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.

有害饮酒造成了严重的公共卫生问题，并且是许多人生活中的一个关键问题。 在退伍军人健康管理局 (VHA) 中，15-30% 的退伍军人在小学就诊。 根据酒精使用障碍识别的阳性筛查结果，护理人员被确定为危险饮酒者 然而，由于存在许多障碍，例如提供商的时间限制，消费测试（AUDIT-C） 以及患者的行为成本（例如前往退伍军人管理局进行定期治疗），其中绝大多数 退伍军人得不到治疗，智能手机技术和专门应用程序（“应用程序”）的开发可能会导致这种情况。 通过将危险饮酒护理扩展到现场预约之外，克服这些障碍 科学文献提供了一种自我导向的、基于证据的治疗应用。 基于智能手机的干预措施治疗危险饮酒的令人信服的案例，并强调了 这项试点研究发起的研究计划建议使用同伴支持在行为改变中的作用。 一个全面的、免费的智能手机应用程序（“Step Away”），可提供持续的证据访问- 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 这种“低阈值干预”（LTI）旨在易于访问、有吸引力、灵活、 私人的、自我指导的，从而规避了许多经常提到的治疗障碍。 尽管实证支持基于移动的技术可以改善危险饮酒者的结果，但 以及将移动技术与同行支持相结合的坚实理论基础，仍然存在 缺乏关于 (a) 这些应用程序和 (b) 集成的适应性、可接受性和实用性的知识 这些应用程序在我们研究计划的目标参与者（即退伍军人）中得到了同行的支持 VHA 初级保健人员对危险饮酒筛查结果呈阳性，我们将解决这些知识空白。 拟议的试点研究并使用定性和定量方法来实现以下目标： 目标 1：使用 M-PACE（通过社区参与进行项目调整的方法）模型 修改危险饮酒移动应用程序（“远离”）以供退伍军人初级护理使用。 危险饮酒筛查呈阳性的患者 (n=12) 和 VA 同伴支持专家 (n=12) 将 被招募来系统地审查未经修改的 Step Away 应用程序，并就其内容和内容提供反馈 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。 最大限度地提高与退伍军人初级保健患者的参与度和有效性。 目标 2：对 LTI（应用程序+同行支持）进行现场测试，以评估其 (a) 可接受性和 (b) 实用性 改善从事危险饮酒的退伍军人初级保健患者的饮酒结果。 将招募经验丰富的初级保健患者 (n=32)，并要求他们每天使用修改后的应用程序，持续四个星期 每周接到 VA 同行支持专家打来的两个电话，客观应用程序使用数据和自我报告。 应用程序将在这四个星期内每天收集报告的饮酒模式，并从 此后第 5 周，将进行后续电话访谈，以获取患者的相关反馈。 应用程序的内容和设计、改进建议、减少饮酒的感知效用以及总体 对 LTI 的满意度。 通过获取有关 LTI 的适应性、可接受性和实用性的数据，我们将能够很好地 提交后续的 HSR&D IIR，这将需要进行大型随机对照试验来测试 这项先进的医疗创新对 VHA 初级护理退伍军人的有效性 这是其目标。 更大的研究计划是增加对“沉默的人”的循证护理的价值和可及性 “大多数”初级保健退伍军人的饮酒水平达到危险水平，但很少寻求治疗。