A Digital Tool to Promote Alcohol and Drug Use Screening, Brief Intervention, and Referral to Treatment Skill Translation: A Mobile App Development and Randomized Controlled Trial Protocol

Abstract

BackgroundTranslation of knowledge and skills from classroom settings to clinical practice is a major challenge in healthcare training, especially for behavioral interventions. For example, screening, brief intervention, and referral to treatment (SBIRT) is a highly-promoted approach to identifying and treating individuals at risk for alcohol or drug problems, yet effective, routine use of SBIRT has lagged.ObjectiveThe objective of this paper is to describe the development, pilot testing, and trial protocol of a mobile app based on the theory of planned behavior (TPB) to promote SBIRT skill translation and application.MethodsIntended for use after classroom training occurs, the mobile app has three primary functions designed to increase behavioral intent to deliver SBIRT: (1) review skills (ie, address knowledge and beliefs about SBIRT), (2) apply skills with patients (ie, build confidence and perceived behavioral control), and (3) report performance data (ie, increase accountability and social norms and/or influence). The app includes depression and anxiety screening tools due to high comorbidity with substance use. A randomized controlled trial (RCT) is in progress among health and social service learners (N=200) recruited from 3 universities and 6 different training programs in nursing, social work, internal medicine, psychiatry, and psychology. Participants are randomized to SBIRT classroom instruction alone or classroom instruction plus app access prior to beginning their field placement rotations. TPB-based data are collected via Qualtrics or via the mobile app pre-post and SBIRT utilization, weekly for 10 weeks. Key outcomes include the frequency of and self-reported confidence in delivery of SBIRT.ResultsBeta testing with advanced practice nursing students (N=22) indicated that the app and its associated assessment tools were acceptable and useful. The system usability scale (SUS) mean was 65.8 (n=19), which indicated that the SBIRT app was acceptable but could benefit from improvement. Indeed, modifications were implemented prior to starting the trial. Enrollment of trial participants began in September 2016. Results are expected by December 2017.ConclusionsThis report describes the process of TPB-based app development and testing, and the protocol for a RCT to determine the effectiveness of the app in enhancing skill translation. If effective, this approach could improve SBIRT implementation, fidelity, and clinical outcomes.

Point-of-Care Mobile Application to Guide Health Care Professionals in Conducting Substance Use Screening and Intervention: A Mixed-Methods User Experience Study

“…Effort spent navigating between screens was one of the factors found to reduce usability ratings in a previous SBIRT app usability study. 21 The final dimension, task-technology fit, was somewhat less strong, though still promising. For example, there was excellent success in the task observation activity (94% success rate), with one feature (save and exit) that gave participants difficulty.…”

“…As compared with the only other published SBIRT app usability study, the app in this study scored approximately 10 points higher on the 100point SUS scale (65.8 vs. 75.9). 21 Therefore, while there is still room to improve, as noted by users' dissatisfaction with a specific feature, usability appears to be strong. Design and user interface factors that may have contributed to favorable usability ratings include screen and navigation simplicity and clear provision and organization of information on each screen.…”

“…A few provider-focused, rather than patient-focused, mHealth apps and products for SBIRT have just very recently been developed. [19][20][21] Like patient self-administered SBIRT programs, provider-focused point-of-care mHealth programs may help to address some of the system-and provider-related implementation barriers. For example, they may increase provider confidence and knowledge in delivering SBIRT, improve fidelity to SBIRT procedures, and streamline SBIRT delivery.…”

“…3 Further, such provider-focused mHealth programs may help to facilitate transfer of skills and knowledge learned by providers during SBIRT trainings to clinical practice, making them better able to address substance use among their patients. 21 Despite the appeal of mHealth point-of-care tools for providers, unsystematic development and adoption can disrupt workflow resulting in increased costs, dissatisfied users, and less effective interventions. 22 User experience testing is a vital standard for software systems targeting public health; however, over 95% of mHealth apps have not been adequately tested for use or uptake into clinical practice.…”

“…This study only very briefly described usability questionnaire results and qualitative feedback received from providers. 21 Another study describes the acceptability of an SBIRT technology program but does not describe a robust user experience study. 20 In fact, most SBIRT technology-based programs have been tested in the context of randomized clinical trials examining patient outcomes.…”