Development and evaluation of an avatar-guided mobile health intervention for emerging adults with alcohol misuse and suicidality

针对酗酒和自杀倾向的新兴成年人开发和评估虚拟化身引导的移动健康干预措施

• 批准号: 10369920
• 负责人: Lourah Marie Kelly
• 金额: $ 19.22万
• 依托单位: UNIVERSITY OF CONNECTICUT SCH OF MED/DNT
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-02-15 至 2024-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10369920
• 关键词: Accident and Emergency department; Address; Adult; Aftercare; Age; Aggressive behavior; Alcohol consumption; Alcoholic Intoxication; Alcohols; Ambulatory Care; Appearance; Area; Attenuated; Award; Behavior monitoring; Caring; Chronic; Clinical; Collaborations; Consultations; Data; Depressed mood; Development; Development Plans; Ecological momentary assessment; Education; Educational workshop; Emergency Care; Emergency department visit; Evaluation; Feedback; Feeling hopeless; Feeling suicidal; Foundations; Future; Goals; Health Benefit; Individual; Intervention; Interview; Link; Mental Health; Mentors; Methods; Mobile Health Application; Moods; Outpatients; Patients; Persons; Phase; Population; Protocols documentation; Provider; Public Health; Randomized; Randomized Controlled Trials; Reading; Reporting; Research; Research Personnel; Risk; Risk Factors; Safety; Services; Severities; Signal Transduction; Suicide; Suicide attempt; Suicide prevention; System; Technology; Testing; Thinking; Time; Training; Voice; Youth; acceptability and feasibility; active control; age group; alcohol comorbidity; alcohol intervention; alcohol misuse; alcohol services; alcohol use disorder; base; binge drinking; career; career development; comorbidity; design; diaries; drinking; efficacy trial; emerging adult; experience; feasibility research; feasibility testing; feasibility trial; follow-up; group intervention; hands on research; high risk population; ideation; informant; iterative design; mHealth; medical specialties; multidisciplinary; novel; pilot trial; programs; reduced alcohol use; safety testing; skills; substance use; substance use treatment; therapy development; trial comparing; unnecessary treatment; usability; young adult

ABSTRACT The proposed K99/R00 award aims to guide the applicant to research independence, specifically in mobile health (mHealth) interventions for emerging adults with alcohol misuse and comorbid conditions. Emerging adults have the highest rates of alcohol use disorders, suicidal ideation, and suicide attempts compared to any other age group. These problems are highly comorbid, with alcohol intoxication serving as a risk factor for suicidality. However, utilization of outpatient treatment services for alcohol or mental health is extremely low in this population, even following emergency department (ED) visits for either problem. Emerging adults are likely to be responsive to mHealth interventions, and mHealth is well-suited to the ED. mHealth can address an urgent public health need by bridging the gap between discharge and access to outpatient care and by supporting emerging adults who do not access outpatient care. This study seeks to design an evidence-informed interactive, avatar-guided mHealth intervention to provide ongoing education, skills practice, mood and behavior monitoring, and personalized feedback to reduce alcohol misuse and suicidality. This mHealth platform will be developed based on a review of commercial suicidality and alcohol mHealth apps, in-person integrated interventions, and an existing avatar-based mHealth platform, developed by co-mentor Easton. The study aims to: 1) seek feedback on the proposed mHealth intervention avatar, content, and features from a national youth advisory board, consumers (e.g., emerging adults with alcohol misuse and suicidality; n=25), clinical experts in emerging adult alcohol and suicidality treatment (n=10) and ED staff (n=10) creating an alpha version of the intervention; 2) test [usability] of the alpha version and [feasibility of research protocols] in an open pilot trial with (n=20) emerging adults, to inform a beta version, and 3) evaluate [acceptability and feasibility] in a randomized controlled [feasibility] trial comparing the beta version [of the avatar-guided mHealth intervention + standard ED care; n=30)] to an active control, a commercial suicide prevention app (MY3 [+ standard ED care; n=30). Secondary aims of the RCT are to test for safety and early signals of efficacy on a range of alcohol, suicidal ideation, and outpatient care variables at 6-, 12-, and 24-weeks post-randomization.] An exploratory aim is to examine within-person changes in same-day alcohol misuse and SI severity between intervention groups via daily diary and ecological momentary assessment. The training and career development plan includes courses, workshops, seminars, reading, and hands-on research in areas critical to the PI’s independence: mHealth intervention development within interdisciplinary teams, integrated alcohol and suicidality interventions for emerging adults, randomized controlled trials with fully-technology-based interventions, and lagged sequential analysis with ecological data. The R00 projects will provide pilot data to support future fully- powered R01 applications for [efficacy trials] of the avatar-guided mHealth intervention. The K99/R00 award will set the foundation of the PI’s independent research career, specializing in mHealth interventions for alcohol misuse.

抽象的 拟议的 K99/R00 奖项旨在引导申请人独立研究，特别是在移动健康领域 （移动健康）针对滥用酒精和合并症的新兴成年人的干预措施。 与任何其他年龄组相比，酒精使用障碍、自杀意念和自杀企图的发生率最高。 这些问题是高度共存的，酒精中毒是自杀的危险因素。 在这一人群中，酒精或心理健康门诊治疗服务的利用率极低，甚至 因任一问题前往急诊室 (ED) 就诊后，新兴成年人可能会对这些问题做出反应。 移动医疗干预措施非常适合急诊室，可以通过以下方式解决紧急的公共卫生需求。 缩小出院与获得门诊护理之间的差距，并支持那些无法获得门诊护理的新兴成年人 本研究旨在设计一种以证据为依据、以头像为指导的移动医疗。 提供持续教育、技能练习、情绪和行为监测以及个性化干预 该移动医疗平台将根据对以下内容的审查而开发。 商业自杀和酒精移动健康应用程序、面对面的综合干预措施以及现有的基于化身的 mHealth 平台，由联合导师 Easton 开发，旨在：1) 寻求对拟议的 mHealth 的反馈。 来自国家青年咨询委员会、消费者（例如新兴成年人）的干预头像、内容和特征 滥用酒精和自杀；n = 25），新兴成人酒精和自杀治疗的临床专家 (n=10) 和 ED 工作人员 (n=10) 创建干预的 alpha 版本；2) 测试 alpha 版本的[可用性]； [研究方案的可行性] 在一项针对 (n=20) 新兴成年人的公开试点试验中，为 beta 版本提供信息，以及 3) 在随机对照[可行性]试验中评估[可接受性和可行性]，比较测试版本[ 化身引导的 mHealth 干预 + 标准 ED 护理；n=30)] 到主动控制，商业自杀 预防应用程序（MY3 [+ 标准 ED 护理；n=30）。 RCT 的次要目标是测试安全性和早期检测。 6、12 和 24 周时对一系列酒精、自杀意念和门诊护理变量的功效信号 随机化后。] 一个探索性的目标是检查当天酒精滥用和 SI 的个人变化 通过每日日记和生态瞬时评估来评估干预组之间的严重程度。 职业发展计划包括关键领域的课程、讲习班、研讨会、阅读和实践研究 PI 的独立性：跨学科团队内的移动医疗干预发展、综合酒精和 针对新兴成年人的自杀干预措施，采用完全基于技术的干预措施的随机对照试验， R00 项目将提供试点数据以支持未来的全面分析。 为阿凡达引导的移动医疗干预的[功效试验]提供支持的 R01 应用程序将设立 K99/R00 奖项。 PI 独立研究生涯的基础，专门研究酒精滥用的移动健康干预措施。