Mechanisms of Change for an Effective Alcohol Text Message Intervention

有效酒精短信干预的变革机制

• 批准号: 9035519
• 负责人: Tammy Chung
• 金额: $ 32.37万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-09-20 至 2021-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9035519
• 关键词: Accident and Emergency department; Address; Age; Alcohol abuse; Alcohols; Algorithms; Attention; Attitude; Behavior; Cereals; Cognition; Collection; Cues; Data; Development; Effectiveness; Emergency Department patient; Emergency department visit; Feedback; Goals; Impulsivity; Individual; Individual Differences; Informal Social Control; Intention; Intervention; Knowledge; Lead; Mediating; Mediator of activation protein; Meta-Analysis; Modeling; Monitor; Motivation; Neurocognition; Outcome; Participant; Patient Self-Report; Patients; Pattern; Phase; Planning Theory; Process; Randomized; Recruitment Activity; Research; Role; Severities; Subgroup; Techniques; Testing; Text; Time; Work; age group; alcohol exposure; alcohol intervention; alcohol related consequences; alcohol use disorder; arm; base; behavior change; binge drinking; computerized; design; discounting; drinking; drinking behavior; effective intervention; follow-up; hazardous drinking; improved; innovation; intervention effect; mHealth; public health relevance; randomized trial; responders and non-responders; response; theories; treatment response; trial design; willingness; young adult

 DESCRIPTION (provided by applicant): Young adults ages 18-25 have high rates of hazardous alcohol use and alcohol-related consequences, but are rarely exposed to alcohol interventions. The Emergency Department (ED) setting provides an important opportunity to identify young adult hazardous drinkers who could benefit from an alcohol intervention. Among young adult hazardous drinkers seen in the ED, a text message (TM) intervention has demonstrated effectiveness in reducing hazardous alcohol use (binge drinking) through 9-month follow-up. However, the "active ingredients" (TM strategies that facilitate reductions in binge drinking) and "mechanisms of change" (processes occurring in the individual that lead to reduced binge drinking) of TM intervention for binge drinking remain unclear, and impede progress in constructing mobile interventions with maximum impact and durability. To address this gap, a dismantling design is needed to determine the TM intervention's component effects, and to identify the mechanisms through which components operate, which will have broad implications for the design of mobile interventions and informing theories of behavior change. This project will determine whether TM intervention "active ingredients" involve the critical combination of "goal prompt" (i.e., TM prompt to commit to a low drinking quantity goal), "feedback" (e.g., real-time TM feedback on willingness to set a drinking goal), and "cued self-monitoring" or each of the three components separately. TM intervention is a methodological innovation in research on mechanisms of behavior change because of high fidelity of intervention delivery via computerized algorithm, and collection of real-time data on response to specific intervention components. Young adult (ages 18-25) ED patients who screen positive for hazardous drinking/AUD (N=1,875) will be recruited to participate in a randomized trial of a 12-week TM intervention to reduce binge drinking. Patients will be randomized to one of five conditions: (1) "Cued Self-Monitoring" (TM control condition), (2) "Goal Prompt", (3) "Feedback", (4) all 3 TM components combined, and (5) Assessment Only (control condition). All participants complete assessments at baseline (ED visit), 3- and 6-months post-randomization. Participants in the four TM arms complete weekly TM queries during the intervention phase to track changes in drinking behavior and proposed mediators of intervention effects (intention, motivation, implicit cognitions) in order to determine component-specific change mechanisms. We also will examine individual differences (e.g., baseline alcohol severity) associated with intervention effects, to identify "for whom" treatment has effects. Determining "how" and "for whom" TM intervention has effects will be used to revise TM intervention content to maximally impact identified mechanisms, and has broader implications in terms of determining key components to include in mobile interventions more generally. Further, fine-grained data on response to intervention collected in real time will enable a paradigm shift based on the development of a more dynamic model of behavior change.

 描述（由申请人提供）：18-25 岁的年轻人危险性饮酒和酒精相关后果的比例很高，但很少接受酒精干预。急诊科 (ED) 环境为识别年轻人的危险性提供了重要机会。可以从干预酒精中受益的饮酒者中，在急诊室看到的年轻成人危险饮酒者中，通过 9 个月的随访，短信 (TM) 干预已证明可以有效减少危险酒精使用（酗酒）。活性成分" （促进减少酗酒的 TM 策略）和 TM 酗酒干预的“变化机制”（个体中发生的导致减少酗酒的过程）仍不清楚，并且阻碍了构建具有最大影响力和持久性的移动干预措施的进展为了解决这一差距，需要进行拆解设计来确定 TM 干预的组成效果，并确定各组成部分运作的机制，这将对移动干预的设计和行为改变的理论产生广泛的影响。将确定TM干预“活性成分”是否涉及“目标提示”（即TM提示致力于低饮酒量目标）、“反馈”（例如，关于设定饮酒意愿的实时TM反馈）的关键组合TM干预是行为改变机制研究的方法论创新，因为通过计算机算法提供高保真度的干预，并收集实时数据将招募危险饮酒/AUD 筛查呈阳性的年轻成人（18-25 岁）ED 患者（N=1,875）参加一项为期 12 周的 TM 干预随机试验，以减少酗酒。患者将被随机分配到以下五种情况之一：(1)“提示自我监控”（TM 控制条件）、(2)“目标提示”、(3)“反馈”、(4) 所有 3 种情况。 TM 组成部分合并，以及 (5) 仅评估（控制条件） 所有参与者在随机化后 3 个月和 6 个月完成评估，并在干预阶段完成每周 TM 查询。跟踪饮酒行为的变化和拟议的干预效果中介因素（意图、动机、内隐认知），以确定特定成分的变化机制。我们还将检查与干预效果相关的个体差异（例如，基线酒精严重程度），以确定。 “为了确定TM干预“如何”和“对谁”产生影响将用于修改TM干预内容，以最大程度地影响已确定的机制，并在确定更广泛的移动干预中包含的关键组成部分方面具有更广泛的影响此外，实时收集的干预反应的细粒度数据将能够基于开发更动态的行为改变模型来实现范式转变。