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Adapting a Digital Intervention to Improve Smoking Cessation in Persons with Serious Mental Illness

采用数字干预措施改善严重精神疾病患者的戒烟情况

基本信息

批准号：
10038395
负责人：
MELANIE E. BENNETT
金额：
$ 66.63万
依托单位：
UNIVERSITY OF MARYLAND BALTIMORE
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-08-21 至 2024-08-20
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10038395
关键词：
Abstinence Accountability Address Admission activity Bipolar Disorder Clinical Collaborations Counseling Cues Custom Data Development Electronic Mail Elements Enrollment Ensure Exercise Feedback Foundations Funding General Population Hospitalization Hospitals Inpatients Internet Intervention Interview Length of Stay Measures Mediator of activation protein Mental Health Monitor Mood Disorders Motivation Outcome Outpatients Participant Patient Self-Report Patients Persons Pharmaceutical Preparations Pilot Projects Population Prevalence Procedures Program Development Protocols documentation Public Health Randomized Recovery Research Risk Factors Running Schizophrenia Self Efficacy Services Smoke Smoker Smoking Specialist Specific qualifier value Target Populations Technology Telephone Testing Text Messaging Time Tobacco Treatment Efficacy Work arm base craving digital efficacy trial evidence base experience follow-up improved inpatient psychiatric settings inpatient service insight mortality nicotine replacement peer support pilot trial programs quitline randomized trial recruit recurrent depression satisfaction service delivery severe mental illness skills training smoking cessation smoking prevalence smoking relapse social networking website therapy design tobacco control treatment as usual usability web site

项目摘要

PROJECT SUMMARY Persons with serious mental illness (SMI) die on average 10-15 years earlier than those in the general population. Smoking is the strongest risk factor for their elevated mortality. Helping SMI smokers to quit is an urgent and unmet need. The hospital is an optimal setting to provide smoking cessation services. Hospital admissions for SMI are common with more than 1.2 million inpatient stays for schizophrenia and mood disorders per year in the US. Hospitalized patients experience required abstinence, are available for counseling, and can try cessation medications in a supportive setting. The challenge is how to engage SMI patients in cessation services post-discharge. An easy-to-access digital intervention is a scalable and sustainable way to bridge the inpatient-to-outpatient gap and to promote sustained abstinence. Digital interventions can deliver all elements of cessation treatment and yield quit rates comparable to face to face and telephonic interventions. SMI patients use and benefit from technology-based interventions but currently there is no digital smoking cessation program addressing their needs. This R34 application will adapt a proven digital intervention, BecomeAnEX (EX), developed and run by Truth Initiative for over 10 years. Its core components are real- time one on one coaching via live chat, nicotine replacement therapy decision support and delivery, personalized quit plans, a large online social network for peer support, a robust and fully integrated text message program, and tailored email messaging. Adaptation will ensure that EX addresses the specific challenges of SMI smokers and is in line with principles of mental health recovery. In Aim 1 we will develop and obtain preliminary feedback about EX-SMI, a version of EX adapted for SMI patients. A priori target mechanisms are motivation, abstinence self-efficacy, and cravings. In Aim 2 we will conduct a one-arm pilot trial and obtain feedback from 20 SMI smokers recruited during psychiatric hospitalization and followed up at 2-weeks and 1-month post-discharge. Feasibility and acceptability will be assessed via participant feedback regarding their intervention experience, changes in motivation, self-efficacy and cravings, and automated tracking data on EX-SMI use post-discharge. In Aim 3, 90 SMI smokers recruited during psychiatric hospitalization will be randomized to usual care or to a revised version of EX-SMI and followed for 3 months after the hospital stay. We will compare the feasibility/acceptability of EX-SMI, measure intervention impact on target mechanisms, and obtain initial estimates of efficacy on 7-day point prevalence abstinence. This pilot work directly addresses priorities of this RFA in refining and optimizing an efficacious intervention for a new target population. Ultimately, this program of research could have a powerful public health impact by increasing smoking cessation among persons with SMI.

项目总结患有严重精神疾病(SMI)的人平均比普通人群早死10-15年。吸烟是导致他们死亡率上升的最大风险因素。帮助SMI吸烟者戒烟是一项紧迫而又未得到满足的任务需要。医院是提供戒烟服务的最佳场所。SMI的入院治疗很常见在美国，每年有超过120万人因精神分裂症和情绪障碍而住院。住院病人经验需要禁欲，可用于咨询，并可以在支持性环境中尝试戒烟药物。挑战是如何让SMI患者在出院后接受戒烟服务。一款易于访问的数字干预是一种可扩展和可持续的方式，以弥合住院患者与门诊患者之间的差距，并促进可持续发展禁欲。数字化干预可以提供戒烟治疗的所有要素，并产生与Face相当的戒毒率进行面对面和电话干预。SMI患者使用并受益于基于技术的干预措施，但目前目前还没有满足他们需求的数字戒烟计划。这款R34应用程序将采用经过验证的数字干预，BecomeAnEX(Ex)，由Truth Initiative开发和运营了10多年。它的核心组成部分是真实的- 通过实时聊天进行一对一辅导、尼古丁替代疗法决策支持和培训、个性化戒烟 Plans，一个用于同伴支持的大型在线社交网络，一个强大的、完全集成的短信程序，以及量身定做的电子邮件消息。适应将确保EX解决SMI吸烟者的具体挑战，并与心理健康康复的原则。在目标1中，我们将开发并获得关于ex-SMI的初步反馈，这是一个版本适用于SMI患者的EX。先验的目标机制是动机、节欲、自我效能和渴望。在……里面目标2我们将进行一项单臂飞行员试验，并从20名在精神病学期间招募的SMI吸烟者那里获得反馈并于出院后2周和1个月进行随访。将对可行性和可接受性进行评估通过参与者反馈他们的干预经验、动机、自我效能感和渴望的变化，以及前SMI的自动跟踪数据使用出院后数据。在AIM 3中，90名SMI吸烟者在精神病治疗期间被招募住院治疗将随机分为常规护理或修订版的ex-SMI，并在治疗结束后随访3个月住院治疗。我们将比较ex-SMI的可行性/可接受性，衡量干预对目标的影响机制，并获得对7天点戒断的疗效的初步估计。这项试点工作直接进行解决这一RFA在改进和优化针对新目标人群的有效干预方面的优先事项。最终，这项研究计划可能会通过增加患有SMI的人。