Constructing a Theory- and Evidence-Based Treatment Rationale for Complex eHealth Interventions: Development of an Online Alcohol Intervention Using an Intervention Mapping Approach

Abstract

BackgroundDue to limited reporting of intervention rationale, little is known about what distinguishes a good intervention from a poor one. To support improved design, there is a need for comprehensive reports on novel and complex theory-based interventions. Specifically, the emerging trend of just-in-time tailoring of content in response to change in target behavior or emotional state is promising.ObjectiveThe objective of this study was to give a systematic and comprehensive description of the treatment rationale of an online alcohol intervention called Balance.MethodsWe used the intervention mapping protocol to describe the treatment rationale of Balance. The intervention targets at-risk drinking, and it is delivered by email, mobile phone text messaging, and tailored interactive webpages combining text, pictures, and prerecorded audio.ResultsThe rationale of the current treatment was derived from a self-regulation perspective, and the overarching idea was to support continued self-regulation throughout the behavior change process. Maintaining the change efforts over time and coping adaptively during critical moments (eg, immediately before and after a lapse) are key factors to successful behavior change. Important elements of the treatment rationale to achieving these elements were: (1) emotion regulation as an inoculation strategy against self-regulation failure, (2) avoiding lapses by adaptive coping, and (3) avoiding relapse by resuming the change efforts after a lapse. Two distinct and complementary delivery strategies were used, including a day-to-day tunnel approach in combination with just-in-time therapy. The tunnel strategy was in accordance with the need for continuous self-regulation and it functions as a platform from which just-in-time therapy was launched. Just-in-time therapy was used to support coping during critical moments, and started when the client reports either low self-efficacy or that they were drinking above target levels.ConclusionsThe descriptions of the treatment rationale for Balance, the alcohol intervention reported herein, provides an intervention blueprint that will aid in interpreting the results from future program evaluations. It will ease comparisons of program rationales across interventions, and may assist intervention development. By putting just-in-time therapy within a complete theoretical and practical context, including the tunnel delivery strategy and the self-regulation perspective, we have contributed to an understanding of how multiple delivery strategies in eHealth interventions can be combined. Additionally, this is a call for action to improve the reporting practices within eHealth research. Possible ways to achieve such improvement include using a systematic and structured approach, and for intervention reports to be published after peer-review and separately from evaluation reports.

Mamma Mia: A Feasibility Study of a Web-Based Intervention to Reduce the Risk of Postpartum Depression and Enhance Subjective Well-Being

“…However, treatment dropout is common to most Internet-based programs [67]. Particularly, for comprehensive multi-session interventions, like Mamma Mia (ie, for each session added), an opportunity for dropout is also added [33]. Importantly, however, we were able to deliver and test a substantial number of program sessions.…”

Is the Construct of Relapse Heuristic, and Does It Advance Alcohol Use Disorder Clinical Practice?

“…Some authors also have distinguished between a "lapse" and a relapse, where a lapse is typically defined as a single instance of use, a slip, or as a discrete outcome of any use (Brownell et al, 1986;Chung & Maisto, 2006;Witkiewitz & Marlatt, 2004). Earlier (Brownell et al, 1986;Prochaska et al, 1992) , 2011;Kirchner et al, 2012;Shiffman, 2005;Witkiewitz & Marlatt, 2004) accounts of relapse have considered it to be part of a dynamic process and have included the behavioral change goal in defining lapse and relapse (Brendryen et al, 2013;Hendershot et al, 2011). In summary, conceptual definitions of relapse have viewed it both as an outcome and as a part of the process of change.…”

Daño cerebral relacionado con el alcohol. Situación actual y llamada a la acción

“…eHealth solutions, which have been suggested to be cost-effective for AUD management (Smit et al, 2011;Stoner & Hendershot, 2012;Brendryen, Johansen, Nesvåg, Kok & Duckert, 2013), could ease the implementation of cognitive testing and rehabilitation.…”