Women Empowered to Connect with Addiction Resources and Engage in Evidence-based Treatment (WE-CARE): A Usability and Feasibility Study of a Mobile Health Application for the Universal Screening of Alcohol, Substance Use, Depression and Anxiety. (Preprint)

Abstract

BACKGROUND Women of childbearing age (WOCA,18-44 years of age) face multiple barriers to receiving screening and treatment for unhealthy alcohol and substance use, depression, and anxiety, including lack of screening in the primary care setting and lack of support in accessing care. The Women Empowered to Connect with Addiction Resources and Engage in Evidence-based Treatment (WE-CARE) mobile app was developed to test universal screening with WOCA and linkage to care after an assessment for substance use disorder (SUD). OBJECTIVE In this study, we aimed to investigate the feasibility and acceptability of providing anonymous screening instruments for alcohol and substance use, as well as depression and anxiety, for women of childbearing age through mobile phones. METHODS We used Agile development principles based on prior formative research to create an alpha version of a WE-CARE mobile health application that was piloted with WOCA (N = 30) who resided in one of six counties in Central Florida. WE-CARE included screening instruments (for substance use, depression, and anxiety), a moderated discussion forum, educational micro-learning videos, an FAQ section, and resources for linkage to treatment. Individuals were recruited using flyers, academic listservs, and a commercial human subject survey company (Prolific). Upon completion of the screening instruments, women explored the educational and linkage to care features of the app and filled out a System Usability Scale (SUS) to evaluate the mobile health app’s usability and acceptability. Post-pilot semi-structured interviews (n = 4) were conducted to further explore the women’s reactions to the application. RESULTS Seventy-seven women downloaded the application and 30 completed testing. WOCA gave the WE-CARE app an excellent SUS score of 86.7 + 12.43 (SD). Out of the 30 participants (African American (N=1, 3.3%), Hispanic (N=6, 20%), more than one race (N=5,16.7%), White (N=14, 46.7%), Unknown (N=7, 23.3%)), 60% (n=18) had results indicating elevated risk for substance use, 50% of these 18 (n=9/18) indicated elevated risk also for anxiety or depression, and 61% (n=11/18) indicated elevated risk for substance use and/or anxiety or depression. Participants reported that WE-CARE was easy to navigate and use but they would like to see more screening questions and more educational content. However, linkage to care was an issue, as none of the women identified as ‘at-risk’ for SUDs contacted the free treatment clinic for further evaluation. CONCLUSIONS The mobile health application was highly rated for acceptability and usability, but participants were not receptive to seeking help at a treatment center after only a few brief encounters with the application. The linkage to care design features was likely insufficient to encourage them to seek treatment. The beta version of WE-CARE will include normative scores for participants to self-evaluate their screening status compared to their age- and gender-matched peers and enhanced linkages to care features. Future development will focus on improving engagement to change behaviors and assess readiness for change.