Real-Time Assessment of Triggers and Coping Responses in China

描述（由申请人提供）：针对阿片类药物使用者中艾滋病毒/艾滋病的高发率，中国最近实施了美沙酮维持治疗（MMT）计划，以降低注射吸毒者（IDUs）的艾滋病毒风险。虽然中国在MMT的实施方面取得了长足的进步，但MMT患者中持续使用阿片类药物的高比率和辍学率仍然存在问题。改善自我监测和自我管理是慢性疾病管理的重要内容，但这些概念对中国MMT提供者和患者来说相对较新。根据认知行为理论，管理诱因/风险和建立应对技能是预防复发和持续康复的关键。更好地了解MMT患者的常见诱因和有效的应对策略将为制定有效的干预措施提供基础。在中国，通信技术和手机的普及为与患者接触和建立网络以及收集有关触发因素和应对反应的生态瞬时评估（EMA）数据提供了巨大的机会。拟议的项目将测试使用手机和短信技术收集EMA触发和应对响应数据的可行性和可接受性。加州大学洛杉矶分校的研究人员开发了一个名为“ANDWellness”的开源移动健康平台，用于支持自我监控和行为干预。我们建议在这一创新平台的基础上，对中国MMT患者的触发因素和应对反应进行实时评估。该研究的目的是：(1)开发一种交互式手机支持的移动健康原型，该原型可以建立风险或触发因素的个性化概况

DESCRIPTION (provided by applicant): Responding to high rates of HIV/AIDS among opiate users, China has recently implemented methadone maintenance treatment (MMT) programs in order to reduce HIV risks among injection drug users (IDUs). While China has made strides in the implementation of MMT, high rates of continued opiate use and dropout among MMT patients remain problematic. Improved self-monitoring and self-management are important elements in chronic disease management, but these concepts are relatively new to Chinese MMT providers and patients. According to cognitive behavioral theories, managing triggers/risks and building coping skills are critical in relapse prevention and sustained recovery. A better understanding of common triggers and effective coping strategies among MMT patients will provide a foundation for developing effective interventions. Communication technologies and the proliferation of cellphones in China provide great opportunities to engage and network with patients and to collect ecological momentary assessment (EMA) data on triggers and coping responses. The proposed project will test the feasibility and acceptability of EMA data collection of triggers and coping responses using cellphone and text messaging technology. An open-source mobile health platform, called "ANDWellness," has been developed by UCLA researchers for supporting self-monitoring and behavioral interventions. We propose to build upon this innovative platform to conduct real-time assessment of triggers and coping responses among MMT patients in China. The study aims are (1) To develop an interactive cellphone-supported mobile health prototype that establishes individualized profiles of risks or triggers and that supports knowledge and skill building, including coping strategies; and (2) To conduct a pilot study to assess the reliability and validity of the EMA data. A secondary objective is to obtain preliminary evidence on self-monitoring in relation to outcome data (e.g., MMT retention, abstinence). The project will be accomplished in two phases: Phase I will develop a smartphone-based prototype of the ANDWellness application. We will also assess the acceptability and feasibility of the prototype. Phase II will consist of a pilot test to examine th acceptability of and compliance with the ANDWellness prototype collecting EMA data on triggers and responses, the correspondence of EMA with the retrospective recall and urine testing, and the relation between EMA and some limited outcomes. These pilot efforts will prepare us for future intervention development based on cellphone technology. The long-term goal of this line of research is to develop promising strategies that optimize treatment effectiveness and support sustained recovery by taking advantage of the popularity of cellphone use, and adapting and applying evidence-based principles to address drug use and HIV/HCV risk behaviors. Thus, the study will contribute to the literature on triggers and coping strategies and will extend NIDA's mission of promulgating research-based interventions to improve treatment services and reduce HIV/HCV transmission globally. PUBLIC HEALTH RELEVANCE: Addressing the linked problems of drug use and HIV/AIDS in China will decrease the spread of these conditions and related consequences worldwide. The study is unique and important because it will develop a novel data collection tool that is built upon innovative mobile health technologies to identify triggers and coping strategies. Knowledge generated can be used to develop interventions appropriate for MMT patients in Chinese communities to help address this important public health problem in China and globally.