Development and Evaluation of a Digital Health Intervention for Substance Use Reduction in Young Refugees With Problematic Use of Alcohol and/or Cannabis—Study Protocol for a Single-Armed Feasibility Trial

Abstract

Background: Refugee populations are at substantial risk of developing substance use disorder (SUD) and other mental health disorders. At the same time, refugee populations face numerous barriers to accessing mental health services. Digital interventions can address some of these issues, as emerging evidence indicates that digital interventions offer an effective, low-cost alternative with high accessibility and similar efficacy as standard SUD prevention programs. As an add-on to traditional services, they further present a viable approach to the lack of personnel available for foreign language communication in preventive and therapeutic settings. In the present study, we thus aim to develop and evaluate a digital health intervention (DHI) for the reduction of substance use for young refugees with problematic use of alcohol and/or cannabis. The intervention will be implemented in a smartphone app, translated into Arabic, English, Farsi, German, and Pashto, and is to be used stand-alone. It is based on methods from cognitive behavioral therapy, contains culturally adapted elements, provides practical information on how to deal safely with alcohol and cannabis, and motivates behavior change through increased self-reflection and behavioral, cognitive, and emotional skills-training in interactive exercises.Methods: We conduct a single-armed feasibility trial among 150 young refugees with problematic use of alcohol and/or cannabis. Participants will receive a digital screening and digital health intervention (DHI) for the reduction of problematic substance use, carried out over a 4-week time frame. The primary outcomes are the intervention's feasibility and the target population's acceptance of the intervention. The secondary outcome is a change in substance use post-intervention from baseline. Measurements are taken pre-intervention (baseline), post-intervention (after 4 weeks), and at 3- and 6-month follow-ups. We expect the intervention to be feasible and accepted by the target group.Discussion: The present study will establish to what degree the digital intervention (the “BePrepared App”) is feasible and accepted by the target group. The evaluation of an easily accessible, feasible, and accepted intervention may impact refugees' mental health and health-related consequences. It aims at overcoming barriers to preventive health care in the substance use field for underserved refugee populations as a tool within a larger set of urgently needed interventions.Trial Registration: DRKS00021095 at the “German Clinical Trials Register” (30.03.2020).

Smartphone-delivered mental health care interventions for refugees: A systematic review of the literature

“…We included two RCTs (Nickerson et al, 2019 ; Röhr et al, 2021 ) and two pilot RCTs (Lindegaard et al, 2021b ; Spanhel et al, 2022 ), three feasibility studies (Holmes et al, 2017 ; Lindegaard et al, 2021a , 2022 ), two qualitative studies on the development process (Burchert et al, 2019 ), and the cultural adaptation of interventions (Spanhel et al, 2019 ). Moreover, two peer-reviewed study protocols (Böge et al, 2020 ; Fischer et al, 2021 ) and three interventions without any published study reports were identified. Of the latter, two were identified by experts ( Almamar and iFight Depression) and one by snowballing (ALMHAR).…”

“…One of the included study protocols described a planned RCT on the efficacy of a stepped and collaborative care model including the smartphone-delivered intervention as one of several low-threshold stand-alone interventions (Böge et al, 2020 ). The other study protocol described a planned one-armed feasibility and acceptability trial of an app targeting problematic use of alcohol and cannabis (Fischer et al, 2021 ). Although one feasibility study also collected data on clinical outcomes, no pre–post comparisons or other inferential statistics were reported (Holmes et al, 2017 ).…”

“…Therefore, we excluded this information from our data extraction table. Five study reports provided information on the topic of data security: one RCT (Röhr et al, 2021 ), one pilot RCT (Lindegaard et al, 2021b ), one qualitative usability study (Burchert et al, 2019 ), and the study protocols (Böge et al, 2020 ; Fischer et al, 2021 ). The qualitative study identified data security as important for the target group.…”

Knowledge of legal rights as a factor of refugee and asylum seekers’ health status: a qualitative study

“… 59 60 In addition, studies have shown that immigrants lag behind in vaccination rates for SARS-CoV-2, either due to vaccine hesitancy 61 or other barriers. 62 Disparities in vaccine coverage against key preventable infections are particularly evident in asylum-seeking children, who are three times less likely to be vaccinated than the local population. 63 Optimal individual and public health, such as appropriate health-seeking behaviour and population-level immunity, can only be achieved if immigrants such as refugees and asylum seekers engage with healthcare systems.…”

Perceptions on a mobile health intervention to improve maternal child health for Syrian refugees in Turkey: Opportunities and challenges for end-user acceptability

“…While specific Syrian refugee data in Turkey is difficult to obtain beyond market surveys, in a recent study with over 1,000 participants, 95.5% of Palestinian refugees in Jordan reported having a mobile phone ( 10 ). Additional qualitative studies demonstrate that mobile health interventions may be acceptable and feasible for refugee populations ( 9 , 11 , 12 ).…”