Levesque D, Umanzor C, de Aguiar E. (2018). Stage-based mobile intervention for substance use disorders in primary care: Development and test of acceptability. JMIR Medical Informatics. 6(1): e1. doi: 10.2196/medinform.7355
Researchers developed and pilot tested an unnamed stage-based digital intervention to facilitate screening, brief intervention, and referral to treatment (SBIRT) of substance use disorders (SUDs) in primary care. A literature review and interviews with 9 experts in SBIRT, SUD treatment, and digital health led researchers to integrate the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) for determining most problematic substance of abuse, establish procedures for providers to help high-risk patients initiate SUD treatment, and emphasize benefits of reducing substance use for patients in pre-contemplation and complementation. The intervention involves computer-delivered SBIRT (assessment of substance use and readiness to quit, feedback, stage-informed goal setting), 30 days of tailored text messages, interactive activities, electronic health record (EHR)-linked dashboards for clinicians, and progress and resources summaries for patients. Researchers recruited 4 providers and 5 patients for pilot testing. Patients completed the intervention after an initial SBIRT session with a provider and completed assessments of intervention acceptability after the initial session and 2 and 4 weeks later. Providers completed interviews about perceptions of SBIRT and intervention acceptability pre- and post-intervention. Providers found the dashboard acceptable (4.4/5), on average. Providers felt the dashboard provided new information about patients and the information presented on the dashboard was clear, concise, and attractive. Providers reported wanting the dashboard to be better integrated with EHR. Patients found the intervention (4.5/5) and text messages (4/5) acceptable, on average. Based on patient feedback, researchers will improve the clarity of the text messages in future iterations of the intervention.