Elison Sarah, Jones Andrew, Ward Jonathan, Davies Glyn, Dugdale Stephanie
Breaking Free Group, 274 Deansgate, Manchester, M3 4JB, UK.
Centre for Epidemiology, University of Manchester, Oxford Road, Manchester, M13 9PL, UK.
Addict Behav. 2017 Nov;74:140-147. doi: 10.1016/j.addbeh.2017.05.028. Epub 2017 May 23.
When evaluating complex, tailorable digital behavioural interventions, additional approaches may be required alongside established methodologies such as randomised controlled trials (RCTs). Research evaluating a computer-assisted therapy (CAT) programme for substance misuse, Breaking Free Online (BFO), is informed by Medical Research Council (MRC) guidance recommending examination of 'mechanisms of action' of individual intervention strategies, which is relevant when evaluating digital interventions with content that may evolve over time.
To report findings from examination of mechanisms of action of tailoring advice within the BFO programme and outcomes from specific intervention strategies.
Analysis of covariance and linear regressions were used to assess intervention completion data, and psychometric and clinical outcomes, for 2311 service users accessing drug and alcohol treatment services across the UK.
Tailoring advice provided to users appeared to prompt them to prioritise completion of intervention strategies associated with their areas of highest biopsychosocial impairment. Completion of specific intervention strategies within BFO were associated with specific clinical outcomes, with a dose response also being found. Mechanisms of action analyses revealed the primacy of cognitions, with cognitive restructuring strategies being associated with improvements in mental health, severity of substance dependence, quality of life and global biopsychosocial functioning.
The MRC framework provides an evolved research paradigm within the field of digital behavioural change. By assessing baseline profiles of need, BFO can target the most appropriate clinical content for individual users. Mechanisms of action research can be used to inform modifications to BFO to continually update clinical content and the technology platform.
在评估复杂的、可定制的数字行为干预措施时，除了随机对照试验（RCT）等既定方法外，可能还需要其他方法。一项针对药物滥用的计算机辅助治疗（CAT）项目“在线解脱”（BFO）的研究，参考了医学研究理事会（MRC）的指导意见，该意见建议检查个体干预策略的“作用机制”，这在评估内容可能随时间演变的数字干预措施时具有相关性。
报告对BFO项目中定制建议的作用机制进行检查的结果以及特定干预策略的效果。
采用协方差分析和线性回归，对英国2311名接受药物和酒精治疗服务的服务使用者的干预完成数据、心理测量和临床结果进行评估。
向用户提供的定制建议似乎促使他们优先完成与他们生物心理社会损伤最严重领域相关的干预策略。BFO中特定干预策略的完成与特定临床结果相关，还发现了剂量反应。作用机制分析揭示了认知的首要性，认知重构策略与心理健康改善、药物依赖严重程度、生活质量和整体生物心理社会功能改善相关。
MRC框架为数字行为改变领域提供了一种发展的研究范式。通过评估需求的基线概况，BFO可以为个体用户提供最合适的临床内容。作用机制研究可用于为BFO的修改提供信息，以不断更新临床内容和技术平台。
