Successful Organizational Strategies to Sustain Use of A-CHESS: A Mobile Intervention for Individuals With Alcohol Use Disorders

Abstract

BackgroundMobile health (mHealth) services are growing in importance in health care research with the advancement of wireless networks, tablets, and mobile phone technologies. These technologies offer a wide range of applications that cover the spectrum of health care delivery. Although preliminary experiments in mHealth demonstrate promising results, more robust real-world evidence is needed for widespread adoption and sustainment of these technologies.ObjectiveOur aim was to identify the problems/challenges associated with sustained use of an mHealth addiction recovery support app and to determine strategies used by agencies that successfully sustained client use of A-CHESS.MethodsQualitative inquiry assessed staff perceptions about organizational attributes and strategies associated with sustained use of the mobile app, A-CHESS. A total of 73 interviews of clinicians and administrators were conducted. The initial interviews (n=36) occurred at the implementation of A-CHESS. Follow-up interviews (n=37) occurred approximately 12 and 24 months later. A coding scheme was developed and Multiuser NVivo was used to manage and analyze the blinded interview data.ResultsSuccessful strategies used by treatment providers to sustain A-CHESS included (1) strong leadership support, (2) use of client feedback reports to follow up on non-engaged clients, (3) identify passionate staff and incorporate A-CHESS discussions in weekly meetings, (4) develop A-CHESS guidelines related to client use, (5) establish internal work groups to engage clients, and (6) establish a financial strategy to sustain A-CHESS use. The study also identified attributes of A-CHESS that enhanced as well as inhibited its sustainability.ConclusionsMobile apps can play an important role in health care delivery. However, providers will need to develop strategies for engaging both staff and patients in ongoing use of the apps. They will also need to rework business processes to accommodate the changes in communication frequency and style, learn to use app data for decision making, and identify financing mechanisms for supporting these changes.

Methodology and Reporting of Mobile Health and Smartphone Application Studies for Schizophrenia

“…Outside of schizophrenia research, one recent study examined how a mobile app intervention for alcoholism could scale beyond a single clinical study 36 to regional clinics. The study noted that the app faced numerous barriers in scaling up; with only 15% of clinics still using it at two years 37 . In part, the potential of smartphone interventions to address population-level unmet needs, and to provide remote support to those who cannot physically access clinical services, has driven the interest in using this technology for schizophrenia.…”

Feasibility and Effects of Digital Interventions to Support People in Recovery From Substance Use Disorders: Systematic Review (Preprint)

“…There was only one study focusing explicitly on prerequisites for a successful implementation of digital interventions. In a study on the implementation of A-CHESS, Ford (2015) found that the following factors were important for a successful and sustained implementation of the intervention: strong leadership support, a staff that is passionate about the intervention, utilizing user feedback to re-engage users who had dropped out, including the intervention in meetings with staff and users, developing internal guidelines for utilizing the intervention, and developing sustainable strategies for financing the intervention.…”

“…The simple interventions seemed relatively easy to develop and implement, especially those using standard text messaging and smartphone applications. Complex interventions seemed also easy to implement, but the study by Ford [62] showed that there are many organizational prerequisites to achieving a sustainable implementation of such interventions over time. In addition to questions about feasible technical solutions, it is important to determine whether the organizational prerequisites are in place to sustain the implementation over time before implementing a digital intervention.…”

Design, Development and Implementation of a Smartphone Overdependence Management System for the Self-Control of Smart Devices

“…Additional unique possibilities by applying telemedicine facilitates monitoring using up-to-date mobile technology [24]. Focusing on monitoring and preventing the relapse of alcohol addicts using smartphones, Gustafson et al [25] proved the effectiveness of smartphone monitoring. Specialized and personalized intervention is possible only based on individually monitored specific data and evidence.…”