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

 描述（由申请人提供）：估计表明，在美国，近1/20的成年女性与患有酒精使用障碍（AUD）的伴侣结婚或同居。这些妇女经常经历严重的心理和身体痛苦，比那些没有澳元的配偶使用更多的医疗保健服务，并承担更高的医疗保健费用。改善他们自己的身心健康本身就很重要，但也可能有助于减少伴侣饮酒，并缓冲伴侣饮酒对子女的负面影响。尽管它们普遍存在，令人痛苦，重要性和成本， 这一群体在很大程度上仍处于隐蔽状态，得不到充分服务。体制、心理和社会经济方面的障碍阻碍了这些妇女寻求帮助，而当她们寻求帮助时，她们也无法获得经过经验检验的较新服务。需要新的替代交付模式来克服障碍，并提供方便的经验评估服务。为了开始满足这一需求，研究人员在之前的第一阶段工作中，将经验测试的面对面应对技能培训计划改编为自定进度的网络版本（StopSpinningMyWheels; SSMW）。SSMW深受欢迎，有很高的参与度，并且相对于没有干预，改善了短期应对技能和负面影响。的增加 技能在一定程度上缓解了痛苦。该提案以试点研究为基础，具体做法是：（a）更新和重新编制SSMW，增加响应式网页设计、更大的内容个性化和更强的可移植性;（B）增加一个补充性移动保健应用程序，使妇女能够使用智能手机访问SSMW内容和互动;（c）开发SSMW辅导门户网站，以便于跟踪参与者的参与情况;以及（d）开发一个免费网络比较（UWC）网站，提供对免费网络信息汇编的访问。然后，我们提出了一个大规模的随机对照试验，其中450名有AUD伴侣的女性将被随机分配到三种情况之一：SSMW与教练支持电话（SSMW+COACH），SSMW没有教练支持（SSMW只），或UWC。将在基线、6周中期、12周后以及随后的6个月和12个月随访时进行评估。我们假设，在减少负面影响方面，两种SSMW条件都比UWC更有效，并且，在考虑教练支持的作用时，SSMW+COACH在吸引参与者和减少负面影响方面比SSMW更有效。我们（a）测试差异技能获得、行为激活和消极思维是否介导了这些效应，（B）研究差异项目参与在这个中介模型中的作用，（c）探索基线消极情感的调节作用。这项工作扩大了我们对这一服务不足群体的干预措施的理解，填补了如何最好地接触和改善其生活的重大公共卫生空白，并可能间接地促进减少其伴侣的问题，并保护其子女免受其负面影响。

 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.