From "Step Away" to "Stand Down": Tailoring a Smartphone App for Self-Management of Hazardous Drinking for Veterans
From "Step Away" to "Stand Down": Tailoring a Smartphone App for Self-Management of Hazardous Drinking for Veterans
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DOI：
10.2196/16062
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发表时间：
2020-02-13
影响因子：
5
通讯作者：
Dulin, Patrick
中科院分区：
文献类型：
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作者：
Blonigen, Daniel;Harris-Olenak, Brooke;Dulin, Patrick
背景：在初级保健就诊期间危险饮酒筛查呈阳性的美国退伍军人可能会受益于移动应用程序。 Step Away 是一个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 并不是为退伍军人设计的，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覆盖范围和有效性。 目的：本研究的主要目的是重新调整 Step Away 的用途，以满足退伍军人初级保健人群的需求和偏好。通过社区参与进行项目适应的方法（M-PACE）模型用于指导适应过程。该模型可以作为一种通用方法，其他研究人员和干预开发人员可以遵循，为新人群系统地定制移动健康工具。方法：招募了在初级保健就诊期间筛查出有害饮酒呈阳性的退伍军人患者（n = 12）和美国退伍军人健康管理局雇用的同行提供者（n = 11）来系统地审查“Step Away”，并通过基于网络的调查和半结构化访谈对其内容和演示提供反馈。主要利益相关者通过迭代过程对参与者的反馈进行了审查，他们认为对应用程序的修改建议可以提高退伍军人的参与度和有效性，同时保持计划的完整性。结果：患者和同行对 Step Away 各个模块的可用性评级一致积极，该应用程序的整体实用性也是如此。关于饮酒对健康的影响和成本的个性化反馈、定制选项以及应用程序基于测量的护理功能被视为参与的促进因素。相反，冗长的文本、小字体和缺乏互动功能被视为老年初级保健人群的潜在障碍。创建退伍军人版本应用程序（Stand Down：饮酒前三思）的修改包括更改应用程序的外观，以纳入更多以退伍军人为中心的内容，添加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饮酒的常见问题和触发因素。结论：M-PACE 模型提供了一种系统方法来重新调整 Step Away 的用途，以满足从事危险饮酒的退伍军人初级保健患者的需求和偏好。 “停止行动”可能是一种创新、低成本的方法，可以扩大对有害饮酒的退伍军人的护理机会。
Background: 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.Objective: 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.Methods: 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.Results: 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.Conclusions: 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.