eHealth Coping Skills Training and Coach Support for Women Whose Partner Has a Drinking Problem

 描述(由申请人提供)：据估计，在美国，每20名成年女性中就有一人与患有酒精使用障碍(AUD)的伴侣结婚或共同生活。这些女性经常经历严重的心理和身体痛苦，与没有AUD的配偶相比，利用的医疗保健服务要多得多，并产生总体更高的医疗费用。改善自己的身心健康本身很重要，但也可能有助于促进伴侣饮酒的减少，并缓冲伴侣饮酒对子女的负面影响。尽管它们普遍存在、痛苦、重要性和成本， 这些人口在很大程度上仍然是隐蔽的，服务不足。制度、心理和社会经济障碍阻碍了这些妇女寻求帮助，而当她们真的寻求帮助时，新的、经过经验检验的服务不在她们的能力范围之内。需要新的替代交付模式来克服这些障碍，并提供对经验评估的服务的轻松访问。为了开始满足这一需求，研究人员在前一阶段的工作中，将经过经验测试的面对面应对技能培训计划调整为自定进度的网络版本(StopSpinningMyWheels；SSMW)。SSMW受到好评，参与度高，与不干预相比，短期应对技能和负面影响有所改善。这一增长 技能在一定程度上起到了缓解痛苦的作用。这项建议建立在试点研究的基础上，方法是：(A)对SSMW进行更新和重新编程，以增加响应式的网页设计、更大的内容个性化和更好的可移植性；(B)增加一个补充的mHealth应用程序，以便妇女可以使用她们的智能手机访问SSMW的内容和互动；(C)开发SSMW教练门户网站，以方便她们跟踪参与者的参与度；以及(D)开发一个常规的Web比较(UWC)网站，提供免费Web信息汇编的访问。然后，我们提出了一项大规模随机对照试验，将450名有AUD伴侣的女性随机分为三种情况之一：有教练支持呼叫的SSMW(SSMW+COACH)，没有教练支持的SSMW(仅SSMW)，或UWC。评估将在基线、6周中期、12周员额以及随后6个月和12个月的后续行动中进行。我们假设，在减少负面影响方面，两种SSMW条件都将比UWC更有效，并且，在考虑教练支持的作用时，SSMW+Coach仅在吸引参与者和减少负面影响方面比SSMW更有效。我们(A)检验差异技能习得、行为激活和消极思维是否对这些影响起到中介作用，(B)研究不同项目投入在这个中介模型中的作用，(C)探索基线负面情绪的调节作用。这项工作扩大了我们对针对这一服务不足群体的干预措施的理解，填补了在如何最好地接触和改善他们的生活方面的一个重大公共卫生空白，并可能间接地促进减少他们伴侣的问题，并保护他们的孩子免受其负面影响。

 DESCRIPTION (provided by applicant): Estimates suggest that nearly 1 in 20 adult women in the U.S. are married to or living with a partner with an alcohol use disorder (AUD). These women often experience significant psychological and physical distress, utilize substantially more health care services than spouses of those without an AUD, and incur overall higher healthcare costs. Improving their own physical and psychological health is important in its own right, but also may help facilitate partner drinking reduction, and buffer the negative effects of the partner's drinking on their children. Despite their prevalence, distress, importance, and cost, this population remains largely hidden and underserved. Institutional, psychological and socioeconomic barriers discourage these women from seeking help, and when they do seek help, the newer, empirically tested services are not within their reach. Novel, alternate delivery models are needed to overcome the barriers, and provide easy access to empirically evaluated services. To begin to meet this need, the investigators, in a prior Stage I effort, adapted an empirically tested face-to-face coping skills training program to a self-paced, Web version (StopSpinningMyWheels; SSMW). SSMW was well-received, had high participation, and, relative to no intervention, improved short-term coping skills and negative affect. The increase in skills partially mediated improvements in distress. This proposal builds on the pilot study by (a) updating and reprogramming SSMW to add responsive web-design, greater content personalization, and increased transportability; (b) adding a complementary mHealth app so women can use their smartphones to access SSMW content and interactivity; (c) developing a SSMW coach web portal to facilitate their tracking of participant engagement; and (d) developing a Usual Web Comparison (UWC) site that provides access to a compilation of free Web information. We then propose a large-scale RCT in which 450 women with an AUD partner will be randomized to one of three conditions: SSMW with coach support calls (SSMW+COACH), SSMW without coach support (SSMW ONLY), or the UWC. Assessments will occur at baseline, a 6-week interim, a 12-week post, and at subsequent 6 and 12-month followups. We hypothesize that, in reducing negative affect, both SSMW conditions will be more effective than UWC, and, in considering the role of coach support, SSMW+COACH will be more effective than SSMW ONLY in engaging participants, and reducing negative affect. We (a) test whether differential skill acquisition, behavioral activation, and negative thinking mediate these effects, (b) study the role of differential program engagement in this mediation model, and (c) explore the moderating role of baseline negative affect. The work expands our understanding of interventions for this underserved group, fills a major public health gap in how best to reach and improve their lives, and may, indirectly, facilitate a reduction in their partner's problem, and protect their children from its negative effects.