Department of Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, United States.
University of Alaska-Anchorage, Anchorage, AK, United States.
JMIR Mhealth Uhealth. 2020 Feb 13;8(2):e16062. doi: 10.2196/16062.
US military veterans who screen positive for hazardous drinking during primary care visits may benefit from a mobile app. Step Away is an evidence-based mobile intervention system for the self-management of hazardous drinking. However, Step Away was not designed for veterans, and differences between veterans and civilians could limit the reach and effectiveness of the app with this population.
The primary objective of this study was to repurpose Step Away to address the needs and preferences of the veteran primary care population. The Method for Program Adaptation through Community Engagement (M-PACE) model was used to guide the adaptation process. This model can serve as a generalizable approach that other researchers and intervention developers can follow to systematically tailor mobile health tools for a new population.
Veteran patients who screened positive for hazardous drinking during a primary care visit (n=12) and peer providers employed by the US Veterans Health Administration (n=11) were recruited to systematically review Step Away and provide feedback on its content and presentation via Web-based surveys and a semistructured interview. Participant feedback was reviewed through an iterative process by key stakeholders who adjudicated which suggested modifications to the app could enhance engagement and effectiveness with veterans while maintaining program integrity.
Usability ratings of the individual modules of Step Away were uniformly positive across patients and peers, as was the perceived utility of the app overall. Personalized feedback on the health consequences and costs of drinking, options for customization, and the measurement-based care capabilities of the app were viewed as facilitators of engagement. Conversely, lengthy text, small font, and a lack of interactive features were viewed as potential barriers with the older primary care population. Modifications to create a veteran version of the app (Stand Down: Think Before You Drink) included altering the appearance of the app to incorporate more veteran-centric content, adding links and options for resources and activities for veterans, and reducing the amount of text and adding veteran-specific references and common concerns and triggers for drinking in this population.
The M-PACE model provided a systematic approach to repurpose Step Away to fit the needs and preferences of veteran primary care patients who engage in hazardous drinking. Stand Down may serve as an innovative, low-cost means of expanding access to care for veterans who engage in hazardous drinking.
在美国初级保健就诊时，筛查出有危险饮酒行为的退伍军人可能会受益于移动应用程序。Step Away 是一种基于证据的移动干预系统，用于危险饮酒的自我管理。然而，Step Away 并非专为退伍军人设计，退伍军人和平民之间的差异可能会限制该应用程序在该人群中的普及程度和效果。
本研究的主要目的是调整 Step Away，以满足退伍军人初级保健人群的需求和偏好。采用社区参与式计划改编方法（M-PACE）模型来指导改编过程。该模型可以作为其他研究人员和干预开发者遵循的通用方法，以系统地为新人群定制移动健康工具。
在初级保健就诊时筛查出有危险饮酒行为的退伍军人患者（n=12）和美国退伍军人事务部（VA）聘用的同行提供者（n=11）被招募来系统地审查 Step Away，并通过网络调查和半结构化访谈提供关于其内容和呈现方式的反馈。关键利益相关者通过迭代过程审查参与者的反馈，判断应用程序的哪些修改建议可以增强与退伍军人的参与度和效果，同时保持项目完整性。
退伍军人患者和同行对 Step Away 的各个模块的可用性评分均为正面，对该应用程序的总体实用性也持肯定态度。个性化反馈饮酒的健康后果和成本、定制选项以及应用程序的基于测量的护理功能被认为是促进参与度的因素。相反，较长的文本、小字体和缺乏交互功能被认为是与年龄较大的初级保健人群相关的潜在障碍。为创建退伍军人版应用程序（Stand Down：Think Before You Drink）而进行的修改包括：改变应用程序的外观，纳入更多以退伍军人为中心的内容；添加指向退伍军人资源和活动的链接和选项；减少文本量，并添加退伍军人特定的参考资料以及该人群中常见的饮酒诱因和触发因素。
M-PACE 模型为调整 Step Away 以满足参与危险饮酒行为的退伍军人初级保健患者的需求和偏好提供了一种系统方法。Stand Down 可能成为一种创新的、低成本的方法，扩大了对参与危险饮酒的退伍军人的护理服务。
