Process evaluation of a technology-delivered screening and brief intervention for substance use in primary care.
Process evaluation of a technology-delivered screening and brief intervention for substance use in primary care.
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DOI：
10.1016/j.invent.2016.01.004
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发表时间：
2016-05-01
期刊：
影响因子：
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通讯作者：
Schwartz RP
中科院分区：
文献类型：
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作者：
Ondersma SJ;Gryczynski J;Mitchell SG;O'Grady KE;Schwartz RP
心理治疗过程研究检查治疗课程的内容及其与结果的关联，试图更好地理解治疗师和客户之间的互动，并阐明行为改变的机制。在技术提供的干预措施中也可以采用类似的方法，这些干预措施的交互过程始终被完美保存并严格定义。本研究旨在通过一项比较新墨西哥州两个初级卫生保健中心的成年人对计算机和治疗师提供的简短干预措施的研究，探讨参与者与计算机提供的简短药物使用干预的互动过程。具体来说，我们试图描述参与者 (N = 178) 在计算机提供的简短干预过程中的选择和反应模式，并在 3 个月的随访中检查该过程与干预反应之间的关联。参与者最有可能选择大麻作为他们希望讨论的第一种物质（n = 114，64.0%）。大多数参与者表示，他们没有因吸毒而遇到任何问题（n = 108，60.7%），但其中近三分之一（n = 32，29.6%）仍然表示希望停止或减少吸毒；确实报告了负面后果的参与者最有可能赞同财务或关系方面的担忧。然而，参与者对改变的重要性或个性化规范反馈的有用性的评分与物质使用频率的变化无关。未来电子干预措施的设计应考虑强调戒烟可能带来的好处，而不是吸毒的负面后果，并且在解决后果时，应考虑重点关注物质使用对人际关系和财务方面的影响。这些发现是使用流程评估来优化电子干预内容的早期但重要的一步。电子卫生干预中的过程变量（例如在交互式干预期间做出的选择）很容易获得。这些变量可以让我们深入了解参与者如何使用电子卫生干预措施。选择和结果之间的相关性也可能指导干预优化和未来的研究。在初级保健中筛查呈阳性的成年人中，108 人 (60.7%) 否认因吸毒而出现任何问题。参与者对改变重要性的评分与物质使用频率的变化无关。
Psychotherapy process research examines the content of treatment sessions and their association with outcomes in an attempt to better understand the interactions between therapists and clients, and to elucidate mechanisms of behavior change. A similar approach is possible in technology-delivered interventions, which have an interaction process that is always perfectly preserved and rigorously definable. The present study sought to examine the process of participants' interactions with a computer-delivered brief intervention for drug use, from a study comparing computer- and therapist-delivered brief interventions among adults at two primary health care centers in New Mexico. Specifically, we sought to describe the pattern of participants' (N = 178) choices and reactions throughout the computer-delivered brief intervention, and to examine associations between that process and intervention response at 3-month follow-up. Participants were most likely to choose marijuana as the first substance they wished to discuss (n = 114, 64.0%). Most participants indicated that they had not experienced any problems as a result of their drug use (n = 108, 60.7%), but nearly a third of these (n = 32, 29.6%) nevertheless indicated a desire to stop or reduce its use; participants who did report negative consequences were most likely to endorse financial or relationship concerns. However, participant ratings of the importance of change or of the helpfulness of personalized normed feedback were unrelated to changes in substance use frequency. Design of future e-interventions should consider emphasizing possible benefits of quitting rather than the negative consequences of drug use, and—when addressing consequences—should consider focusing on the impacts of substance use on relationship and financial aspects. These findings are an early but important step toward using process evaluation to optimize e-intervention content. Process variables in eHealth interventions—such as choices made during an interactive intervention—are readily available. Such variables can provide insight into how participants use eHealth interventions. Correlations between choices and outcomes may also guide intervention optimization and future research. Among screen-positive adults in primary care, 108 (60.7%) denied any problems as a result of their drug use. Participant ratings of the importance of change were unrelated to changes in substance use frequency.