A Gambling Just-In-Time Adaptive Intervention (GamblingLess: In-The-Moment): Protocol for a Microrandomized Trial

Abstract

Background The presence of discrete but fluctuating precipitants, in combination with the dynamic nature of gambling episodes, calls for the development of tailored interventions delivered in real time, such as just-in-time adaptive interventions (JITAIs). JITAIs leverage mobile and wireless technologies to address dynamically changing individual needs by providing the type and amount of support required at the right time and only when needed. They have the added benefit of reaching underserved populations by providing accessible, convenient, and low-burden support. Despite these benefits, few JITAIs targeting gambling behavior are available. Objective This study aims to redress this gap in service provision by developing and evaluating a theoretically informed and evidence-based JITAI for people who want to reduce their gambling. Delivered via a smartphone app, GamblingLess: In-The-Moment provides tailored cognitive-behavioral and third-wave interventions targeting cognitive processes explicated by the relapse prevention model (cravings, self-efficacy, and positive outcome expectancies). It aims to reduce gambling symptom severity (distal outcome) through short-term reductions in the likelihood of gambling episodes (primary proximal outcome) by improving craving intensity, self-efficacy, or expectancies (secondary proximal outcomes). The primary aim is to explore the degree to which the delivery of a tailored intervention at a time of cognitive vulnerability reduces the probability of a subsequent gambling episode. Methods GamblingLess: In-The-Moment interventions are delivered to gamblers who are in a state of receptivity (available for treatment) and report a state of cognitive vulnerability via ecological momentary assessments 3 times a day. The JITAI will tailor the type, timing, and amount of support for individual needs. Using a microrandomized trial, a form of sequential factorial design, each eligible participant will be randomized to a tailored intervention condition or no intervention control condition at each ecological momentary assessment across a 28-day period. The microrandomized trial will be supplemented by a 6-month within-group follow-up evaluation to explore long-term effects on primary (gambling symptom severity) and secondary (gambling behavior, craving severity, self-efficacy, and expectancies) outcomes and an acceptability evaluation via postintervention surveys, app use and engagement indices, and semistructured interviews. In all, 200 participants will be recruited from Australia and New Zealand. Results The project was funded in June 2019, with approval from the Deakin University Human Research Ethics Committee (2020-304). Stakeholder user testing revealed high acceptability scores. The trial began on March 29, 2022, and 84 participants have been recruited (as of June 24, 2022). Results are expected to be published mid-2024. Conclusions GamblingLess: In-The-Moment forms part of a suite of theoretically informed and evidence-based web-based and mobile gambling interventions. This trial will provide important empirical data that can be used to facilitate the JITAI’s optimization to make it a more effective, efficient, and scalable tailored intervention. Trial Registration Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12622000490774; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380757&isClinicalTrial=False International Registered Report Identifier (IRRID) PRR1-10.2196/38958

Participant Engagement in Microrandomized Trials of mHealth Interventions: Scoping Review

“…Sixteen (80%) out of the 20 studies that explicitly measured engagement included at least 1 measure of this category. Generally, researchers used 2 types of system usage data: (1) responsiveness to self-reports, logs, or EMAs [ 23 , 24 , 26 , 27 , 29 , 30 , 33 , 35 - 37 , 41 , 42 ] and (2) access or use of interventions [ 22 , 26 , 33 , 35 , 36 , 39 - 41 , 43 ].…”

Participant Engagement in Microrandomized Trials of mHealth Interventions: Scoping Review

“…16 out of the 20 studies (80%) to measure engagement included at least one measure of this category. Generally, researchers measured usage in three domains: (1) usage of a mobile application [17,21,28,35,38], (2) participant retention [18,25,30,31],…”

“…One study planned to measure usage in terms of time since last interaction with the intervention application [28]. In four studies, usage (or rather the lack thereof) was operationalized as participant retention [18,25,30,31]. Interestingly, the measurement of engagement as participant retention was unique to studies that were designed to evaluate the effect of intervention components on health outcomes.…”

“…11 out of the 20 studies (55%) to measure engagement included at least one measure of this category. 10 out of 11 studies measured responsiveness in terms of survey completion (completion of single items, logs, diaries, or ecological momentary assessments) [18,19,21,22,25,28,30,31,36,37]. Aguilera et al [18] for example, measured engagement as response rates to daily text messages tasking participants to rate their mood.…”