Facilitators and barriers to a contingency management alcohol intervention involving a transdermal alcohol sensor

Abstract

Research on contingency management is limited due to feasibility issues with monitoring adherence. Incentives usually depend on objective measures to verify compliance; therefore, biological markers for identifying alcohol use are not as dependable for the use of financial contingency studies. The Secure Continuous Remote Alcohol Monitor (SCRAM) is an objective alcohol biosensor that can be locked onto a person's ankle to address these limitations. In preparation for a large, contingency management study for HIV-positive and HIV-negative persons with heavy drinking, the aims for the study were to (1) explore barriers and facilitators to participating in a contingency management intervention using the SCRAM ankle monitor as the potential alcohol measure for the intervention; (2) explore levels of appropriate compensation for using the SCRAM and for study assessments as part of a contingency management intervention study; and (3) attitudes and beliefs on lifestyle changes as a consequence of wearing the SCRAM among HIV-positive and HIV-negative heavy drinkers in Florida. Five focus groups were conducted and we collected qualitative data from thirty-seven individuals (18 men; 19 women). During the analysis, six themes were identified as barriers and facilitators for participation in a contingency management intervention using the SCRAM sensor to measure alcohol use: (1) health assessment, (2) monetary incentives including payment structure and levels of compensation, (3) stigma associated with wearing the SCRAM sensor, (4) aesthetics and other related concerns with wearing the SCRAM sensor, (5) motivation to stop drinking, and (6) social support. Stigma was a major barrier for wearing the SCRAM sensor; however, if participants were motivated to change their behavior then the monetary incentives became a facilitator to wearing the sensor. In addition to the financial contingency method, social support may further increase the odds for participants to change their behaviors.

Acceptability and Feasibility of Wearable Transdermal Alcohol Sensors: Systematic Review

“…SCRAM is the device that is the biggest of the various models and typically worn on the ankle. Participants described rarely noticing SCRAM [ 8 , 23 , 25 , 30 , 36 ]; however, there were a few activities when the device was more noticeable, such as bathing, sport, sleep, and the device vibration/size impacting work and clothing choice [ 12 , 14 , 23 , 25 , 30 , 37 ]. When rating the SCRAM comfort, on average, it was rated as comfortable by wearers [ 25 , 36 ], and in another study, over half of the participants reported adjusting to any initial discomfort [ 30 ].…”

“…Sixteen studies used a version of SCRAM [8,12,14,[23][24][25][29][30][31][32][33][34][35][36][37][38], 4 used a version of WrisTAS [39][40][41][42], 3 used BACtrack Skyn [7,38,43], and 1 used Quantac Tally [7]. Some studies used more than 1 version or brand of device.…”

“…Due to the nature of many studies, blinding of participants or staff was not possible; in some, there were clear differences between groups [34] or CM incentives were provided [25], where the staff were required to know participant allocation. In many studies, there was only 1 group of participants who all completed the same task and so randomization was not required [7,8,12,23,[29][30][31][32][33][35][36][37][38][39][40][41][42][43]. Not all studies provided clear information on participant information, randomization, incomplete outcome data, and selective reporting; therefore, there was potential bias due to limited information [7,12,14,23,24,29,34,35,38,[40][41][42][43].…”

Perceptions, awareness, and barriers to care regarding obesity and diabetes among Latinx in Miami and Escambia, Florida: a qualitative geographical comparative study

“…Other studies like Villalba (2020), Fukunaga (2011) and Chang (2018) have used similarly large number of groups in their study. [21][22][23] The research protocol was approved by the Institutional Review Board of University of West Florida where the study was initiated.…”

“…Clinical characteristics were self-reported and collected information on health insurance, annual checkup of glucose level and diagnoses with Type 2 DM by a physician Our data collection approach for demographic data is similar to the approach applied by other studies like Villalba (2020), Bosma et al ( 2020 ) and Fukunaga (2011). 21,22,24…”