Center of Excellence in Substance Addiction Treatment and Education (CESATE), Veterans Affairs Puget Sound Health Care System, Seattle, WA, United States.
Health Services Research & Development Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, WA, United States.
JMIR Mhealth Uhealth. 2021 Apr 8;9(4):e25927. doi: 10.2196/25927.
Alcohol misuse is common among Operation Enduring Freedom and Operation Iraqi Freedom veterans, yet barriers limit treatment participation. Mobile apps hold promise as means to deliver alcohol interventions to veterans who prefer to remain anonymous, have little time for conventional treatments, or live too far away to attend treatment in person.
This pilot study evaluated the usability and acceptability of Step Away, a mobile app designed to reduce alcohol-related risks, and explored pre-post changes on alcohol use, psychological distress, and quality of life.
This single-arm pilot study recruited Operation Enduring Freedom and Operation Iraqi Freedom veterans aged 18 to 55 years who exceeded National Institute on Alcohol Abuse and Alcoholism drinking guidelines and owned an iPhone. Enrolled veterans (N=55) completed baseline and 1-, 3-, and 6-month assessments. The System Usability Scale (scaled 1-100, ≥70 indicating acceptable usability) assessed the effectiveness, efficiency, and satisfaction dimensions of usability, while a single item (scaled 1-9) measured the attractiveness of 10 screenshots. Learnability was assessed by app use during week 1. App engagement (proportion of participants using Step Away, episodes of use, and minutes per episode per week) over 6 months measured acceptability. Secondary outcomes included pre-post change on heavy drinking days (men: ≥5 drinks per day; women: ≥4 drinks per day) and Short Inventory of Problems-Revised, Kessler-10, and brief World Health Organization Quality of Life Questionnaire scores.
Among the 55 veterans enrolled in the study, the mean age was 37.4 (SD 7.6), 16% (9/55) were women, 82% (45/55) were White, and 82% (45/55) had an alcohol use disorder. Step Away was used by 96% (53/55) of participants in week 1, 55% (30/55) in week 4, and 36% (20/55) in week 24. Step Away use averaged 55.1 minutes (SD 57.6) in week 1 and <15 minutes per week in weeks 2 through 24. Mean System Usability Scale scores were 69.3 (SD 19.7) and 71.9 (SD 15.8) at 1 and 3 months, respectively. Median attractiveness scores ranged from 5 to 8, with lower ratings for text-laden screens. Heavy drinking days decreased from 29.4% (95% CI 23.4%-35.4%) at baseline to 16.2% (95% CI 9.9%-22.4%) at 6 months (P<.001). Likewise, over 6 months, Short Inventory of Problems-Revised scores decreased from 6.3 (95% CI 5.1-7.5) to 3.6 (95% CI 2.4-4.9) (P<.001) and Kessler-10 scores decreased from 18.8 (95% CI 17.4-20.1) to 17.3 (95% CI 15.8-18.7) (P=.046). Changes were not detected on quality of life scores.
Operation Enduring Freedom and Operation Iraqi Freedom veterans found the usability of Step Away to be acceptable and engaged in the app over the 6-month study. Reductions were seen in heavy drinking days, alcohol-related problems, and Kessler-10 scores. A larger randomized trial is warranted to confirm our findings.
酒精滥用在阿富汗和伊拉克自由行动的退伍军人中很常见，但由于存在障碍，他们参与治疗的比例有限。移动应用程序有望成为向那些更喜欢匿名、没有太多时间接受传统治疗或居住距离治疗地点太远而无法亲自接受治疗的退伍军人提供酒精干预的手段。
本试点研究评估了 Step Away 的可用性和可接受性，Step Away 是一款旨在降低与酒精相关风险的移动应用程序，并探讨了酒精使用、心理困扰和生活质量的前后变化。
这项单臂试点研究招募了年龄在 18 至 55 岁之间、超过国家酒精滥用和酒精中毒研究所饮酒指南且拥有 iPhone 的阿富汗和伊拉克自由行动的退伍军人。入组的退伍军人（N=55）完成了基线和 1、3 和 6 个月的评估。系统可用性量表（1-100 分，≥70 分表示可接受的可用性）评估了有效性、效率和满意度维度的可用性，而一个单独的项目（1-9 分）衡量了 10 个屏幕截图的吸引力。在第 1 周评估应用程序学习能力。在 6 个月内，通过参与者使用 Step Away 的比例、使用次数和每周每 episode 的分钟数来衡量接受度。次要结局包括 Heavy Drinking Days（男性：≥5 杯/天；女性：≥4 杯/天）和简短的问题清单修订版、Kessler-10 和世界卫生组织生活质量问卷得分的前后变化。
在研究中入组的 55 名退伍军人中，平均年龄为 37.4（SD 7.6），16%（9/55）为女性，82%（45/55）为白人，82%（45/55）患有酒精使用障碍。在第 1 周，有 96%（53/55）的参与者使用了 Step Away，第 4 周为 55%（30/55），第 24 周为 36%（20/55）。第 1 周的平均使用时间为 55.1 分钟（SD 57.6），而在第 2 周到第 24 周，每周的使用时间不到 15 分钟。平均系统可用性量表得分分别为 1 个月时的 69.3（SD 19.7）和 3 个月时的 71.9（SD 15.8）。吸引力评分中位数范围为 5 至 8，文字较多的屏幕评分较低。与基线相比，重度饮酒天数从 29.4%（95%CI 23.4%-35.4%）降至 6 个月时的 16.2%（95%CI 9.9%-22.4%）（P<.001）。同样，在 6 个月期间，简短问题清单修订版评分从 6.3（95%CI 5.1-7.5）降至 3.6（95%CI 2.4-4.9）（P<.001），Kessler-10 评分从 18.8（95%CI 17.4-20.1）降至 17.3（95%CI 15.8-18.7）（P=.046）。生活质量评分没有变化。
阿富汗和伊拉克自由行动的退伍军人发现 Step Away 的可用性可以接受，并在 6 个月的研究中使用了该应用程序。重度饮酒天数、酒精相关问题和 Kessler-10 评分均有所下降。需要进行更大规模的随机试验来证实我们的发现。
