The social mediation role of mobile technology is typified by mHealth apps designed to connect individuals to others and support substance use disorder (SUD) recovery. In this study, we examined the use and utility of one such app designed to support people living with HIV (PLWH) and SUD. Drawing on Ling’s emphasis on reciprocity and micro-coordination in mobile telephony as a social mediation technology, we gathered digital trace data from app logs to construct two metrics, initiation (i.e. whether a particular feature is engaged on a given day) and intensity (i.e. degree of involvement in the activity when engaged on that day), at three levels of communication—networked (one-to-many), dyadic (one-to-one), and intraindividual (self-to-self). We consider these system features alongside use of information resources, games and relaxation links, a meeting and events calendar, and support tools to address use urges. We found few differences in patterns of use by race, sex, and age, though African Americans were less likely to engage in intraindividual expression, whereas women and older users were more likely to make use of this feature. The initiation and intensity of network and dyadic reception, as well as the intensity of network expression, predicts recovery outcomes as measured on a weekly “check-in” survey, suggesting the utility of mobile log data for digital phenotyping in mHealth. By implementing this app during the COVID-19 pandemic, the study also found the disruption caused by national lockdown was negatively related to the app use.
Introduction: Smartphone apps to support individuals in recovery from substance use disorders (SUDs) are increasingly available. Although many people with SUDs express interest in recovery support apps, few try them or use them long-term. Strategies like gamification and contingency management are increasingly being considered to sustain engagement. This study sought to describe features of a recovery support app called the Addiction version of the Comprehensive Health Enhancement Support System (A-CHESS) that are most used by individuals in SUD recovery and what makes individuals more likely to use these apps. Methods: A total of 202 people with A-CHESS accounts completed an online survey assessing their experiences using A-CHESS between April and June 2021. We described app features reported to be most beneficial for managing anxiety, loneliness, and isolation during COVID-19; reasons for not using A-CHESS; and suggested app features for future recovery support apps. Results: Respondents had a mean age of 41 years, 85% were White, and 61% were female. Respondents reported that app features related to messaging (ie, open discussion boards and private messaging) and informational or motivational resources were the most useful for managing isolation, anxiety, and loneliness. Reasons for not using A-CHESS were not knowing how to use the app and the app not being part of a person-alized treatment plan. The most common suggested components for future apps were rewards for meeting goals and a support meeting locator. Conclusions: Ensuring that health apps are intuitive and include features that appeal to patients and educating patients about features apps already include that help them meet goals may enhance engagement with recovery apps.
BACKGROUND COVID-19 social distancing guidelines caused a rapid transition to telephone and video technologies for the delivery of substance use disorder (SUD) treatment. The study examined: a) adoption of these technologies across the SUD service continuum; b) acceptance of these technologies by service providers; and c) intention of providers to use these technologies following the pandemic. An additional analysis used the validated Technology Acceptance Model (TAM) to test the rigor of the intent to use the technology post-pandemic. OBJECTIVE Specific hypotheses were that over 50% of organizations would use telephone and video technologies, that organizations would report statistically significant odds of increasing their use of technology after the COVID-19 pandemic, and that perceived usefulness of telephone and video technologies would mediate the effect of ease of use on intention to use. METHODS An on-line survey distributed between May and August, 2020 measured current use of telephone and video services, assessed perceived organizational readiness to use these services, and gauged intent to use telephone and video applications post-COVID-19. Seven of the 10 Regional Addiction Technology Transfer Centers (ATTCs), representing 43 states, distributed the survey. The unit of analysis was the organization. RESULTS Four hundred and fifty-seven organizations responded. Overall, there was widespread use of technology; greater than 70% of organizations reported using telephone or video for most services. For all but two services (residential and buprenorphine services by telephone), organizations reported significantly greater odds (mean OR = 3.79; range from 1.87 to 6.98) of intending to use technology to deliver services post COVID-19. Clinical users regarded video more favorably than telephone for all but two services. Readiness for telephone and video use was high across numerous factors, though telephone services were viewed as being more accessible. Consistent with the TAM, perceived usefulness and ease of use influenced intention to use both telephone and video technologies. CONCLUSIONS The overall perceived ease of use and usefulness of telephone and video-based services provide a promising outlook for use of these services post the COVID-19 pandemic. Future studies should continue to review the acceptance of these services and their comparative impact on care outcomes. CLINICALTRIAL This trial is not currently registered since it was not an randomized controlled trial.
Background Researchers have conducted numerous studies seeking to understand how to improve the implementation of changes in health care organizations, but less focus has been given to applying lessons already learned from implementation science. Finding innovative ways to apply these findings efficiently and consistently will improve current research on implementation strategies and allow organizations utilizing these techniques to make changes more effectively. Objective This research aims to compare a practical implementation approach that uses principles from prior implementation studies to more traditional ways of implementing change. Methods A total of 43 addiction treatment sites in Iowa were randomly assigned to 2 different implementation strategies in a randomized comparative effectiveness trial studying the implementation of an eHealth substance use disorder treatment technology. One strategy used an adaptation of the Network for the Improvement of Addiction Treatment (NIATx) improvement approach, while the other used a traditional product training model. This paper discusses lessons learned about implementation. Results This midterm report indicates that use of the NIATx approach appears to be leading to improved outcomes on several measures, including initial and sustained use of new technology by both counselors and patients. Additionally, this research indicates that seamlessly integrating organizational changes into existing workflows and using coaching to overcome hurdles and assess progress are important to improve implementation projects. Conclusions At this interim point in the study, it appears that the use of the NIATx improvement process leads to better outcomes in implementation of changes within health care organizations. Moreover, some strategies used in this improvement process are particularly useful and should be drawn on more heavily in future implementation efforts. Trial Registration ClinicalTrials.gov NCT03954184; https://clinicaltrials.gov/ct2/show/NCT03954184
BACKGROUND Multiple chronic conditions (MCCs) are common and expensive among older adults. Of Medicare beneficiaries, two-thirds have multiple conditions (eg, diabetes, osteoarthritis) and account for more than 90% of Medicare spending. At the same time, patients with MCCs experience lower quality of life and worse medical and psychiatric outcomes than patients without MCCs. In primary care settings, where MCCs are generally treated, care often focuses on lab results and medication management, and not quality of life, due in part to time constraints. eHealth systems, which have been shown to improve multiple outcomes, may be able to fill the gap, supplementing primary care and improving the lives of patients with MCCs. OBJECTIVE To assess effects of ElderTree, an eHealth intervention for older adults with MCCs, on quality of life and related measures. METHODS In this unblinded study, 346 adults age 65+ with at least 3 of 5 targeted high-risk chronic conditions (hypertension, hyperlipidemia, diabetes, osteoarthritis, BMI 30+) were recruited from primary care clinics and randomized 1:1 to one of two conditions: (1) usual care plus laptop computer, Internet service, and ElderTree, or (2) a control consisting of usual care plus laptop and Internet but no ElderTree. Patients with ElderTree have access for 12 months and will be followed for an additional 6 months after the intervention ends, for a total of 18 months. Primary outcomes are the differences between the two groups on measures of quality of life, psychological well-being, and loneliness. Secondary outcomes are between-groups differences on lab scores, number and severity of falls, symptom distress, medication adherence, and crisis and long-term healthcare use. We will also examine mediators and moderators of the effects of ElderTree. At baseline and months 6, 12, and 18, patients complete written surveys comprising validated scales selected for good psychometric properties with similar populations; lab data are collected from electronic health records; healthcare use and chronic conditions are collected from both health records and patient surveys; and ElderTree use data are collected continuously in system logs. We will use general linear models and linear mixed models to evaluate primary and secondary outcomes over time, with treatment condition as a between-subjects factor. Separate analyses will be conducted for outcomes that are noncontinuous or not correlated with other outcomes. RESULTS Recruitment ran from January 2018 through December 2019; a total of 346 participants were recruited. The intervention period will end June 2021. CONCLUSIONS With self-management and motivational strategies, health tracking, educational tools, and peer community and support, ElderTree may help improve outcomes for patients coping with ongoing, complex MCCs. In addition, it may relieve some stress on the primary care system, with potential cost implications. CLINICALTRIAL ClinicalTrials.gov NCT03387735
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