探索适合酒精使用障碍的移动健康干预:定性研究

IF 6.2 2区 医学 Q1 HEALTH CARE SCIENCES & SERVICES
Nora Jacobson, Linda S Park, Alice Pulvermacher, Samantha Voelker, Mallory Herzog, Andrew Quanbeck
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引用次数: 0

摘要

背景:实施框架,如探索、准备、实施、维持模式,强调干预与其环境之间契合的重要性,其中包括目标人群的需求,以及实施组织的文化、资源和能力。虽然缺乏配合是实施的主要障碍,但配合往往不是实施研究的重点。本文使用fit作为镜头来检查Tula的实施情况,Tula是一款移动健康应用程序,旨在减少符合轻度至中度酒精使用障碍标准的个体的危险饮酒天数,在三组随机对照试验中(应用程序单独,应用程序加同伴指导,应用程序加健康指导)。目的:我们试图更好地理解试验结果,并为未来在卫生保健组织中实施数字卫生干预提供可操作的指导。方法:对18名试验参与者和7名图拉实施者进行半结构化访谈。试验参与者从试验的每个环节中平均抽取,代表了对应用程序表现出高参与度和低参与度的参与者。实施者由一名项目经理、4名同伴导师和2名健康教练组成。对参与者的采访重点是他们的动机、意见和干预经历,以及他们对干预后饮酒行为的看法,包括他们如何使用该应用程序来改变这种行为。对实现者的访谈集中在他们的角色、变革理论、对干预的看法和需要改进的领域。所有访谈都使用快速定性分析,包括演绎和归纳成分。结果:我们确定了适合和不适合的区域。例如,在实现者的变革理论和参与者对变革如何发生的描述之间有很好的契合。这款应用的多功能性提高了健身效果,它允许参与者定制自己的体验。相反,人们注意到这款应用无法培养许多参与者之间的联系,而且在干预过程中,同伴导师的角色与他们更广泛的职业精神之间存在脱节。结论:关注配合提供了一个有用的指导,以加强未来迭代的Tula应用程序,从而更好地维持干预。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Exploring Fit in a Mobile Health Intervention for Alcohol Use Disorder: Qualitative Study.

Background: Implementation frameworks such as the Exploration, Preparation, Implementation, Sustainment model emphasize the importance of the fit between an intervention and its context, which includes the needs of its target population, as well as the culture, resources, and capabilities of the implementing organization. Although lack of fit is a major barrier to implementation, fit has not often been a focus of implementation research. This paper uses fit as a lens to examine the implementation of Tula, a mobile health app aimed at reducing risky drinking days among individuals meeting the criteria for mild to moderate alcohol use disorder, in a 3-arm (app alone, app plus peer mentoring, and app plus health coaching) randomized controlled trial.

Objective: We sought to better understand the trial results and to provide actionable guidance for future implementation of digital health interventions in health care organizations.

Methods: Semistructured interviews with 18 trial participants and 7 Tula implementers were conducted. Trial participants were pulled equally from each arm of the trial and represented participants who demonstrated both high and low engagement with the app. Implementers consisted of a project manager, 4 peer mentors, and 2 health coaches. Interviews with participants focused on their motivations, opinions, and experiences of the intervention and their perception of their drinking behavior following the intervention, including how their use of the app worked to change that behavior. Interviews with implementers were centered on their roles, theories of change, perceptions of intervention, and areas for improvement. All interviews were analyzed using rapid qualitative analysis with deductive and inductive components.

Results: We identified areas of both fit and misfit. For example, there was a good fit between implementers' theories of change and participants' description of how change occurred. Fit was improved by the versatility of the app, which allowed participants to customize their experiences. Conversely, misfit was noted in the app's inability to cultivate connection for many participants and a disjunction between the role of peer mentors in the intervention and their broader professional ethos.

Conclusions: Focusing on fit provides a useful guide to enhance future iterations of the Tula app that lead to better sustainment of the intervention.

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来源期刊
JMIR mHealth and uHealth
JMIR mHealth and uHealth Medicine-Health Informatics
CiteScore
12.60
自引率
4.00%
发文量
159
审稿时长
10 weeks
期刊介绍: JMIR mHealth and uHealth (JMU, ISSN 2291-5222) is a spin-off journal of JMIR, the leading eHealth journal (Impact Factor 2016: 5.175). JMIR mHealth and uHealth is indexed in PubMed, PubMed Central, and Science Citation Index Expanded (SCIE), and in June 2017 received a stunning inaugural Impact Factor of 4.636. The journal focusses on health and biomedical applications in mobile and tablet computing, pervasive and ubiquitous computing, wearable computing and domotics. JMIR mHealth and uHealth publishes since 2013 and was the first mhealth journal in Pubmed. It publishes even faster and has a broader scope with including papers which are more technical or more formative/developmental than what would be published in the Journal of Medical Internet Research.
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