt L, Elliott L. Implementation of online opioid overdose prevention, recognition and response trainings for professional first responders: Year 1 survey results. Drug Alcohol Depend 2016; 169:1-4. [PMID: 27744100 PMCID: PMC5140716 DOI: 10.1016/j.drugalcdep.2016.10.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 10/01/2016] [Accepted: 10/02/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND This article reports on the first web-based implementation of an opioid-overdose prevention, recognition and response training for professional first responders. The training was disseminated nationally over one listserv in November 2014. The same year, following Act 139, which mandated the provision of an online training for police officers in Pennsylvania, the Pennsylvania Department of Health approved the training. It was subsequently adopted as the primary training tool for police and other first responders in Pennsylvania and has been used as a training tool by first responders nationally. METHODS Analyses employed descriptive statistics to report characteristics of a sample of 387 professional first responders who completed a survey about their experience with the online training. Z-ratios were used to compare independent proportions related to overdose, naloxone, and satisfaction with the training between key subgroups, and paired t-tests were used to compare participant responses to a range of items pre- and post-participation in the training. RESULTS Between January-October 2015, 4804 first responders took the training; 1697 (35.3%) agreed to be contacted; of these, 387 (22.8%) completed a survey about the training and subsequent overdose response experiences. The majority (86.4%) were from Pennsylvania, with police representing over half of the sample. Analysis of the post-training survey indicates high satisfaction with content, format and mode of delivery, and high satisfaction with items related to confidence and overdose reversal preparedness. CONCLUSIONS This study demonstrates the feasibility and acceptability of implementing online training for first responders in overdose prevention, recognition and response.
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Affiliation(s)
- Janie Simmons
- National Development and Research Institutes, Inc. 71 West 23rd Street, New York, NY 10010, United States.
| | - Sonali Rajan
- Department of Health and Behavior Studies, Teachers College, Columbia University, Box 114, 525 West 120th Street, New York, NY 10027
| | - Lloyd Goldsamt
- New York University Meyers College of Nursing, 433 First Avenue, Room 739, New d. York, NY 10010
| | - Luther Elliott
- National Development and Research Institutes, Inc. 71 West 23rd Street, New York, NY 10010
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Widman L, Golin CE, Noar SM, Massey J, Prinstein MJ. ProjectHeartforGirls.com: Development of a Web-Based HIV/STD Prevention Program for Adolescent Girls Emphasizing Sexual Communication Skills. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2016; 28:365-377. [PMID: 27710087 PMCID: PMC5257203 DOI: 10.1521/aeap.2016.28.5.365] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
This article describes the development of ProjectHeartforGirls.com , an interactive web-based program designed to improve sexual communication skills and reduce the risk of HIV/STDs among adolescent girls, a population at heightened risk for negative sexual health outcomes (Centers for Disease Control and Prevention, 2013). Although sexual communication is a critical predictor of safer sex among teens, there are few online interventions that target these skills as a central program component. We developed ProjectHeartforGirls.com to fill this gap. Program development involved (1) identifying the target population (ethnically diverse high school girls), (2) clarifying the theoretical foundation (Reasoned Action Model), (3) conducting formative qualitative research (n = 25 girls), (4) drafting initial program content, (5) receiving ongoing feedback from a teen advisory board (n = 5 girls), (6) programming online content, and (7) conducting usability testing (n = 6 girls). These steps are described along with the final intervention product, which is currently being evaluated in a randomized controlled trial.
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Abstract
Preventing or mitigating substance use among youth generally involves 3 different intervention frameworks: universal prevention, selective prevention, and treatment. Each of these levels of intervention poses unique therapeutic and implementation challenges. Technology-based interventions provide solutions to many of these problems by delivering evidence-based interventions in a consistent and cost-effective manner. This article summarizes the current state of the science of technology-based interventions for preventing substance use initiation and mitigating substance use and associated consequences among youth.
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Sockolow P, Schug S, Zhu J, Smith TJ, Senathirajah Y, Bloom S. At-risk adolescents as experts in a new requirements elicitation procedure for the development of a smart phone psychoeducational trauma-informed care application. Inform Health Soc Care 2016; 42:77-96. [PMID: 27259373 DOI: 10.1080/17538157.2016.1177532] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND/PURPOSE Adolescents from urban, socioeconomically disadvantaged communities of color encounter high rates of adverse childhood experiences. To address the resulting multidimensional problems, we developed an innovative approach, Experiential Participatory and Interactive Knowledge Elicitation (EPIKE), using remote experiential needs elicitation methods to generate design and content requirements for a mobile health (mHealth) psychoeducational intervention. METHODS At a community-based organization in a northeastern city, the research team developed EPIKE by incorporating elicitation of input on the graphics and conducting remotely recorded experiential meetings and iterative reviews of the design to produce an mHealth smartphone story application (app) prototype for the participants to critique. The 22 participants were 13- to 17-year-olds, predominantly African American and female, from underresourced communities. RESULTS The four goals of the design process were attained: 1) story development from participant input; 2) needs-elicitation that reflected the patient-centered care approach; 3) interactive story game creation that accommodates the participants' emotional and cognitive developmental needs; 4) development of a game that adolescents can relate to and that which matches their comfort levels of emotional intensity. CONCLUSIONS The EPIKE approach can be used successfully to identify the needs of adolescents across the digital divide to inform the design and development of mHealth apps.
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Affiliation(s)
- Paulina Sockolow
- a College of Nursing and Health Professions, Drexel University , Philadelphia , PA , USA
| | - Seran Schug
- b Department of Sociology and Anthropology, Rowan University , Glassboro , NJ , USA
| | - Jichen Zhu
- c Westphal College of Media Arts and Design, Drexel University , Philadelphia , PA , USA
| | - T J Smith
- d Alliance For Positive Health , Albany , NY , USA
| | | | - Sandra Bloom
- a College of Nursing and Health Professions, Drexel University , Philadelphia , PA , USA
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Kennedy DP, Hunter SB, Chan Osilla K, Maksabedian E, Golinelli D, Tucker JS. A computer-assisted motivational social network intervention to reduce alcohol, drug and HIV risk behaviors among Housing First residents. Addict Sci Clin Pract 2016; 11:4. [PMID: 26979982 PMCID: PMC4791809 DOI: 10.1186/s13722-016-0052-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 03/01/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Individuals transitioning from homelessness to housing face challenges to reducing alcohol, drug and HIV risk behaviors. To aid in this transition, this study developed and will test a computer-assisted intervention that delivers personalized social network feedback by an intervention facilitator trained in motivational interviewing (MI). The intervention goal is to enhance motivation to reduce high risk alcohol and other drug (AOD) use and reduce HIV risk behaviors. METHODS/DESIGN In this Stage 1b pilot trial, 60 individuals that are transitioning from homelessness to housing will be randomly assigned to the intervention or control condition. The intervention condition consists of four biweekly social network sessions conducted using MI. AOD use and HIV risk behaviors will be monitored prior to and immediately following the intervention and compared to control participants' behaviors to explore whether the intervention was associated with any systematic changes in AOD use or HIV risk behaviors. DISCUSSION Social network health interventions are an innovative approach for reducing future AOD use and HIV risk problems, but little is known about their feasibility, acceptability, and efficacy. The current study develops and pilot-tests a computer-assisted intervention that incorporates social network visualizations and MI techniques to reduce high risk AOD use and HIV behaviors among the formerly homeless. CLINICALTRIALS. GOV IDENTIFIER NCT02140359.
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Affiliation(s)
| | - Sarah B Hunter
- RAND, 1776 Main Street, Santa Monica, CA, 90407-2138, USA
| | | | | | | | - Joan S Tucker
- RAND, 1776 Main Street, Santa Monica, CA, 90407-2138, USA
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Guarino H, Acosta M, Marsch LA, Xie H, Aponte-Melendez Y. A mixed-methods evaluation of the feasibility, acceptability, and preliminary efficacy of a mobile intervention for methadone maintenance clients. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2016; 30:1-11. [PMID: 26618796 PMCID: PMC4924621 DOI: 10.1037/adb0000128] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Despite the recent explosion of behavioral health interventions delivered on mobile devices, little is known about factors that make such applications practical, engaging and useful to their target audience. This study reports on the feasibility, acceptability and preliminary efficacy of a prototype of a novel, interactive mobile psychosocial intervention to reduce problematic drug use among clients in methadone maintenance treatment (MMT). A mixed-methods pilot study with new MMT clients (n = 25) indicated that the mobile intervention approach was feasible, and that participants found the intervention highly acceptable and useful. On 100-point visual analog scale (VAS) items, participants reported high levels of liking the program (M = 75.6), and endorsed it as useful (M = 77.5), easy to use (M = 80.7), and containing a significant amount of new information (M = 74.8). When compared with 25 study participants who received standard MMT alone, pilot participants rated their treatment significantly higher in interestingness and usefulness, and were significantly more satisfied with their treatment. In qualitative interviews, participants reported using the mobile intervention in a range of settings, including during times of heightened risk for substance use, and finding it helpful in managing drug cravings. Additionally, pilot participants showed evidence of increased treatment retention and abstinence from illicit opioids (in terms of effect size) over a 3-month period relative to those in standard MMT, suggesting the application's potential to enhance treatment outcomes. These promising findings suggest that an evidence-based mobile therapeutic tool addressing substance use may appeal to drug treatment clients and have clinical utility as an adjunct to formal treatment.
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Affiliation(s)
- Honoria Guarino
- Center for Technology and Health, National Development and Research Institutes, New York, NY
| | - Michelle Acosta
- Center for Technology and Health, National Development and Research Institutes, New York, NY
| | - Lisa A. Marsch
- Center for Technology and Behavioral Health, Dartmouth Center for Psychiatric Research, Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, NH
| | - Haiyi Xie
- Center for Technology and Behavioral Health, Dartmouth Center for Psychiatric Research, Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, NH
| | - Yesenia Aponte-Melendez
- Center for Technology and Health, National Development and Research Institutes, New York, NY
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26
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Westergaard RP, Hull SJ, Merkow A, Stephens LK, Hochstatter KR, Olson-Streed HK, Baker LM, Hess TM. Computerized Tailored Interventions to Enhance Prevention and Screening for Hepatitis C Virus Among People Who Inject Drugs: Protocol for a Randomized Pilot Study. JMIR Res Protoc 2016; 5:e15. [PMID: 26800903 PMCID: PMC4744331 DOI: 10.2196/resprot.4830] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 10/28/2015] [Accepted: 11/14/2015] [Indexed: 11/24/2022] Open
Abstract
Background Hepatitis C virus (HCV) infection is a growing problem among people who inject drugs. Strategies to reduce disease transmission (eg, syringe exchange programs) and facilitate HCV screening and linkage are available but are under-utilized in many communities affected by injection drug use. Novel approaches to increasing the use of these strategies are needed. Objective The goals of this project are to (1) develop and pilot test a computerized tailored intervention for increasing HCV screening and decreasing risky drug use behavior among people who inject drugs and (2) determine the feasibility of disseminating such an intervention using peer-based referrals in the setting of a community-based syringe exchange program. Methods This 2-arm, randomized pilot study is being conducted in a large-volume, multisite syringe exchange program in southern Wisconsin. A social network–based strategy was used to recruit a total of 235 adults who reported past-month injection of opioids, cocaine, or methamphetamine. Network recruiters were identified among clients requesting services from the syringe exchange program and were enlisted to refer eligible peers to the study. All participants completed a computer-adapted questionnaire eliciting information about risk behaviors and their knowledge, attitudes, and prior experiences related to HCV screening. Subjects were then randomly assigned to receive usual care, consisting of standard counseling by syringe exchange staff, or the Hep-Net intervention, which provides algorithm-based, real-time tailored feedback and recommendations for behavior change in the style of motivational interviewing. Changes in drug use behaviors and attitudes will be assessed during a second session between 90 and 180 days after the baseline visit. Frequency of repeat HCV testing and HCV incidence will be assessed through a database search 1 year after study completion. Results Recruitment for this study was completed in April 2015. Follow-up of enrolled participants is expected to continue until March 2016. Network recruiters were enrolled who referred a total of 195 eligible peers (overall N=235). At baseline, the median age was 34 years; 41.3% (97/235) were non-white; and 86.4% (203/235) reported predominantly injecting heroin. Most participants (161/234, 68.8%) reported sharing injection equipment in the past and of these, 30.4% (49/161) had never been tested for HCV. Conclusions This study will provide preliminary evidence to determine whether incorporating computerized behavioral interventions into existing prevention services at syringe exchange programs can lead to adoption of healthier behaviors. Trial Registration ClinicalTrials.gov NCT02474043; https://clinicaltrials.gov/ct2/show/NCT02474043 (Archived by WebCite at http://www.webcitation.org/6dbjUQG7J)
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Affiliation(s)
- Ryan P Westergaard
- Division of Infectious Diseases, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States.
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Ramsey A, Lord S, Torrey J, Marsch L, Lardiere M. Paving the Way to Successful Implementation: Identifying Key Barriers to Use of Technology-Based Therapeutic Tools for Behavioral Health Care. J Behav Health Serv Res 2016; 43:54-70. [PMID: 25192755 PMCID: PMC4362852 DOI: 10.1007/s11414-014-9436-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This study aimed to identify barriers to use of technology for behavioral health care from the perspective of care decision makers at community behavioral health organizations. As part of a larger survey of technology readiness, 260 care decision makers completed an open-ended question about perceived barriers to use of technology. Using the Consolidated Framework for Implementation Research (CFIR), qualitative analyses yielded barrier themes related to characteristics of technology (e.g., cost and privacy), potential end users (e.g., technology literacy and attitudes about technology), organization structure and climate (e.g., budget and infrastructure), and factors external to organizations (e.g., broadband accessibility and reimbursement policies). Number of reported barriers was higher among respondents representing agencies with lower annual budgets and smaller client bases relative to higher budget, larger clientele organizations. Individual barriers were differentially associated with budget, size of client base, and geographic location. Results are discussed in light of implementation science frameworks and proactive strategies to address perceived obstacles to adoption and use of technology-based behavioral health tools.
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Affiliation(s)
- Alex Ramsey
- Center for Mental Health Services Research, Brown School of Social Work, Washington University in St. Louis, One Brookings Drive, St. Louis, MO, 63130, USA
| | - Sarah Lord
- Center for Technology and Behavioral Health, Dartmouth Psychiatric Research Center, 85 Mechanic Street, Suite B4-1, Lebanon, NH, 03766, USA.
| | - John Torrey
- Dartmouth Psychiatric Research Center, 85 Mechanic Street, Suite B4-1, Lebanon, NH, 03766, USA
| | - Lisa Marsch
- Center for Technology and Behavioral Health, Dartmouth Psychiatric Research Center, 85 Mechanic Street, Suite B4-1, Lebanon, NH, 03766, USA
| | - Michael Lardiere
- National Council for Behavioral Health, 1701 K St, NW Ste # 400, Washington, DC, 20006, USA
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Young SD, Swendeman D, Holloway IW, Reback CJ, Kao U. Use of Technology to Address Substance Use in the Context of HIV: A Systematic Review. Curr HIV/AIDS Rep 2015; 12:462-71. [PMID: 26475670 PMCID: PMC4749410 DOI: 10.1007/s11904-015-0295-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Substance users are at elevated risk for HIV. HIV researchers, particularly at the intersection of HIV and substance use, have requested new methods to better understand and address this important area. New technologies, such as social media and mobile applications, are increasingly being used as research tools in studies on HIV and substance use. These technologies have the potential to build on existing recruitment methods, provide new and improved intervention methods, and introduce novel ways of monitoring and predicting new HIV cases. However, little work has been done to review and broadly explore the types of studies being conducted on the use of technologies to address HIV and substance use. This systematic literature review identified studies on this topic between 2005 and 2015. We identified 33 studies on this topic after excluding studies that did not fit inclusion criteria. Studies were either observational (n = 24) or interventional (n = 9), with the majority being pilot studies exploring the feasibility of using these new technologies to study HIV and substance use. We discuss the implications of this work along with limitations and recommendations for future research on this topic.
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Affiliation(s)
- Sean D Young
- UCLA Department of Family Medicine, University of California Institute for Prediction Technology, 10880 Wilshire Blvd Suite 1800, Los Angeles, CA, 90049, USA.
| | - Dallas Swendeman
- UCLA Department of Psychiatry and Biobehavioral Sciences, UCLA Center for HIV Identification, Prevention, and Treatment Services, Los Angeles, CA, USA
| | - Ian W Holloway
- Department of Social Welfare, UCLA Luskin School of Public Affairs, Los Angeles, CA, USA
| | - Cathy J Reback
- Friends Research Institute, Inc., David Geffen School of Medicine, Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA
| | - Uyen Kao
- UCLA Department of Family Medicine, UCLA Center for HIV Identification, Prevention, and Treatment Services, Los Angeles, CA, USA
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Kim SJ, Marsch LA, Guarino H, Acosta M, Aponte-Melendez Y. Predictors of outcome from computer-based treatment for substance use disorders: Results from a randomized clinical trial. Drug Alcohol Depend 2015; 157:174-8. [PMID: 26433562 PMCID: PMC4663155 DOI: 10.1016/j.drugalcdep.2015.09.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 09/14/2015] [Accepted: 09/22/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Although empirical evidence for the effectiveness of technology-mediated interventions for substance use disorders is rapidly growing, the role of baseline characteristics of patients in predicting treatment outcomes of a technology-based therapy is largely unknown. METHOD Participants were randomly assigned to either standard methadone maintenance treatment or reduced standard treatment combined with the computer-based therapeutic education system (TES). An array of demographic and behavioral characteristics of participants (N=160) was measured at baseline. Opioid abstinence and treatment retention were measured weekly for a 52-week intervention period. Generalized linear model and Cox-regression were used to estimate the predictive roles of baseline characteristics in predicting treatment outcomes. RESULTS We found significant predictors of opioid abstinence and treatment retention within and across conditions. Among 21 baseline characteristics of participants, employment status, anxiety, and ambivalent attitudes toward substance use predicted better opioid abstinence in the reduced-standard-plus-TES condition compared to standard treatment. Participants who had used cocaine/crack in the past 30 days at baseline showed lower dropout rates in standard treatment, whereas those who had not used exhibited lower dropout rates in the reduced-standard-plus-TES condition. CONCLUSIONS This study is the first randomized controlled trial, evaluating over a 12-month period, how various aspects of participant characteristics impact outcomes for treatments that do or do not include technology-based therapy. Compared to standard alone treatment, including TES as part of the care was preferable for patients who were employed, highly anxious, and ambivalent about substance use and did not produce worse outcomes for any subgroups of participants.
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Affiliation(s)
- Sunny J. Kim
- Corresponding author: , Phone: 1-603-448-0263. ext. 146
| | - Lisa A. Marsch
- Center for Technology and Behavioral Health, Dartmouth Psychiatric Research Center, Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth College, 85 Mechanic Street, Suite B4-1, Lebanon, NH 03766, USA, , http://www.c4tbh.org
| | - Honoria Guarino
- National Development and Research Institutes, Inc., 71 West 23rd Street, New York, NY 10010, USA.
| | - Michelle Acosta
- National Development and Research Institutes, Inc., 71 West 23rd Street, 4th floor, New York, NY 10010, USA,
| | - Yesenia Aponte-Melendez
- National Development and Research Institutes, Inc., 71 West 23rd Street, New York, NY 10010, USA.
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Bailey J, Mann S, Wayal S, Hunter R, Free C, Abraham C, Murray E. Sexual health promotion for young people delivered via digital media: a scoping review. PUBLIC HEALTH RESEARCH 2015. [DOI: 10.3310/phr03130] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundYoung people are at risk of poor sexual health and are, therefore, in need of comprehensive, effective sexual health education. Young people are confident and constant users of digital technology, such as the internet and mobile phones, and there are many innovative possibilities for sexual health education involving these technologies.ObjectivesTo summarise evidence on effectiveness, cost-effectiveness and mechanism of action of interactive digital interventions (IDIs) for sexual health; optimal practice for intervention development; contexts for successful implementation; research methods for digital intervention evaluation; and the future potential of sexual health promotion via digital media.DesignLiterature review of evidence on digital interventions for sexual health for young people, integrating the findings with the views of young people, parents and experts in digital media/sexual health. IDIs are defined as digital media programmes that provide health information and tailored decision support, behaviour-change support and/or emotional support. We focus on sexual well-being for young people aged 13–24 years in the UK.ResultsThere are many imaginative IDIs for sexual health promotion, but few interventions address issues that are important to young people, such as sexual pleasure and relationships. It is vital to collaborate with young people and to use Behaviour-Change Theory in designing interventions. We located 19 randomised controlled trials of IDIs for sexual health promotion for young people, finding a moderate effect on sexual health knowledge [standardised mean difference (SMD) 0.54, 95% confidence interval (CI) 0.17 to 0.92], a small effect on confidence (self-efficacy) (SMD 0.11, 95% CI 0.02 to 0.20) and a positive effect on sexual behaviour (odds ratio 1.28, 95% CI 1.01 to 1.61), but no significant effects on safer sex intention or biological outcomes. One study suggests that IDIs may be as good as face-to-face interventions for sexual health knowledge and safer sex intention. There are no existing data on the cost-effectiveness of IDIs for sexual health promotion. The impact of an IDI will be determined by the proportion of the target population reached, intervention efficacy, adoption in a setting, how well it is delivered and maintenance/sustainability. All of these elements must be addressed for IDIs to be successful. More collaboration is needed to capitalise on the knowledge of users and stakeholders, the design and software skills of the commercial sector and the theoretical expertise and evaluation skills of academia.ConclusionsIDIs are effective for knowledge acquisition and sexual behaviour, and could usefully contribute to sexual health education in schools, in clinic settings and online; however, there are obstacles to overcome, such as access to information technology and ensuring the quality and safety of interventions.Future workMore evidence is needed on the best designs for interventions (e.g. choice of behaviour-change mechanisms and interactive features) and the best models of delivery (e.g. setting, modes of delivery, methods of facilitation and support for engagement) to improve sexual behaviour, biological outcomes and sexual well-being in a cost-effective way.FundingThe National Institute for Health Research Public Health Research programme.
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Affiliation(s)
- Julia Bailey
- e-Health unit, Research Department of Primary Care and Population Health, University College London, London, UK
| | - Sue Mann
- Camberwell Sexual Health Centre, King’s College Hospital, London, UK
| | - Sonali Wayal
- e-Health unit, Research Department of Primary Care and Population Health, University College London, London, UK
| | - Rachael Hunter
- PRIMENT Clinical Trials Unit, Research Department of Primary Care and Population Health, University College London, London, UK
| | - Caroline Free
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Elizabeth Murray
- e-Health unit, Research Department of Primary Care and Population Health, University College London, London, UK
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Budney AJ, Stanger C, Tilford JM, Scherer E, Brown PC, Li Z, Li Z, Walker D. Computer-assisted behavioral therapy and contingency management for cannabis use disorder. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2015; 29:501-11. [PMID: 25938629 PMCID: PMC4586287 DOI: 10.1037/adb0000078] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Computer-assisted behavioral treatments hold promise for enhancing access to and reducing costs of treatments for substance use disorders. This study assessed the efficacy of a computer-assisted version of an efficacious, multicomponent treatment for cannabis use disorders (CUD), that is, motivational enhancement therapy, cognitive-behavioral therapy, and abstinence-based contingency-management (MET/CBT/CM). An initial cost comparison was also performed. Seventy-five adult participants, 59% Black, seeking treatment for CUD received either, MET only (BRIEF), therapist-delivered MET/CBT/CM (THERAPIST), or computer-delivered MET/CBT/CM (COMPUTER). During treatment, the THERAPIST and COMPUTER conditions engendered longer durations of continuous cannabis abstinence than BRIEF (p < .05), but did not differ from each other. Abstinence rates and reduction in days of use over time were maintained in COMPUTER at least as well as in THERAPIST. COMPUTER averaged approximately $130 (p < .05) less per case than THERAPIST in therapist costs, which offset most of the costs of CM. Results add to promising findings that illustrate potential for computer-assisted delivery methods to enhance access to evidence-based care, reduce costs, and possibly improve outcomes. The observed maintenance effects and the cost findings require replication in larger clinical trials.
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Marsch LA, Guarino H, Grabinski MJ, Syckes C, Dillingham ET, Xie H, Crosier BS. Comparative Effectiveness of Web-Based vs. Educator-Delivered HIV Prevention for Adolescent Substance Users: A Randomized, Controlled Trial. J Subst Abuse Treat 2015; 59:30-7. [PMID: 26293644 DOI: 10.1016/j.jsat.2015.07.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 06/25/2015] [Accepted: 07/02/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Young people who engage in substance use are at risk for becoming infected with HIV and diseases with similar transmission dynamics. Effective disease prevention programs delivered by prevention specialists exist but are rarely provided in systems of care due to staffing/resource constraints and operational barriers-and are thus of limited reach. Web-based prevention interventions could possibly offer an effective alternative to prevention specialist-delivered interventions and may enable widespread, cost-effective access to evidence-based prevention programming. Previous research has shown the HIV/disease prevention program within the Web-based therapeutic education system (TES) to be an effective adjunct to a prevention specialist-delivered intervention. The present study was the first randomized, clinical trial to evaluate the comparative effectiveness of this Web-based intervention as a standalone intervention relative to a traditional, prevention specialist-delivered intervention. METHODS Adolescents entering outpatient treatment for substance use participated in this multi-site trial. Participants were randomly assigned to either a traditional intervention delivered by a prevention specialist (n=72) or the Web-delivered TES intervention (n=69). Intervention effectiveness was assessed by evaluating changes in participants' knowledge about HIV, hepatitis, and sexually transmitted infections, intentions to engage in safer sex, sex-related risk behavior, self-efficacy to use condoms, and condom use skills. FINDINGS Participants in the TES intervention achieved significant and comparable increases in HIV/disease-related knowledge, condom use self-efficacy, and condom use skills and comparable decreases in HIV risk behavior relative to participants who received the intervention delivered by a prevention specialist. Participants rated TES as easier to understand. CONCLUSION This study indicates that TES is as effective as HIV/disease prevention delivered by a prevention specialist. Because technology-based interventions such as TES have high fidelity, are inexpensive and scalable, and can be implemented in a wide variety of settings, they have the potential to greatly increase access to effective prevention programming.
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Affiliation(s)
- Lisa A Marsch
- Dartmouth College, Geisel School of Medicine, Department of Psychiatry, Center for Technology and Behavioral Health, Rivermill Commercial Center, 85 Mechanic Street, Suite B4-1, Lebanon, NH 03766.
| | - Honoria Guarino
- National Development and Research Institutes, Inc., 71 West 23rd Street, 4th Floor, New York, NY 10010
| | | | - Cassandra Syckes
- National Development and Research Institutes, Inc., 71 West 23rd Street, 4th Floor, New York, NY 10010
| | - Elaine T Dillingham
- National Development and Research Institutes, Inc., 71 West 23rd Street, 4th Floor, New York, NY 10010
| | - Haiyi Xie
- Dartmouth College, Geisel School of Medicine, Department of Psychiatry, Center for Technology and Behavioral Health, Rivermill Commercial Center, 85 Mechanic Street, Suite B4-1, Lebanon, NH 03766
| | - Benjamin S Crosier
- Dartmouth College, Geisel School of Medicine, Department of Psychiatry, Center for Technology and Behavioral Health, Rivermill Commercial Center, 85 Mechanic Street, Suite B4-1, Lebanon, NH 03766
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Campbell ANC, Nunes EV, Pavlicova M, Hatch-Maillette M, Hu MC, Bailey GL, Sugarman DE, Miele GM, Rieckmann T, Shores-Wilson K, Turrigiano E, Greenfield SF. Gender-based Outcomes and Acceptability of a Computer-assisted Psychosocial Intervention for Substance Use Disorders. J Subst Abuse Treat 2014; 53:9-15. [PMID: 25613105 DOI: 10.1016/j.jsat.2014.12.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 12/17/2014] [Accepted: 12/22/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Digital technologies show promise for increasing treatment accessibility and improving quality of care, but little is known about gender differences. This secondary analysis uses data from a multi-site effectiveness trial of a computer-assisted behavioral intervention, conducted within NIDA's National Drug Abuse Clinical Trials Network, to explore gender differences in intervention acceptability and treatment outcomes. METHODS Men (n=314) and women (n=192) were randomly assigned to 12-weeks of treatment-as-usual (TAU) or modified TAU+Therapeutic Education System (TES), whereby TES substituted for 2hours of TAU per week. TES is composed of 62 Web-delivered, multimedia modules, covering skills for achieving and maintaining abstinence plus prize-based incentives contingent on abstinence and treatment adherence. Outcomes were: (1) abstinence from drugs and heavy drinking in the last 4weeks of treatment, (2) retention, (3) social functioning, and (4) drug and alcohol craving. Acceptability was the mean score across five indicators (i.e., interesting, useful, novel, easy to understand, and satisfaction). RESULTS Gender did not moderate the effect of treatment on any outcome. Women reported higher acceptability scores at week 4 (p=.02), but no gender differences were detected at weeks 8 or 12. Acceptability was positively associated with abstinence, but only among women (p=.01). CONCLUSIONS Findings suggest that men and women derive similar benefits from participating in a computer-assisted intervention, a promising outcome as technology-based treatments expand. Acceptability was associated with abstinence outcomes among women. Future research should explore characteristics of women who report less satisfaction with this modality of treatment and ways to improve overall acceptability.
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Affiliation(s)
- Aimee N C Campbell
- Columbia University Department of Psychiatry New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA; Mount Sinai St. Luke's Hospital Department of Psychiatry and Behavioral Health, 1111 Amsterdam Ave, New York, NY 10025, USA.
| | - Edward V Nunes
- Columbia University Department of Psychiatry New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA
| | - Martina Pavlicova
- Columbia University Mailman School of Public Health Department of Biostatistics, 722 West 168th Street, 6th Floor, New York, NY 10032, USA
| | - Mary Hatch-Maillette
- University of Washington Department of Psychiatry and Behavioral Sciences and Alcohol and Drug Abuse Institute, 1107 NE 45th Street, Suite 120, Box 354805, Seattle, WA 98105, USA
| | - Mei-Chen Hu
- Columbia University Medical Center, Department of Psychiatry, 630 West 168th Street, New York, NY 10032, USA
| | - Genie L Bailey
- Stanley Street Treatment and Research Center and Brown University Alpert Medical School, 386 Stanley St, Fall River, MA 02720, USA
| | - Dawn E Sugarman
- Harvard Medical School, Department of Psychiatry and McLean Hospital Division of Alcohol and Drug Abuse, 115 Mill Street, Belmont, MA 02478, USA
| | - Gloria M Miele
- Columbia University Department of Psychiatry New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA
| | - Traci Rieckmann
- Oregon Health and Science University School of Medicine, 3181S.W. Sam Jackson Park Rd., Portland, OR 97239, USA
| | - Kathy Shores-Wilson
- University of Texas Southwestern Medical Center Department of Psychiatry, 5323 Harry Hines Blvd., Dallas, TX 75390, USA
| | - Eva Turrigiano
- Columbia University Department of Psychiatry New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA
| | - Shelly F Greenfield
- Harvard Medical School, Department of Psychiatry and McLean Hospital Division of Alcohol and Drug Abuse, 115 Mill Street, Belmont, MA 02478, USA
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DeSmet A, Van Ryckeghem D, Compernolle S, Baranowski T, Thompson D, Crombez G, Poels K, Van Lippevelde W, Bastiaensens S, Van Cleemput K, Vandebosch H, De Bourdeaudhuij I. A meta-analysis of serious digital games for healthy lifestyle promotion. Prev Med 2014; 69:95-107. [PMID: 25172024 PMCID: PMC4403732 DOI: 10.1016/j.ypmed.2014.08.026] [Citation(s) in RCA: 165] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 08/15/2014] [Accepted: 08/17/2014] [Indexed: 12/14/2022]
Abstract
Several systematic reviews have described health-promoting effects of serious games but so far no meta-analysis has been reported. This paper presents a meta-analysis of 54 serious digital game studies for healthy lifestyle promotion, in which we investigated the overall effectiveness of serious digital games on healthy lifestyle promotion outcomes and the role of theoretically and clinically important moderators. Findings showed that serious games have small positive effects on healthy lifestyles (g=0.260, 95% CI 0.148; 0.373) and their determinants (g=0.334, 95% CI 0.260; 0.407), especially for knowledge. Effects on clinical outcomes were significant, but much smaller (g=0.079, 95% CI 0.038; 0.120). Long-term effects were maintained for all outcomes except for behavior. Serious games are best individually tailored to both socio-demographic and change need information, and benefit from a strong focus on game theories or a dual theoretical foundation in both behavioral prediction and game theories. They can be effective either as a stand-alone or multi-component programs, and appeal to populations regardless of age and gender. Given that effects of games remain heterogeneous, further explorations of which game features create larger effects are needed.
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Affiliation(s)
- Ann DeSmet
- Department of Movement and Sports Sciences, Faculty of Medicine and Health Sciences, Ghent University, Watersportlaan 2, B-9000 Ghent, Belgium.
| | - Dimitri Van Ryckeghem
- Department of Experimental-Clinical and Health Psychology, Ghent University, Belgium
| | - Sofie Compernolle
- Department of Movement and Sports Sciences, Faculty of Medicine and Health Sciences, Ghent University, Watersportlaan 2, B-9000 Ghent, Belgium
| | - Tom Baranowski
- Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Debbe Thompson
- Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Geert Crombez
- Department of Experimental-Clinical and Health Psychology, Ghent University, Belgium
| | - Karolien Poels
- Department of Communication Studies, Faculty of Political and Social Sciences, University of Antwerp, Belgium
| | - Wendy Van Lippevelde
- Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Belgium
| | - Sara Bastiaensens
- Department of Communication Studies, Faculty of Political and Social Sciences, University of Antwerp, Belgium
| | - Katrien Van Cleemput
- Department of Communication Studies, Faculty of Political and Social Sciences, University of Antwerp, Belgium
| | - Heidi Vandebosch
- Department of Communication Studies, Faculty of Political and Social Sciences, University of Antwerp, Belgium
| | - Ilse De Bourdeaudhuij
- Department of Movement and Sports Sciences, Faculty of Medicine and Health Sciences, Ghent University, Watersportlaan 2, B-9000 Ghent, Belgium
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DeSmet A, Shegog R, Van Ryckeghem D, Crombez G, De Bourdeaudhuij I. A Systematic Review and Meta-analysis of Interventions for Sexual Health Promotion Involving Serious Digital Games. Games Health J 2014; 4:78-90. [PMID: 26181801 DOI: 10.1089/g4h.2014.0110] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Serious games may be effective in promoting sexual health behavior. Their confidential nature may encourage users to discuss sensitive sexuality topics. Furthermore, they can tailor messages to the individual's needs and may be intrinsically motivating. This meta-analysis investigates the effectiveness of interventions for sexual health promotion that use serious games. MATERIALS AND METHODS A database search was conducted in PubMed, Web of Science, CINAHL, and PsycINFO for publications before the end of July 2013. Serious digital games studies measuring effects on behavior or its determinants, using a control condition, allowing the calculation of an effect size (Hedges' g, random-effects model) were included. RESULTS Seven game studies for sexual health promotion were included. These showed positive effects on determinants (g=0.242; 95 percent confidence interval, 0.129, 0.356), albeit of small effect size. The effects on behavior, measured in only two studies, were not significant (g=0.456; 95 percent confidence interval, -0.649, 1.561). Most games did not use many game features that are considered to be immersive or enhancing flow. Instead, there was a strong reliance on pure gamification features, such as rewards and feedback. CONCLUSIONS The effectiveness of the next generation of games may be enhanced by building on the behavioral change and educational gaming literatures (e.g., using role-play and simulation game formats, individual tailoring, offering adaptation in the difficulty of the challenge, and amount and timing of the feedback). There is a need for studies with rigorous evaluations of game effectiveness, longer-term follow-up, and using measures of behavior rather than merely their determinants.
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Affiliation(s)
- Ann DeSmet
- 1 Department of Movement and Sport Sciences, Faculty of Medicine and Health Sciences, Ghent University , Ghent, Belgium
| | - Ross Shegog
- 2 Center for Health Promotion & Prevention Research, School of Public Health, University of Texas , Houston, Texas
| | - Dimitri Van Ryckeghem
- 3 Department of Experimental-Clinical and Health Psychology, Ghent University , Ghent, Belgium
| | - Geert Crombez
- 3 Department of Experimental-Clinical and Health Psychology, Ghent University , Ghent, Belgium
| | - Ilse De Bourdeaudhuij
- 1 Department of Movement and Sport Sciences, Faculty of Medicine and Health Sciences, Ghent University , Ghent, Belgium
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Use of digital media technology for primary prevention of STIs/HIV in youth. J Pediatr Adolesc Gynecol 2014; 27:244-57. [PMID: 24332613 DOI: 10.1016/j.jpag.2013.07.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2013] [Revised: 07/22/2013] [Accepted: 07/23/2013] [Indexed: 02/06/2023]
Abstract
STUDY OBJECTIVE The relevant literature was reviewed to identify issues in research evaluating digital media technology (DMT) interventions for the primary prevention of STIs/HIV in adolescents and young adults. METHOD A literature search with relevant key terms was conducted in PubMed, for articles with studies that included: (a) participants between 11-29 years; (b) use of one or more of the following forms of DMT: interactive digital video or CD-ROM, computer, text messaging, or Internet; (c) evaluation of an STI/HIV primary prevention intervention; and (d) use of a cognitive, psychosocial, behavioral, or biological outcome. RESULTS Twenty-nine studies were identified and included in the review. Based on the review of these studies, 7 main issues were discussed and recommendations for improving future research were offered. The 7 main issues were: (a) need for a balance between universal application and specific sub-group focus, (b) lack of a developmental framework, (c) challenge of applying DMT in resource limited contexts, (d) rapidly changing nature of DMT, (e) lack of biological outcomes, (f) lack of comparison/control groups to assess the impact of DMT, and (g) limited temporal follow-up. CONCLUSIONS There is increasing literature evaluating the effectiveness of DMT for preventing STIs/HIV among adolescents and young adults. A careful consideration of 7 main issues identified in the literature can improve the design and evaluation of these interventions and enhance our understanding of their effectiveness.
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Using findings in multimedia learning to inform technology-based behavioral health interventions. Transl Behav Med 2014; 3:234-43. [PMID: 24073174 DOI: 10.1007/s13142-012-0137-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Clinicians and researchers are increasingly using technology-based behavioral health interventions to improve intervention effectiveness and to reach underserved populations. However, these interventions are rarely informed by evidence-based findings of how technology can be optimized to promote acquisition of key skills and information. At the same time, experts in multimedia learning generally do not apply their findings to health education or conduct research in clinical contexts. This paper presents an overview of some key aspects of multimedia learning research that may allow those developing health interventions to apply informational technology with the same rigor as behavioral science content. We synthesized empirical multimedia learning literature from 1992 to 2011. We identified key findings and suggested a framework for integrating technology with educational and behavioral science theory. A scientific, evidence-driven approach to developing technology-based interventions can yield greater effectiveness, improved fidelity, increased outcomes, and better client service.
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Quanbeck AR, Gustafson DH, Marsch LA, McTavish F, Brown RT, Mares ML, Johnson R, Glass JE, Atwood AK, McDowell H. Integrating addiction treatment into primary care using mobile health technology: protocol for an implementation research study. Implement Sci 2014; 9:65. [PMID: 24884976 PMCID: PMC4072605 DOI: 10.1186/1748-5908-9-65] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 05/17/2014] [Indexed: 11/10/2022] Open
Abstract
Background Healthcare reform in the United States is encouraging Federally Qualified Health Centers and other primary-care practices to integrate treatment for addiction and other behavioral health conditions into their practices. The potential of mobile health technologies to manage addiction and comorbidities such as HIV in these settings is substantial but largely untested. This paper describes a protocol to evaluate the implementation of an E-Health integrated communication technology delivered via mobile phones, called Seva, into primary-care settings. Seva is an evidence-based system of addiction treatment and recovery support for patients and real-time caseload monitoring for clinicians. Methods/Design Our implementation strategy uses three models of organizational change: the Program Planning Model to promote acceptance and sustainability, the NIATx quality improvement model to create a welcoming environment for change, and Rogers’s diffusion of innovations research, which facilitates adaptations of innovations to maximize their adoption potential. We will implement Seva and conduct an intensive, mixed-methods assessment at three diverse Federally Qualified Healthcare Centers in the United States. Our non-concurrent multiple-baseline design includes three periods — pretest (ending in four months of implementation preparation), active Seva implementation, and maintenance — with implementation staggered at six-month intervals across sites. The first site will serve as a pilot clinic. We will track the timing of intervention elements and assess study outcomes within each dimension of the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework, including effects on clinicians, patients, and practices. Our mixed-methods approach will include quantitative (e.g., interrupted time-series analysis of treatment attendance, with clinics as the unit of analysis) and qualitative (e.g., staff interviews regarding adaptations to implementation protocol) methods, and assessment of implementation costs. Discussion If implementation is successful, the field will have a proven technology that helps Federally Qualified Health Centers and affiliated organizations provide addiction treatment and recovery support, as well as a proven strategy for implementing the technology. Seva also has the potential to improve core elements of addiction treatment, such as referral and treatment processes. A mobile technology for addiction treatment and accompanying implementation model could provide a cost-effective means to improve the lives of patients with drug and alcohol problems. Trial registration ClinicalTrials.gov (NCT01963234).
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Affiliation(s)
- Andrew R Quanbeck
- Center for Health Enhancement Systems Studies, Industrial and Systems Engineering Department, University of Wisconsin - Madison, Madison, WI 53706, USA.
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Staton-Tindall M, Havens JR, Webster JM, Leukefeld C. METelemedicine: a pilot study with rural alcohol users on community supervision. J Rural Health 2014; 30:422-32. [PMID: 24800699 DOI: 10.1111/jrh.12076] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE This pilot study examined a telemedicine-based intervention using motivational enhancement therapy (METelemedicine) to reduce alcohol use among a sample of at-risk, rural alcohol users. METHODS A total of 127 rural alcohol users were recruited from community supervision offices and engaged in brief intervention sessions using telemedicine. Analysis examined alcohol outcomes at 3 months postbaseline. FINDINGS Findings indicated that although there were no overall differences between comparison groups on alcohol outcomes, 3+ sessions of METelemedicine significantly reduced the likelihood of any alcohol use by 72% (P < .05). In addition, 3+ sessions of the intervention predicted fewer days of drinking in the follow-up period, fewer drinks per week, and fewer days experiencing alcohol problems. CONCLUSIONS Findings demonstrate that telemedicine may be a promising approach to deliver interventions with alcohol users who may not utilize formal treatment services. This method has potential to decrease some of the barriers to access and use of evidence-based treatment for populations in need of services.
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Affiliation(s)
- Michele Staton-Tindall
- College of Social Work, University of Kentucky, Lexington, Kentucky; Center on Drug and Alcohol Research, University of Kentucky, Lexington, Kentucky
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Kurth AE, Spielberg F, Cleland CM, Lambdin B, Bangsberg DR, Frick PA, Severynen AO, Clausen M, Norman RG, Lockhart D, Simoni JM, Holmes KK. Computerized counseling reduces HIV-1 viral load and sexual transmission risk: findings from a randomized controlled trial. J Acquir Immune Defic Syndr 2014; 65:611-20. [PMID: 24384803 PMCID: PMC3999203 DOI: 10.1097/qai.0000000000000100] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Evaluate a computerized intervention supporting antiretroviral therapy (ART) adherence and HIV transmission prevention. DESIGN Longitudinal randomized controlled trial. SETTINGS An academic HIV clinic and a community-based organization in Seattle. SUBJECTS In a total of 240 HIV-positive adults on ART, 209 completed 9-month follow-up (87% retention). INTERVENTION Randomization to computerized counseling or assessment only, 4 sessions over 9 months. MAIN OUTCOME MEASURES HIV-1 viral suppression, and self-reported ART adherence and transmission risks, compared using generalized estimating equations. RESULTS Overall, intervention participants had reduced viral load: mean 0.17 log10 decline, versus 0.13 increase in controls, P = 0.053, and significant difference in ART adherence baseline to 9 months (P = 0.046). Their sexual transmission risk behaviors decreased (odds ratio = 0.55, P = 0.020), a reduction not seen among controls (odds ratio = 1.1, P = 0.664), and a significant difference in change (P = 0.040). Intervention effect was driven by those most in need; among those with detectable virus at baseline (>30 copies/mL, n = 89), intervention effect was mean 0.60 log10 viral load decline versus 0.15 increase in controls, P = 0.034. ART adherence at the final follow-up was 13 points higher among intervention participants versus controls, P = 0.038. CONCLUSIONS Computerized counseling is promising for integrated ART adherence and safer sex, especially for individuals with problems in these areas. This is the first intervention to report improved ART adherence, viral suppression, and reduced secondary sexual transmission risk behavior.
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Affiliation(s)
- Ann E Kurth
- *New York University College of Nursing, New York, NY; †School of Nursing, Biobehavioral Nursing and Health Systems, University of Washington, Seattle, WA; ‡Research Triangle Institute, San Francisco, CA; Departments of §Global Health; ‖Medicine, University of Washington, Seattle, WA; ¶Pangaea Global AIDS Foundation, Oakland, CA; #University of California, San Francisco, CA; **Harborview Medical Center, HIV-Specialty Clinic Affiliated With UW, Seattle, WA; and ††Department of Psychology, University of Washington, Seattle, WA
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Chaple M, Sacks S, McKendrick K, Marsch LA, Belenko S, Leukefeld C, Prendergast M, French M. Feasibility of a computerized intervention for offenders with substance use disorders: a research note. JOURNAL OF EXPERIMENTAL CRIMINOLOGY 2014; 10:105-127. [PMID: 24634641 PMCID: PMC3945711 DOI: 10.1007/s11292-013-9187-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
OBJECTIVES Despite evidence that treatment is effective in reducing recidivism among inmates with substance use problems, scarce resources mean that few of those in need of treatment actually receive it. Computerized substance abuse interventions could be used to expand access to treatment in prisons without placing an undue burden on resources. The major aim of the study was to compare treatment conditions in terms of their service utilization, skills acquisition, and treatment satisfaction. METHODS The study recruited men and women with substance use disorders from 10 prisons in 4 states. In an open label clinical trial, 494 subjects were randomly assigned either to the Experimental condition, a computerized drug treatment intervention, the Therapeutic Education System (TES; n = 249), or to the Control condition, Standard Care (n = 245). Chi-square tests compared groups on categorical variables and independent samples t tests were used for interval level continuous variables. RESULTS Initial evidence demonstrated: (1) comparable group rates of session attendance and high rates of TES module completion for experimental subjects; (2) comparable group gains in the development of coping skills; and (3) a more favorable view of TES than of Standard Care. CONCLUSIONS Collectively, these results show that a computerized intervention, such as TES, can be implemented successfully in prison. Given the barriers to the delivery of substance abuse treatment typically encountered in correctional settings, computerized interventions have the potential to fill a significant treatment gap and are particularly well suited to inmates with mild to moderate substance use disorders who often are not treated.
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Affiliation(s)
- Michael Chaple
- Center for the Integration of Research & Practice (CIRP), National Development & Research Institutes, Inc. (NDRI), 71 W 23 Street, 8th Floor, New York, NY 10010 USA
| | - Stanley Sacks
- Center for the Integration of Research & Practice (CIRP), National Development & Research Institutes, Inc. (NDRI), 71 W 23 Street, 8th Floor, New York, NY 10010 USA
| | - Karen McKendrick
- Center for the Integration of Research & Practice (CIRP), National Development & Research Institutes, Inc. (NDRI), 71 W 23 Street, 8th Floor, New York, NY 10010 USA
| | - Lisa A. Marsch
- Psychiatry, Dartmouth Medical School, 1 Rope Ferry Road, Hanover, NH 03755-1404 USA
| | - Steven Belenko
- Department of Criminal Justice, Temple University, Gladfelter Hall, 5th Fl, 1115 Polett Walk, Philadelphia, PA 19122 USA
| | - Carl Leukefeld
- Department of Behavioral Science, University of Kentucky, 111 Medical Behavioral Science Bldg 0086, Lexington, KY 40536-0086 USA
| | - Michael Prendergast
- Criminal Justice Research Group, Integrated Substance Abuse Programs (ISAP), University of California Los Angeles (UCLA), 11075 Santa Monica Blvd, Suite 100, Los Angeles, 90025 USA
| | - Michael French
- Economics, Health Administration & Policy Program, and Health Economics Research Group, University of Miami, 5202 University Dr, Merrick Bldg, Rm 121F, POB 248162, Coral Gables, FL 33124-2030 USA
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Marsch LA, Guarino H, Acosta M, Aponte-Melendez Y, Cleland C, Grabinski M, Brady R, Edwards J. Web-based behavioral treatment for substance use disorders as a partial replacement of standard methadone maintenance treatment. J Subst Abuse Treat 2013; 46:43-51. [PMID: 24060350 DOI: 10.1016/j.jsat.2013.08.012] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Revised: 08/06/2013] [Accepted: 08/07/2013] [Indexed: 01/06/2023]
Abstract
This study is the first experimental trial to evaluate the effectiveness of a Web-based behavioral intervention when deployed in a model where it partially substituted for standard counseling in a community-based specialty addiction treatment program. New opioid-dependent intakes in methadone maintenance treatment (n=160) were randomly assigned for 12months to either: (1) standard treatment or (2) reduced standard treatment plus a Web-based psychosocial intervention, the Therapeutic Education System (TES). Results demonstrated that replacing a portion of standard treatment with TES resulted in significantly greater rates of objectively measured opioid abstinence (48% vs. 37% abstinence across all study weeks; F(1, 158)=5.90, p<.05 and 59% vs. 43% abstinence on weeks participants provided urine samples for testing; F(1, 158)=8.81, p<.01). This result was robust and was evident despite how opioid abstinence was operationally defined and evaluated. The potential implications for service delivery models within substance abuse treatment programs and other healthcare entities are discussed.
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Smartphone Delivery of Mobile HIV Risk Reduction Education. AIDS Res Treat 2013; 2013:231956. [PMID: 24159383 PMCID: PMC3789326 DOI: 10.1155/2013/231956] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Revised: 06/20/2013] [Accepted: 07/17/2013] [Indexed: 11/17/2022] Open
Abstract
We sought to develop and deploy a video-based smartphone-delivered mobile HIV Risk Reduction (mHIVRR) intervention to individuals in an addiction treatment clinic. We developed 3 video modules that consisted of a 10-minute HIVRR video, 11 acceptability questions, and 3 knowledge questions and deployed them as a secondary study within a larger study of ecological momentary and geographical momentary assessments. All 24 individuals who remained in the main study long enough completed the mHIVRR secondary study. All 3 videos met our a priori criteria for acceptability "as is" in the population: they achieved median scores of ≤2.5 on a 5-point Likert scale; ≤20% of the individuals gave them the most negative rating on the scale; a majority of the individuals stated that they would not prefer other formats over video-based smartphone-delivered one (all P < 0.05). Additionally, all of our video modules met our a priori criteria for feasibility: ≤20% of data were missing due to participant noncompliance and ≤20% were missing due to technical failure. We concluded that video-based mHIVRR education delivered via smartphone is acceptable, feasible and may increase HIV/STD risk reduction knowledge. Future studies, with pre-intervention assessments of knowledge and random assignment, are needed to confirm these findings.
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Marsch LA, Carroll KM, Kiluk BD. Technology-based interventions for the treatment and recovery management of substance use disorders: a JSAT special issue. J Subst Abuse Treat 2013; 46:1-4. [PMID: 24041749 DOI: 10.1016/j.jsat.2013.08.010] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Accepted: 08/08/2013] [Indexed: 11/16/2022]
Abstract
A growing line of research has highlighted the promising role that interactive web and mobile technologies may play in improving the effectiveness, cost-effectiveness, and reach of efforts to assess, prevent, treat, and support the recovery management of substance use disorders and other risk behavior. Manuscripts in this special issue of the Journal of Substance Abuse Treatment focus on the application of technology to the delivery of interventions for the treatment and recovery management of substance use disorders. These manuscripts are intended to highlight the diversity and current state of the science of empirically-supported innovations in this area of intervention delivery. The included manuscripts range from experimental evaluations of a variety of types of technology-based interventions (brief interventions, behavior therapy, medication adherence tools, and HIV prevention interventions) and technology platforms (mobile, Web, videoconferencing, and telephone-based interactive voice response), for an array of populations (adults, adolescents, criminal justice populations, and post-partum women), in a number of different settings (addiction specialty treatment programs, schools, emergency rooms, and criminal justice settings). They additionally reflect a variety of experimental research designs, including those focused on the design, development, and clinical evaluation of these technology-based therapeutic tools, as well as research focused on models for their successful implementation and sustained use.
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Labacher L, Mitchell C. Talk or text to tell? How young adults in Canada and South Africa prefer to receive STI results, counseling, and treatment updates in a wireless world. JOURNAL OF HEALTH COMMUNICATION 2013; 18:1465-1476. [PMID: 24015829 DOI: 10.1080/10810730.2013.798379] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Young adults often lack access to confidential, long-lasting, and nonjudgmental interactions with sexual health professionals at brick-and-mortar clinics. To ensure that patients return for their STI test results, post-result counseling, and STI-related information, computer-mediated health intervention programming allows them to receive sexual health information through onsite computers, the Internet, and mobile phone calls and text messages. To determine whether young adults (age: M = 21 years) prefer to communicate with health professionals about the status of their sexual health through computer-mediated communication devices, 303 second-year university students (183 from an urban North American university and 120 from a periurban university in South Africa) completed a paper-based survey indicating how they prefer to communicate with doctors and nurses: talking face to face, mobile phone call, text message, Internet chat programs, Facebook, Twitter, or e-mail. Nearly all students, and female students in South Africa in particular, prefer to receive their STI test results, post-results counseling, and STI-related information by talking face to face with doctors and nurses rather than communicating through computers or mobile phones. Results are clarified in relation to gender, availability of various technologies, and prevalence of HIV in Canada and in South Africa.
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Affiliation(s)
- Lukas Labacher
- a Department of Integrated Studies in Education , McGill University , Montreal , Quebec , Canada
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Abstract
Technology such as the Internet and mobile phones offers considerable promise for affecting the assessment, prevention, and treatment of and recovery from substance use disorders. Technology may enable entirely new models of behavioral health care within and outside of formal systems of care. This article reviews the promise of technology-based therapeutic tools for affecting the quality and reach of addiction treatment and recovery support systems, as well as the empirical support to date for this approach. Potential models for implementing technology-based interventions targeting substance use disorders are described. Opportunities to optimize the effectiveness and impact of technology-based interventions targeting addiction and recovery, along with outstanding research needs, are discussed.
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Affiliation(s)
- Lisa A Marsch
- Department of Psychiatry, Dartmouth College, Lebanon, New Hampshire 03766, USA.
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Guse K, Levine D, Martins S, Lira A, Gaarde J, Westmorland W, Gilliam M. Interventions using new digital media to improve adolescent sexual health: a systematic review. J Adolesc Health 2012; 51:535-43. [PMID: 23174462 DOI: 10.1016/j.jadohealth.2012.03.014] [Citation(s) in RCA: 216] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Revised: 03/14/2012] [Accepted: 03/18/2012] [Indexed: 11/18/2022]
Abstract
New digital media (e.g., the Internet, text messaging, and social networking sites [SNS]) have dramatically altered the communication landscape, especially for youth. These communication platforms present new tools for engaging youth in sexual health promotion and risk reduction. We searched eight public databases across multiple disciplines for all peer-reviewed studies published between January 2000 and May 2011 that empirically evaluated the impact of digital media-based interventions on the sexual health knowledge, attitudes, and/or behaviors of adolescents aged 13-24 years. Of 942 abstracts, 10 met inclusion criteria. Seven studies were conducted in the United States. Eight described Web-based interventions, one used mobile phones, and one was conducted on an SNS. Two studies significantly delayed initiation of sex, and one was successful in encouraging users of an SNS to remove sex references from their public profile. Seven interventions significantly influenced psychosocial outcomes such as condom self-efficacy and abstinence attitudes, but at times the results were in directions unexpected by the study authors. Six studies increased knowledge of HIV, sexually transmitted infections, or pregnancy. This area of research is emerging and rapidly changing. More data from controlled studies with longer (>1 year) follow-up and measurement of behavioral outcomes will provide a more robust evidence base from which to judge the effectiveness of new digital media in changing adolescent sexual behavior.
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Affiliation(s)
- Kylene Guse
- Section of Family Planning and Contraceptive Research, Department of Obstetrics and Gynecology, The University of Chicago, Chicago, Illinois 60637, USA
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Acosta MC, Marsch LA, Xie H, Guarino H, Aponte-Melendez Y. A Web-Based Behavior Therapy Program Influences the Association Between Cognitive Functioning and Retention and Abstinence in Clients Receiving Methadone Maintenance Treatment. J Dual Diagn 2012; 8:283-293. [PMID: 23671409 PMCID: PMC3650891 DOI: 10.1080/15504263.2012.723317] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Deficits in cognitive functioning have been well-documented in persons with substance use disorders. In addition, some evidence suggests that poorer cognitive functioning predicts poorer engagement in substance abuse treatment and worse treatment outcomes. TRIAL DESIGN Non-blind, randomized clinical trial with parallel design. METHODS Clients were recruited from a local methadone maintenance clinic within the first 30 days of treatment. All participants completed a comprehensive, computerized neuropsychological assessment (MicroCog) at the time they entered the clinical trial. Participants were randomized to receive 12 months of either standard methadone maintenance treatment, or methadone maintenance treatment with an integrated web-based intervention as part of treatment. The aims of the current study were to (1) characterize the cognitive functioning of clients entering methadone maintenance treatment; (2) evaluate the impact of cognitive functioning on the primary outcomes of treatment retention and opioid abstinence; and (3) determine whether cognitive functioning had a differential impact on these outcomes across treatment conditions. Randomization was non-blind and participants were stratified on past month cocaine use, prior history of methadone, LAAM or buprenorphine treatment, and counselor. RESULTS Eighty participants were randomized to each condition (total n=160). Mean scores on MicroCog scales fell in the average and low average ranges and there were no differences in scores between treatment groups. Lower scores on General Cognitive Proficiency predicted longer study retention (χ2=5.03, p < .05), though this effect was quite small. Generalized linear modeling showed that scores on all MicroCog scales except for Spatial Processing significantly predicted opioid abstinence (defined as percent of total weeks and percent of tested weeks with continuous abstinence), with lower scores predicting smaller percentages of continuous weeks of abstinence. This pattern was not evident in regression analyses in which abstinence was defined as number of total weeks of abstinence. An interaction effect was observed, whereby lower cognitive scores predicted lower levels of abstinence for participants in standard methadone maintenance treatment, but not for those who received the web-based intervention as part of methadone maintenance treatment. CONCLUSIONS Technology-based interventions may hold promise for minimizing the impact of poorer cognitive functioning on treatment outcomes.
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Affiliation(s)
- Michelle C Acosta
- Center for Technology and Health, National Development and Research Institutes, Inc., New York, New York, USA
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Marsch LA, Dallery J. Advances in the psychosocial treatment of addiction: the role of technology in the delivery of evidence-based psychosocial treatment. Psychiatr Clin North Am 2012; 35:481-93. [PMID: 22640767 PMCID: PMC3362794 DOI: 10.1016/j.psc.2012.03.009] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The clinical community has a growing array of psychosocial interventions with a strong evidence base available for the treatment of SUDs. Considerable opportunity exists for leveraging technology in the delivery of evidence-based interventions to promote widespread reach and impact of evidence-based care. Data from this line of research to date are promising, and underscore the potential public health impact of technology-based therapeutic tools. To fully realize the potential of technology-delivered interventions, several areas of inquiry remain important. First, scientifically sound strategies should be explored to ensure technology-based interventions are optimally designed to produce maximal behavior change. Second, efficient and effective methods should be identified to integrate technology-based interventions into systems of care in a manner that is most responsive to the needs of individual users. Third, payment, privacy, and regulatory systems should be refined and extended to go beyond electronic medical records and telehealth/distance care models, and support the deployment of technology-based systems to enhance the quality, efficiency and cost-effectiveness of care. Fourth, the mechanisms underlying behavior change derived from technology-based treatments should be explicated, including new mechanisms that may be tapped via novel, technology-based tools. Such work will be critical in isolating mechanisms that are useful in predicting treatment response, and in ensuring that key ingredients are present in technology-based interventions as they are made widely available.
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Affiliation(s)
- Lisa A. Marsch
- Center for Technology and Behavioral Health; Dartmouth Psychiatric Research Center; Department of Psychiatry; Dartmouth College; Rivermill Commercial Center; 85 Mechanic Street; Suite B4-1; Lebanon, NH 03766; Voice: 603-448-0263, ext. 147; Fax: 603-448-3976
| | - Jesse Dallery
- Department of Psychology, University of Florida, PO Box 112250, Gainesville, FL 32611, Voice: 352-273-2182; Fax: 352-392-7985
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Malow RM, Rosenberg R, Dévieux JG. Introduction to Special Section on HIV/AIDS and Substance Use in the Caribbean (Part 3): Perspectives on Substance Abuse Treatment as HIV Prevention and Implementation Science in the Youth Culture of Web 2.0. ACTA ACUST UNITED AC 2011; 10:384-7. [PMID: 22158339 DOI: 10.1177/1545109711430924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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