N A Dowling, S S Merkouris, C J Greenwood, G J Youssef, A C Thomas, C O Hawker, D I Lubman, S N Rodda
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引用次数: 0
Abstract
Background: Mobile health interventions, particularly dynamic Just-In-Time Adaptive Interventions (JITAIs), can overcome barriers to gambling treatment by offering timely, accessible support in people's everyday lives. GamblingLess: In-The-Moment is a theoretically-informed and evidence-based app-delivered JITAI to people who want to quit or reduce their gambling. The JITAI aims to reduce gambling symptom severity through short-term reductions in the likelihood of gambling episodes by improving cognitive vulnerability (craving intensity, self-efficacy, or positive outcome expectancies). It administers three daily ecological momentary assessments (EMAs) to deliver tailored interventions in moments of cognitive vulnerability. Given that intervention acceptability and engagement are likely to improve clinical outcomes, this study aimed to comprehensively examine these constructs for GamblingLess: In-The-Moment.
Methods: A 28-day micro-randomised trial (MRT) was conducted, with a supplementary six-month within-group follow-up evaluation and a mixed-methods acceptability/engagement evaluation. The acceptability/engagement evaluation included: (1) app use and engagement indices across the MRT (n = 192; 66% male; agemedian=35 years); (2) app acceptability measures administered at post-intervention (n = 161; 84% completion rate), and (3) semi-structured interviews (n = 11).
Results: App use and engagement indices indicated that the JITAI was an attractive option for gambling support. Participants completed 5,116 EMAs (compliance rate = 32%, averaging 27 EMAs), spent an average of 30 min in the app, and completed an average of nine intervention activities from a pool of 53 activities they could repeatedly access. Subjective quality and perceived impact scores well exceeded minimally acceptable standards but 77% of participants preferred a hybrid push-pull approach and many endorsed less frequent EMAs (52%) but a longer program (58%). Participants also endorsed additional features, such as in-person support, motivational messages, gambling feedback, saving favourite activities, online discussion boards, virtual computer coaches, and in-app rewards. Interviews revealed two distinct themes: (1) facilitation of gambling reductions through check-ins/availability, personal tailoring, seamless and holistic support, and treatment experience suitability; and (2) promoting behaviour change through enhanced awareness, goal-setting, skill-building, and positive habit formation.
Conclusions: GamblingLess: In-The-Moment was highly accepted and was generally perceived as effective in supporting reductions in gambling behaviour. The findings underscore the iterative process for JITAI development and highlight several avenues for its optimisation, particularly in relation to enhancing user engagement and reducing user fatigue.
Trial registration: The evaluation was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12622000490774) in March, 2022.
期刊介绍：
Addiction Science & Clinical Practice provides a forum for clinically relevant research and perspectives that contribute to improving the quality of care for people with unhealthy alcohol, tobacco, or other drug use and addictive behaviours across a spectrum of clinical settings.
Addiction Science & Clinical Practice accepts articles of clinical relevance related to the prevention and treatment of unhealthy alcohol, tobacco, and other drug use across the spectrum of clinical settings. Topics of interest address issues related to the following: the spectrum of unhealthy use of alcohol, tobacco, and other drugs among the range of affected persons (e.g., not limited by age, race/ethnicity, gender, or sexual orientation); the array of clinical prevention and treatment practices (from health messages, to identification and early intervention, to more extensive interventions including counseling and pharmacotherapy and other management strategies); and identification and management of medical, psychiatric, social, and other health consequences of substance use.
Addiction Science & Clinical Practice is particularly interested in articles that address how to improve the quality of care for people with unhealthy substance use and related conditions as described in the (US) Institute of Medicine report, Improving the Quality of Healthcare for Mental Health and Substance Use Conditions (Washington, DC: National Academies Press, 2006). Such articles address the quality of care and of health services. Although the journal also welcomes submissions that address these conditions in addiction speciality-treatment settings, the journal is particularly interested in including articles that address unhealthy use outside these settings, including experience with novel models of care and outcomes, and outcomes of research-practice collaborations.
Although Addiction Science & Clinical Practice is generally not an outlet for basic science research, we will accept basic science research manuscripts that have clearly described potential clinical relevance and are accessible to audiences outside a narrow laboratory research field.
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