Evaluating the Adaptability and Implementation Potential of an Innovative Alcohol Intervention for Veterans in Primary Care: Integrating Mobile-based Applications with Peer Support

评估初级保健退伍军人创新酒精干预措施的适应性和实施潜力：将基于移动的应用程序与同伴支持相结合

• 批准号: 9397399
• 负责人: Daniel Michael Blonigen
• 金额: --
• 依托单位: VETERANS ADMIN PALO ALTO HEALTH CARE SYS
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-01 至 2019-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9397399
• 关键词: Address; Address; Alcohol consumption; Alcohol consumption; Appointment; Appointment; Behavioral; Behavioral; Caring; Caring; Cellular Phone; Cellular Phone; Characteristics; Characteristics; Chronic; Chronic; Communities; Communities; Consumption; Consumption; Coupled; Coupled; Data; Data; Data Reporting; Effectiveness; Effectiveness; Enrollment; Enrollment; Evidence based intervention; Evidence based intervention; Evidence based treatment; Evidence based treatment; Feedback; Feedback; Foundations; Foundations; Frequencies; Frequencies; Goals; Goals; Health; Health; Health Care Costs; Health Care Costs; Healthcare; Healthcare; Healthcare Systems; Healthcare Systems; Homogeneously Staining Region; Individual; Individual; Internet; Internet; Intervention; Intervention; Interview; Interview; Knowledge; Knowledge; Literature; Literature; Long-Term Care; Long-Term Care; Medical; Medical; Mental Health; Mental Health; Mental Health Services; Mental Health Services; Methods; Methods; Mission; Mission; Modeling; Modeling; Modification; Modification; Outcome; Outcome; Participant; Participant; Patient Care; Patient Care; Patient Self-Report; Patient Self-Report; Patients; Patients; Pattern; Pattern; Phonation; Pilot Projects; Pilot Projects; Population; Population; Positioning Attribute; Positioning Attribute; Primary Health Care; Primary Health Care; Privatization; Privatization; Provider; Provider; Public Health; Public Health; Randomized Controlled Trials; Randomized Controlled Trials; Recruitment Activity; Research; Research; Resources; Resources; Risk; Risk; Role; Role; Sampling; Sampling; Self-Direction; Self-Direction; Specialist; Specialist; Structure; Structure; Suggestion; Suggestion; Surveys; Surveys; Technology; Technology; Telephone; Telephone; Testing; Testing; Therapeutic; Therapeutic; Time; Time; Training; Training; Travel; Travel; Veterans; Veterans; alcohol abuse therapy; alcohol abuse therapy; alcohol availability; alcohol availability; alcohol intervention; alcohol intervention; alcohol use disorder; alcohol use disorder; barrier to care; base; base; cost; cost; cost effectiveness; cost effectiveness; design; design; drinking; drinking; evidence base; evidence base; field study; field study; flexibility; flexibility; follow-up; follow-up; hazardous drinking; hazardous drinking; health administration; health administration; health care service utilization; health care service utilization; improved; improved; improved outcome; improved outcome; innovation; innovation; mobile application; mobile application; mobile computing; mobile computing; operation; operation; organizational structure; patient screening; peer support; peer support; person centered; person centered; preference; preference; programs; programs; recruit; satisfaction; satisfaction; smartphone Application; sociodemographics; success; success; systematic review; systematic review; technological innovation; technological innovation; technology development; technology development; tool; tool

Hazardous drinking poses a significant public health problem and is a critical issue in the lives of a large population of Veterans. In the Veterans Health Administration (VHA), 15-30% of Veterans seen in Primary Care are identified as hazardous drinkers based on a positive screen on the Alcohol Use Disorder Identification Test for Consumption (AUDIT-C); however, due to a number of barriers such as time constraints on providers and behavioral costs to patients (e.g., traveling to VA for regular treatment sessions), the vast majority of these Veterans go untreated. Smartphone technology and the development of specialized applications (“apps”) can overcome these barriers by extending care for hazardous drinking beyond the onsite appointment through prescribing a self-directed, evidence-based treatment application. The scientific literature provides a compelling case for smartphone-based interventions in treating hazardous drinking, as well as underscores the role of peer support in behavioral change. The program of research initiated by this pilot study proposes use of a comprehensive, no-cost smartphone application (“Step Away”) to provide continuous access to evidence- based intervention methods for hazardous drinking, coupled with support from a trained VA Peer Support Specialist. This “Low Threshold Intervention” (LTI) is designed to be easily accessible, engaging, flexible, private, and self-directed, thus circumventing many of the often-cited barriers to treatment. Despite empirical support for mobile-based technology to improve outcomes for hazardous drinkers, as well as the strong theoretical foundation for integration of mobile technology with peer support, there remains a lack of knowledge regarding the adaptability, acceptability, and utility of (a) these apps, and (b) integration of these apps with peer support among the target participants in our program of research – i.e., Veterans seen in VHA Primary Care who screen positive for hazardous drinking. We will address these knowledge gaps in the proposed pilot study and use qualitative and quantitative methods to achieve the following aims: Aim 1: Use the M-PACE (Method for Program Adaptation through Community Engagement) model to modify a mobile application for hazardous drinking (“Step Away”) for use with Veterans. Veteran Primary Care patients (n=12) who screen positive for hazardous drinking, and VA Peer Support Specialists (n=12) will be recruited to systematically review the un-modified Step Away app and provide feedback on its content and presentation via online surveys and a semi-structured interview. This feedback will guide modification of Step Away to maximize its engagement and effectiveness with Veteran Primary Care patients. Aim 2: Conduct a field test of the LTI (app+peer support) to evaluate its (a) acceptability, and (b) utility in improving drinking outcomes among Veteran Primary Care patients who are engaging in hazardous drinking. Veteran Primary Care patients (n=32) will be recruited and asked to use the modified app daily for four weeks and receive two phone calls per week from a VA Peer Support Specialist. Objective app usage data and self- reported drinking patterns will be gathered daily by the app during this four-week period and extracted from the app thereafter. In Week 5, follow-up phone interviews will be conducted to obtain patients’ feedback related to the app’s content and design, suggestions for improvement, perceived utility for reducing drinking, and overall satisfaction with the LTI. By obtaining data on the adaptability, acceptability, and utility of the LTI, we will be well-positioned to submit a subsequent HSR&D IIR, which would entail a large randomized controlled trial to test the effectiveness of this advanced healthcare innovation with Veterans in VHA Primary Care. The goal of this larger program of research is to increase the value and accessibility of evidence-based care for the “silent majority” of Veterans in Primary Care who engage in hazardous levels of drinking but rarely seek treatment.

危险饮酒构成了一个重大的公共卫生问题，是大型生活中的关键问题 退伍军人人口。在退伍军人卫生管理局（VHA）中，在初级的退伍军人中有15-30％ 根据酒精使用障碍识别的正面屏幕，护理被确定为有害饮酒者 消费测试（审核-C）；但是，由于许多障碍，例如对提供商的时间限制 和患者的行为成本（例如，前往VA进行常规治疗课程），其中绝大多数 退伍军人不受治疗。智能手机技术和专门应用程序的开发（“应用”）可以 克服这些障碍，通过将危险饮酒的护理扩展到现场约会之外 规定自我指导的基于证据的治疗应用。科学文献提供了 基于智能手机的干预措施在治疗危险饮酒方面引人入胜的案例，并强调 同伴支持在行为改变中的作用。该试点研究提出的建议使用的研究计划使用 全面的，无成本的智能手机应用程序（“走开”），可连续获取证据 - 基于危险饮酒的干预方法，加上训练有素的VA同伴支持的支持 专家。这种“低阈值干预”（LTI）旨在易于访问，引人入胜，灵活， 私人和自我指导，因此规避了许多经常被引用的治疗障碍。 尽管对基于移动的技术的经验支持以改善危险饮酒者的结果，但 以及强大的理论基础，将移动技术与同伴支持的集成在一起，仍然存在 缺乏有关（a）这些应用程序的适应性，可接受性和效用的知识，（b）集成 这些应用程序在我们的研究计划中具有同行支持的同行支持 - 即 VHA初级保健，筛选危险饮酒阳性。我们将解决这些知识差距 拟议的试点研究并使用定性和定量方法来实现以下目的： 目标1：使用M-PACE（通过社区参与的程序适应方法）模型 修改移动应用程序，以供危险饮酒（“走开”），以与退伍军人一起使用。资深初级保健 患者（n = 12）筛选危险饮酒阳性的患者和VA同伴支持专家（n = 12）将是 被招募以系统地审查未修改的步骤外应用程序，并提供有关其内容和的反馈 通过在线调查和半结构化访谈进行演示。此反馈将指导步骤的修改 以最大程度地提高其与资深初级保健患者的参与度和有效性。 目标2：对LTI（APP+同行支持）进行现场测试，以评估其（a）可接受性，以及（b）在 改善从事危险饮酒的资深初级保健患者中的饮酒结果。 资深初级保健患者（n = 32）将被招募，并要求每天使用修改应用程序四个星期 并每周从VA同伴支持专家那里接听两个电话。客观的应用程序使用数据和自我 报告的饮酒方式将在这四个星期的时间内每天收集 此后。在第5周，将进行后续电话采访，以获取患者的反馈 该应用程序的内容和设计，改进的建议，减少饮酒的效用以及总体 对LTI的满意。 通过获取有关LTI的适应性，可接受性和效用的数据，我们将有充分的位置 提交随后的Hsr＆d IIR，这将需要进行大型随机对照试验以测试 这项先进的医疗保健创新的有效性与VHA初级保健中的退伍军人。目标的目标 更大的研究计划是提高基于证据护理的价值和可及性对“无声 在初级保健中的退伍军人多数”，他们从事危险水平的饮酒水平，但很少寻求治疗。