Bayrakdarian Natalie D, Bonar Erin E, Duguid Isabelle, Hellman Lauren, Salino Sarah, Wilkins Chelsea, Jannausch Mary, McKay James R, Staton Michele, Dollard Katherine, Nahum-Shani Inbal, Walton Maureen A, Blow Frederic C, Coughlin Lara N
Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States.
Injury Prevention Center, University of Michigan, Ann Arbor, MI, United States.
Drug Alcohol Depend Rep. 2024 Mar 12;11:100225. doi: 10.1016/j.dadr.2024.100225. eCollection 2024 Jun.
At-risk alcohol use is associated with increased adverse health consequences, yet is undertreated in healthcare settings. People residing in rural areas need improved access to services; however, few interventions are designed to meet the needs of rural populations. Mobile interventions can provide feasible, low-cost, and scalable means for reaching this population and improving health, and behavioral economic approaches are promising.
We conducted a pilot randomized controlled trial focused on acceptability and feasibility of a mobile behavioral economic intervention for 75 rural-residing adults with at-risk alcohol use. We recruited participants from a large healthcare system and randomized them to one of four virtually-delivered conditions reflecting behavioral economic approaches: episodic future thinking (EFT), volitional choice (VC), both EFT and VC, or enhanced usual care control (EUC). The intervention included a telephone-delivered induction session followed by two weeks of condition-consistent ecological momentary interventions (EMIs; 2x/day) and ecological momentary assessments (EMAs; 1x/day). Participants completed assessments at baseline, post-intervention, and two-month follow-up, and provided intervention feedback.
All participants completed the telephone-delivered session and elected to receive EMI messages. Average completion rate of EMAs across conditions was 92.9%. Among participants in active intervention conditions, 89.3% reported the induction session was helpful and 80.0% reported it influenced their future drinking. We also report initial alcohol use outcomes.
The behavioral economic intervention components and trial procedures evaluated here appear to be feasible and acceptable. Next steps include determination of their efficacy to reduce alcohol use and public health harms.
危险饮酒与不良健康后果增加有关，但在医疗环境中治疗不足。农村地区居民需要更好地获得服务；然而，很少有干预措施是为满足农村人口的需求而设计的。移动干预可以为接触这一人群和改善健康提供可行、低成本且可扩展的方法，行为经济学方法很有前景。
我们进行了一项试点随机对照试验，重点关注针对75名有危险饮酒行为的农村成年人的移动行为经济学干预的可接受性和可行性。我们从一个大型医疗系统招募参与者，并将他们随机分配到反映行为经济学方法的四种虚拟交付条件之一：情景式未来思维（EFT）、意志选择（VC）、EFT和VC两者，或强化常规护理对照（EUC）。干预包括一次电话引导课程，随后是两周与条件一致的生态瞬时干预（EMIs；每天2次）和生态瞬时评估（EMAs；每天1次）。参与者在基线、干预后和两个月随访时完成评估，并提供干预反馈。
所有参与者都完成了电话引导课程，并选择接收EMI信息。各条件下EMA的平均完成率为92.9%。在积极干预条件下的参与者中，89.3%报告引导课程有帮助，80.0%报告它影响了他们未来的饮酒行为。我们还报告了初始饮酒结果。
这里评估的行为经济学干预成分和试验程序似乎是可行和可接受的。下一步包括确定它们在减少饮酒和公共卫生危害方面的效果。
