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Jones M, Seel CJ, Dymond S. Electronic-Screening, Brief Intervention and Referral to Treatment (e-SBIRT) for Addictive Disorders: Systematic Review and Meta-Analysis. SUBSTANCE USE & ADDICTION JOURNAL 2024:29767342241248926. [PMID: 38756012 DOI: 10.1177/29767342241248926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
BACKGROUND Addictive disorders are significant global public health burdens. Treatment uptake with these disorders is low and outcomes can be mixed. Electronic screening, brief intervention, and referral to treatment (e-SBIRT) programs have potential to improve uptake and treatment outcomes. To date, however, no prior review of the literature has been conducted to gauge the effectiveness of e-SBIRT for addictive disorders. METHODS We conducted a systematic review and meta-analysis of the literature concerning e-SBIRT for addictive disorders by surveying the MEDLINE, PubMed, Web of Science, Scopus, Embase, and PsycInfo databases on January 17, 2023. RESULTS Ten articles were included at analysis reporting evaluation of e-SBIRT interventions for substance use disorders including alcohol use in a variety of settings. No articles were identified regarding treatment for behavioral addictions such as disordered/harmful gambling. Meta-analysis found e-SBIRT to be effective at reducing drinking frequency in the short term only. e-SBIRT was not found to be advantageous over control conditions for abstinence or other treatment outcomes. We identified and described common components of e-SBIRT programs and assessed the quality of available evidence, which was generally poor. CONCLUSION The present findings suggest that research regarding e-SBIRT is concentrated exclusively on higher-risk substance use. There is a lack of consensus regarding the effectiveness of e-SBIRT for addictive disorders. Although common features exist, e-SBIRT designs are variable, which complicates identification of the most effective components. Overall, the quality of outcome evidence is low, and furthermore, high-quality experimental treatment evaluation research is needed.
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Affiliation(s)
- Matthew Jones
- School of Psychology, Swansea University, Swansea, UK
| | | | - Simon Dymond
- School of Psychology, Swansea University, Swansea, UK
- Department of Psychology, Reykjavík University, Reykjavík, Iceland
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Adhikari K, Teare GF, Belon AP, Lee B, Kim MO, Nykiforuk C. Screening, brief intervention, and referral to treatment for tobacco consumption, alcohol misuse, and physical inactivity: an equity-informed rapid review. Public Health 2024; 226:237-247. [PMID: 38091812 DOI: 10.1016/j.puhe.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 09/26/2023] [Accepted: 11/01/2023] [Indexed: 01/15/2024]
Abstract
OBJECTIVE This rapid review systematically synthesizes evidence of the effectiveness of the Screening, Brief Intervention, and Referral (SBIR/T) approach for tobacco use, alcohol misuse, and physical inactivity. STUDY DESIGN This was a rapid review. METHODS We searched primary studies between 2012 and 2022 in seven electronic databases. The search strategy used concepts related to alcohol-related disorders, intoxication, cigarette, nicotine, physical activity, exercise, sedentary, screening, therapy, and referral. We reviewed both title/abstract and full-text using a priori set inclusion and exclusion criteria to identify the eligible studies. We appraised study quality, extracted data, and summarized the characteristics of the included studies. We applied health equity lenses in the synthesis. RESULTS Of the 44 included studies, most focused on alcohol misuse. SBIR/T improved patients' attitudes toward alcohol behavior change, improved readiness and referral initiation for change, and effectively reduced alcohol consumption. Few studies pertained to smoking and physical inactivity. Most studies on smoking demonstrated effectiveness pertaining to patients' acceptance of referral recommendations, improved readiness and attempts to quitting smoking, and reduced or cessation of smoking. Findings were mixed about the effectiveness of SBIR/T in improving physical activity. Minimal studies exist on the impacts of SBIR/T for these three risk factors on healthcare resource use or costs. Studies considering diverse population characteristics in the design and effectiveness assessment of the SBIR/T intervention are lacking. CONCLUSIONS More research on the impacts of SBIR/T on tobacco use, alcohol misuse, and physical inactivity is required to inform the planning and delivery of SBIR/T for general and disadvantaged populations.
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Affiliation(s)
- K Adhikari
- Provincial Population and Public Health, Alberta Health Services, Canada; Department of Community Health Sciences, University of Calgary, Canada.
| | - G F Teare
- Provincial Population and Public Health, Alberta Health Services, Canada; Department of Community Health Sciences, University of Calgary, Canada
| | - A P Belon
- Centre for Healthy Communities, School of Public Health, University of Alberta, Canada
| | - B Lee
- Centre for Healthy Communities, School of Public Health, University of Alberta, Canada
| | - M O Kim
- Centre for Healthy Communities, School of Public Health, University of Alberta, Canada
| | - C Nykiforuk
- Centre for Healthy Communities, School of Public Health, University of Alberta, Canada
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Simpson T, Sistad R, Brooks JT, Newberger NG, Livingston NA. Seeking care where they can: A systematic review of global trends in online alcohol treatment utilization among non-veteran and veteran women. DRUG AND ALCOHOL DEPENDENCE REPORTS 2022; 5:100116. [PMID: 36844155 PMCID: PMC9948922 DOI: 10.1016/j.dadr.2022.100116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 10/21/2022] [Accepted: 11/04/2022] [Indexed: 11/19/2022]
Abstract
Background Findings from a person-level meta-analysis of online alcohol intervention trials suggest that women disproportionately seek out such interventions (Riper et al., 2018). Although women may be a "hidden population" that is particularly drawn to online alcohol interventions, trial design features may explain women's apparent over-representation in these trials. Methods This systematic review examined associations between gender-tailored recruitment/inclusion criteria and proportions of women enrolled in online alcohol intervention trials, evaluated whether community samples have greater proportions of women than clinical samples, and compared country-specific average proportions of women in trials to country-specific proportions of women with Alcohol Use Disorder (AUD). Results Forty-four trials met inclusion/exclusion criteria, 34 community samples and 10 drawn from clinical settings; 4 studies included U.S. veterans and were examined separately. The average proportion of community-recruited women across the studies was 51.20% and the average proportion of clinically-recruited women was 35.81%, a difference that was statistically significant. Across the countries with relevant trials, the expected proportion of those with AUD who are women is 27.1% (World Population Review, 2022). Only 2 studies used targeted recruitment for women so no between-group tests were conducted. There was not a statistically significant difference in the proportion of women across trials that did and did not use gender-tailored alcohol inclusion criteria. Conclusions Results from this systematic review suggest that study design factors do not account for the marked over-representation of women in online alcohol interventions, indicating that women are indeed a "hidden population" whose needs should be understood and accommodated.
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Affiliation(s)
- Tracy Simpson
- Center of Excellence in Substance Addiction Treatment & Education, VA Puget Sound Healthcare System, Seattle, WA, USA,University of Washington School of Medicine, Seattle, WA, USA,Corresponding author at: 1660 S. Columbian Way (S-116-CESATE), Seattle, WA 98108, USA.
| | - Rebecca Sistad
- VA Boston Healthcare System, Boston, MA, USA,Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Jack T. Brooks
- VA Boston Healthcare System, Boston, MA, USA,Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Noam G. Newberger
- National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System, Boston, MA, USA
| | - Nicholas A. Livingston
- VA Boston Healthcare System, Boston, MA, USA,Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA,National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System, Boston, MA, USA
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Fu R, Yuan C, Sun W, Wang W, Zhang L, Zhai J, Guan Q, Wu X, Long J, Zhao M, Du J. Effectiveness of E-SBIRT intervention in community healthcare institution in China: study proposal for a randomised controlled trial. Gen Psychiatr 2021; 34:e100486. [PMID: 34651102 PMCID: PMC8475130 DOI: 10.1136/gpsych-2021-100486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 08/20/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Many studies have demonstrated the effectiveness of Screening, Brief Intervention and Referral to Treatment (SBIRT) in addressing substance use problem. However, owing to the shortage of counsellors, it has not been widely used in China. With the development of smart medicine, we developed a web-based electronic SBIRT (E-SBIRT) program and explored the effectiveness of E-SBIRT in reducing substance use in China. METHODS A randomised controlled trial will be conducted in primary healthcare institutions. Four primary healthcare institutions will be selected and randomly divided into an intervention group and a control group (each institution will recruit 60 participants, and in total, 240 participants will be recruited). The control group will get a pamphlet of drug abuse prevention, and the intervention group will get the E-SBIRT intervention and the pamphlet. Both groups will receive baseline and follow-up assessment at 1 and 3 months after the intervention. The primary outcome is the change in scores on the Alcohol, Smoking and Substance Use Involvement Screening Test, and the secondary outcomes include changes in motivation, depression, anxiety, positive/negative emotion, self-esteem, addiction knowledge and addiction severity index. CONCLUSIONS If the 'E-SBIRT' program is found to be effective, it will be an accessible, affordable and widely implementable intervention to help participants at moderate risk of substance use to reduce their consumption. The potential benefit is to provide early intervention to high-risk patients in time and reduce the harmful consequences to individuals and society. TRIAL REGISTRATION NUMBER NCT03452241.
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Affiliation(s)
- Rao Fu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chenxin Yuan
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Sun
- Community Health Service Center of Jiangning Road, Shanghai, China
| | - Wenzheng Wang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lei Zhang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jing Zhai
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qun Guan
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaojun Wu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiang Long
- Psychological Science Research Institute, Université Catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Min Zhao
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiang Du
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Almklov E, Afari N, Floto E, Lindamer L, Hurst S, Pittman JOE. Post-9/11 Veteran Satisfaction With the VA eScreening Program. Mil Med 2021; 185:519-529. [PMID: 32060553 DOI: 10.1093/milmed/usz324] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 08/08/2019] [Accepted: 08/13/2019] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION eScreening is a mobile health technology resource for veterans and staff to support Veterans Health Administration initiatives such as early identification of health problems, shared decision-making, and measurement-based care. METHODS We conducted an exploratory mixed methods retrospective study with newly enrolling post-9/11 veterans to (1) understand eScreening user experience and obtain practical feedback on the technology to guide improvements, (2) assess veteran satisfaction with eScreening following improvements to the technology, and (3) examine veteran characteristics associated with eScreening satisfaction. Focus group data were collected on user experience with eScreening from a sample of veterans who participated in an eScreening pilot. Guided by a user-centered design approach, findings informed improvements to the technology. Survey data were subsequently collected from a large cohort of veterans to assess satisfaction with the improved program. Questionnaire data were also collected to examine variables associated with eScreening satisfaction. Qualitative focus group data were analyzed using content analysis. Descriptive statistics were used to characterize sociodemographic variables, questionnaires, and satisfaction ratings. Correlations were run to examine the relationship between certain veteran characteristics (eg, age, resiliency, anxiety, insomnia, post-traumatic stress disorder, somatic symptoms, depression, pain) and satisfaction with eScreening. All research activities were conducted at VA San Diego Healthcare System and approved by the Institutional Review Board. RESULTS Focus group data revealed that veterans were largely satisfied with eScreening, but they suggested some improvements (eg, to interface functionality), which were integrated into an updated version of eScreening. Following these changes, survey data revealed that veterans were highly satisfied with eScreening, including its usability, information security, and impact on health services. There were statistically significant, though not clinically meaningful relationships between health-related characteristics and satisfaction with eScreening. However, millennials showed significantly higher satisfaction ratings compared with non-millennials. CONCLUSIONS These findings support the use of patient experiences and feedback to aide product development. In addition, post-9/11 veterans support the use of eScreening to assist health screening. However, evaluating the eScreening program in more diverse veteran groups and Veterans Affairs settings is needed to improve the generalizability of these findings to the larger veteran population.
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Affiliation(s)
- Erin Almklov
- VA Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr, San Diego, CA 92161.,VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA 92161
| | - Niloofar Afari
- VA Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr, San Diego, CA 92161.,VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA 92161.,Department of Psychiatry, University of California, San Diego, 9500 Gilman Dr, La Jolla, San Diego, CA 92093
| | - Elizabeth Floto
- VA Roseburg Health Care System, 913 NW Garden Valley Blvd, Roseburg, OR 97470
| | - Laurie Lindamer
- VA Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr, San Diego, CA 92161.,VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA 92161.,Department of Psychiatry, University of California, San Diego, 9500 Gilman Dr, La Jolla, San Diego, CA 92093
| | - Samantha Hurst
- Department of Family Medicine and Public Health, University of California, San Diego, 9500 Gilman Dr, La Jolla, San Diego, CA 92093
| | - James O E Pittman
- VA Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr, San Diego, CA 92161.,VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA 92161.,Department of Psychiatry, University of California, San Diego, 9500 Gilman Dr, La Jolla, San Diego, CA 92093
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Emergency Department Screening for Unhealthy Alcohol and Drug Use with a Brief Tablet-Based Questionnaire. Emerg Med Int 2020; 2020:8275386. [PMID: 32724677 PMCID: PMC7382715 DOI: 10.1155/2020/8275386] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 05/21/2020] [Accepted: 06/08/2020] [Indexed: 01/12/2023] Open
Abstract
Background Screening for unhealthy alcohol and drug use in the emergency department (ED) can be challenging due to crowding, lack of privacy, and overburdened staff. The objectives of this study were to determine the feasibility and utility of a brief tablet-based screening method in the ED and if patients would consider a face-to-face meeting with a certified alcohol and drug counselor (CADC) for more in-depth screening, brief intervention, and referral to treatment (SBIRT) helpful via this interface. Methods A tablet-based questionnaire was offered to 500 patients. Inclusion criteria were age ≥18, Emergency Severity Index 2–5, and English comprehension. Subjects were excluded if they had evidence of acute intoxication and/or received sedating medication. Results A total of 283 (57%) subjects were enrolled over a 4-week period, which represented an increase of 183% over the monthly average of patients referred for SBIRT by the CADC prior to the study. There were 131 (46%) who screened positive for unhealthy alcohol and drug use, with 51 (39%) and 37 (28%) who screened positive for solely unhealthy alcohol use and drug use/drug use disorders, respectively. There were 43 (33%) who screened positive for combined unhealthy alcohol and drug use. Despite willingness to participate in the tablet-based questionnaire, only 20 (15%) with a positive screen indicated via the tablet that a face-to-face meeting with the CADC for further SBIRT would be helpful. Conclusion Brief tablet-based screening for unhealthy alcohol and drug use in the ED was an effective method to increase the number of adult patients identified than solely by their treating clinicians. However, only a minority of subjects screening positive using this interface believed a face-to-face meeting with the CADC for further SBIRT would be helpful.
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Pot AL, Le Faou AL, Airagnes G, Limosin F. [Not Available]. SANTE PUBLIQUE (VANDOEUVRE-LES-NANCY, FRANCE) 2020; 32:315-327. [PMID: 33512098 DOI: 10.3917/spub.204.0315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Given the high prevalence of alcohol use disorder (AUD) amongst patients in Emergency Rooms (ER), it is recommended to carry out a systematized screening of at-risk drinkers, followed if necessary by a brief intervention (BI) to prevent AUD-related damages. This intervention has been the subject of numerous efficacy and feasibility studies. The purpose of this review of the literature is to identify optimal strategies for systematic screening and BI that can be deployed in the ER. METHODS We selected randomized controlled trials, meta-analysis and reviews of the literature published between July 2014 and March 2019 evaluating the effectiveness of BI in the ER on reducing alcohol consumption. RESULTS Thirteen articles were included. There is a significant heterogeneity of the methodologies used and the interventions carried out. The majority of studies conclude in the effectiveness of BI on reducing alcohol consumption, with however differences between the studies in effect size, and an effectiveness that seems to decrease over time. CONCLUSION The BI in the ER appears to be effective on reducing alcohol consumption but with a modest effect size and heterogeneity of the interventions tested, so that the optimal modalities of its implementation remain to be defined. Further studies to compare different interventions and identify at-risk subgroups would be needed to optimize the use of BI in the ER.
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Burner E, Zhang M, Terp S, Ford Bench K, Lee J, Lam CN, Torres JR, Menchine M, Arora S. Feasibility and Acceptability of a Text Message-Based Intervention to Reduce Overuse of Alcohol in Emergency Department Patients: Controlled Proof-of-Concept Trial. JMIR Mhealth Uhealth 2020; 8:e17557. [PMID: 32496203 PMCID: PMC7303828 DOI: 10.2196/17557] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 03/25/2020] [Accepted: 03/28/2020] [Indexed: 01/12/2023] Open
Abstract
Background Emergency department (ED) patients have high rates of risky alcohol use, and an ED visit offers an opportunity to intervene. ED-based screening, brief intervention, and referral to treatment (SBIRT) reduces alcohol use and health care costs. Mobile health (mHealth) interventions may expand the impact of SBIRTs but are understudied in low-resource ED populations. Objective The objective of this study was to assess the feasibility of and patient satisfaction with a text-based mHealth extension of an ED screening program to reduce risky alcohol use in low-income, urban patients. Methods Research assistants screened a convenience sample of ED patients in person for risky alcohol use via the Alcohol Use Disorders Identification Test (AUDIT). Patients who reported AUDIT scores ≥8 and <20 were informed of their AUDIT score and risk. RAs invited patients with SMS text message–capable phones to receive mROAD (mobilizing to Reduce Overuse of Alcohol in the ED), an SMS text message–based extension of the ED screening program. mROAD is a 7-day program of twice-daily SMS text messages based on the National Institutes of Health’s Rethinking Drinking campaign. Participants were allocated to a control group (daily sham text messages without specific guidance on behaviors, such as “Thanks for taking part!”) or to the mROAD intervention group. Patients were interviewed at 30 days to assess acceptability, satisfaction, and changes in drinking behavior. Satisfaction was examined descriptively. Pre and post measurements of drinking behaviors and motivation were compared, as were differences in change scores between the intervention arms. Results Of 1028 patients screened, 95 (9.2%) exhibited risky alcohol use based on AUDIT, and 23/95 (24%) of those patients did not own an SMS text messaging–capable phone; this left 72/95 (76%) eligible patients. Among eligible participants, 48/72 (67%) agreed to enroll; 31/48 (65%) achieved follow-up (18/24 (75%) in the intervention group and 13/24 (55%) in the control group). Participants who completed follow-up reported high satisfaction. Changes in behavior were similar between the arms. Overall, the number of drinking days reported in the prior 30 days decreased by 5.0 (95% CI 1.7-8.3; P=.004), and the number of heavy drinking days decreased by 4.1 (95% CI 1.0 to 7.15, P=.01). Patients reported an 11-point increase (95% CI 2.6-20, P=.01, 10% overall increase) in motivation to change alcohol use via the Change Questionnaire. The were no statistical differences in drinking days, heavy drinking days, or motivation to change between the arms. Conclusions The mROAD trial was feasible. Over three-quarters of ED patients with risky alcohol use owned a text message–capable phone, and two-thirds of these patients were willing to participate; only 1 patient opted out of the intervention. Although 35% of patients were lost to follow-up at 30 days, those patients who did follow up had favorable impressions of the program; more than 90% reported that SMS text messages were a “good way to teach,” and 89% of intervention arm participants enjoyed the program and found that the messages were motivating. Both the mROAD and sham message groups showed promising changes in alcohol use and motivation to change. mROAD is a feasible intervention that may reduce rates of risky alcohol use in ED patients. Trial Registration ClinicalTrials.gov NCT02158949; https://clinicaltrials.gov/ct2/show/NCT02158949
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Affiliation(s)
- Elizabeth Burner
- Department of Emergency Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States.,Los Angeles County + University of Southern California Medical Center, Los Angeles, CA, United States
| | - Mark Zhang
- Department of Emergency Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States.,Los Angeles County + University of Southern California Medical Center, Los Angeles, CA, United States
| | - Sophie Terp
- Department of Emergency Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States.,Los Angeles County + University of Southern California Medical Center, Los Angeles, CA, United States.,Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, United States
| | - Kelsey Ford Bench
- Department of Emergency Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States.,Los Angeles County + University of Southern California Medical Center, Los Angeles, CA, United States
| | - Joshua Lee
- Department of Emergency Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States.,Los Angeles County + University of Southern California Medical Center, Los Angeles, CA, United States
| | - Chun Nok Lam
- Department of Emergency Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States.,Los Angeles County + University of Southern California Medical Center, Los Angeles, CA, United States
| | - Jesus R Torres
- School of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Michael Menchine
- Department of Emergency Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States.,Los Angeles County + University of Southern California Medical Center, Los Angeles, CA, United States.,Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, United States
| | - Sanjay Arora
- Department of Emergency Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States.,Los Angeles County + University of Southern California Medical Center, Los Angeles, CA, United States.,Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, United States
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Saha K, Torous J, Ernala SK, Rizuto C, Stafford A, De Choudhury M. A computational study of mental health awareness campaigns on social media. Transl Behav Med 2019; 9:1197-1207. [PMID: 30834942 PMCID: PMC6875652 DOI: 10.1093/tbm/ibz028] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 01/03/2019] [Accepted: 01/31/2019] [Indexed: 12/27/2022] Open
Abstract
As public discourse continues to progress online, it is important for mental health advocates, public health officials, and other curious parties and stakeholders, ranging from researchers, to those affected by the issue, to be aware of the advancing new mediums in which the public can share content ranging from useful resources and self-help tips to personal struggles with respect to both illness and its stigmatization. A better understanding of this new public discourse on mental health, often framed as social media campaigns, can help perpetuate the allocation of sparse mental health resources, the need for educational awareness, and the usefulness of community, with an opportunity to reach those seeking help at the right moment. The objective of this study was to understand the nature of and engagement around mental health content shared on mental health campaigns, specifically #MyTipsForMentalHealth on Twitter around World Mental Health Awareness Day in 2017. We collected 14,217 Twitter posts from 10,805 unique users between September and October 2017 that contained the hashtag #MyTipsForMentalHealth. With the involvement of domain experts, we hand-labeled 700 posts and categorized them as (a) Fact, (b) Stigmatizing, (c) Inspirational, (d) Medical/Clinical Tip, (e) Resource Related, (f) Lifestyle or Social Tip or Personal View, and (g) Off Topic. After creating a "seed" machine learning classifier, we used both unsupervised and semi supervised methods to classify posts into the various expert identified topical categories. We also performed a content analysis to understand how information on different topics spread through social networks. Our support vector machine classification algorithm achieved a mean cross-validation accuracy of 0.81 and accuracy of 0.64 on unseen data. We found that inspirational Twitter posts were the most spread with a mean of 4.17 retweets, and stigmatizing content was second with a mean of 3.66 retweets. Classification of social media-related mental health interactions offers valuable insights on public sentiment as well as a window into the evolving world of online self-help and the varied resources within. Our results suggest an important role for social media-based peer support to not only guide information seekers to useful content and local resources but also illuminate the socially-insular aspects of stigmatization. However, our results also reflect the challenges of quantifying the heterogeneity of mental health content on social media and the need for novel machine learning methods customized to the challenges of the field.
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Affiliation(s)
- Koustuv Saha
- School of Interactive Computing, College of Computing, Georgia Institute of Technology, Atlanta, USA
| | - John Torous
- Division of Digital Psychiatry, Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | - Sindhu Kiranmai Ernala
- School of Interactive Computing, College of Computing, Georgia Institute of Technology, Atlanta, USA
| | - Conor Rizuto
- Division of Digital Psychiatry, Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | - Amanda Stafford
- Division of Digital Psychiatry, Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | - Munmun De Choudhury
- School of Interactive Computing, College of Computing, Georgia Institute of Technology, Atlanta, USA
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Pittman JOE, Afari N, Floto E, Almklov E, Conner S, Rabin B, Lindamer L. Implementing eScreening technology in four VA clinics: a mixed-method study. BMC Health Serv Res 2019; 19:604. [PMID: 31462280 PMCID: PMC6712612 DOI: 10.1186/s12913-019-4436-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 08/16/2019] [Indexed: 11/10/2022] Open
Abstract
Background Technology-based self-assessment (TB-SA) benefits patients and providers and has shown feasibility, ease of use, efficiency, and cost savings. A promising TB-SA, the VA eScreening program, has shown promise for the efficient and effective collection of mental and physical health information. To assist adoption of eScreening by healthcare providers, we assessed technology-related as well as individual- and system-level factors that might influence the implementation of eScreening in four diverse VA clinics. Methods This was a mixed-method, pre-post, quasi-experimental study originally designed as a quality improvement project. The clinics were selected to represent a range of environments that could potentially benefit from TB-SA and that made use of the variety eScreening functions. Because of limited resources, the implementation strategy consisted of staff education, training, and technical support as needed. Data was collected using pre- and post-implementation interviews or focus groups of leadership and clinical staff, eScreening usage data, and post-implementation surveys. Data was gathered on: 1) usability of eScreening; 2) knowledge about and acceptability and 3) facilitators and barriers to the successful implementation of eScreening. Results Overall, staff feedback about eScreening was positive. Knowledge about eScreening ranged widely between the clinics. Nearly all staff felt eScreening would fit well into their clinical setting at pre-implementation; however some felt it was a poor fit with emergent cases and older adults at post-implementation. Lack of adequate personnel support and perceived leadership support were barriers to implementation. Adequate training and technical assistance were cited as important facilitators. One clinic fully implemented eScreening, two partially implemented, and one clinic did not implement eScreening as part of normal practice after 6 months as measured by usage data and self-report. Organizational engagement survey scores were higher among clinics with full or partial implementation and low in the clinic that did not implement. Conclusions Despite some added work load for some staff and perceived lack of leadership support, eScreening was at least partially implemented in three clinics. The technology itself posed no barriers in any of the settings. An implementation strategy that accounts for increased work burden and includes accountability may help in future eScreening implementation efforts. Note. This abstract was previously published (e.g., Annals of Behavioral Medicine 53: S1–S842, 2019). Electronic supplementary material The online version of this article (10.1186/s12913-019-4436-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- James O E Pittman
- VA Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr., San Diego, CA, 92161, USA. .,Department of Psychiatry, University of California San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, USA.
| | - Niloofar Afari
- VA Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr., San Diego, CA, 92161, USA.,Department of Psychiatry, University of California San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, USA
| | - Elizabeth Floto
- VA Roseburg Health Care System, 913 NW Garden Valley Blvd, Roseburg, OR, 97470, USA
| | - Erin Almklov
- VA Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr., San Diego, CA, 92161, USA
| | - Susan Conner
- Gallup Inc., 901 F Street, NW, Washington, DC, 20004, USA
| | - Borsika Rabin
- VA Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr., San Diego, CA, 92161, USA.,Department of Family Medicine and Public Health, University of California San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, USA
| | - Laurie Lindamer
- VA Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr., San Diego, CA, 92161, USA.,Department of Psychiatry, University of California San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, USA
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11
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Ramsey AT, Satterfield JM, Gerke DR, Proctor EK. Technology-Based Alcohol Interventions in Primary Care: Systematic Review. J Med Internet Res 2019; 21:e10859. [PMID: 30958270 PMCID: PMC6475823 DOI: 10.2196/10859] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 01/29/2019] [Accepted: 01/30/2019] [Indexed: 12/23/2022] Open
Abstract
Background Primary care settings are uniquely positioned to reach individuals at risk of alcohol use disorder through technology-delivered behavioral health interventions. Despite emerging effectiveness data, few efforts have been made to summarize the collective findings from these delivery approaches. Objective The aim of this study was to review recent literature on the use of technology to deliver, enhance, or support the implementation of alcohol-related interventions in primary care. We focused on addressing questions related to (1) categorization or target of the intervention, (2) descriptive characteristics and context of delivery, (3) reported efficacy, and (4) factors influencing efficacy. Methods We conducted a comprehensive search and systematic review of completed studies at the intersection of primary care, technology, and alcohol-related problems published from January 2000 to December 2018 within EBSCO databases, ProQuest Dissertations, and Cochrane Reviews. Of 2307 initial records, 42 were included and coded independently by 2 investigators. Results Compared with the years of 2000 to 2009, published studies on technology-based alcohol interventions in primary care nearly tripled during the years of 2010 to 2018. Of the 42 included studies, 28 (64%) were randomized controlled trials. Furthermore, studies were rated on risk of bias and found to be predominantly low risk (n=18), followed by moderate risk (n=16), and high risk (n=8). Of the 24 studies with primary or secondary efficacy outcomes related to drinking and drinking-related harms, 17 (71%) reported reduced drinking or harm in all primary and secondary efficacy outcomes. Furthermore, of the 31 studies with direct comparisons with treatment as usual (TAU), 13 (42%) reported that at least half of the primary and secondary efficacy outcomes of the technology-based interventions were superior to TAU. High efficacy was associated with provider involvement and the reported use of an implementation strategy to deliver the technology-based intervention. Conclusions Our systematic review has highlighted a pattern of growth in the number of studies evaluating technology-based alcohol interventions in primary care. Although these interventions appear to be largely beneficial in primary care, outcomes may be enhanced by provider involvement and implementation strategy use. This review enables better understanding of the typologies and efficacy of these interventions and informs recommendations for those developing and implementing technology-based alcohol interventions in primary care settings.
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Affiliation(s)
- Alex T Ramsey
- Department of Psychiatry, Washington University School of Medicine, St Louis, MO, United States
| | - Jason M Satterfield
- Department of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Donald R Gerke
- Graduate School of Social Work, University of Denver, Denver, CO, United States
| | - Enola K Proctor
- Brown School of Social Work, Washington University in St Louis, St Louis, MO, United States
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12
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Bunn TL, Quesinberry D, Jennings T, Kizewski A, Jackson H, McKee S, Eustice S. Timely linkage of individuals to substance use disorder treatment: development, implementation, and evaluation of FindHelpNowKY.org. BMC Public Health 2019; 19:177. [PMID: 30744608 PMCID: PMC6371481 DOI: 10.1186/s12889-019-6499-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 01/30/2019] [Indexed: 11/20/2022] Open
Abstract
Background Substance use disorders (SUD) have steadily increased over the last two decades. Seeking SUD treatment involves searching SUD treatment facility types (inpatient, outpatient and intensive outpatient, residential and family residential, and detoxification facilities) that offer specialized SUD treatment depending on individual needs and preferences. Referrals to SUD treatment require innovative strategies that rapidly link individuals to SUD treatment when they are at the critical stage of readiness. The aim of this study was to develop, implement, and evaluate a user-friendly SUD treatment facility opening availability website called FindHelpNowKY.org. The objectives of the study were to 1) recruit SUD treatment facility and partner participation; 2) develop platform, content, and analytics for the FindHelpNowKY.org website intervention with an information repository; 3) assess barriers and facilitators to implementation; and 4) evaluate the development and implementation of FindHelpNowKY.org. Methods Website development stakeholders were identified and the website concept was developed. The logic model for FindHelpNowKY.org outlined resources, activities, and outputs as well as the associated short-term, medium-term, and long-term objectives, along with a website evaluation plan. Website usability and focus group testing was conducted. Information repository resource documents were compiled and categorized. An inventory of Kentucky-based SUD treatment facilities was compiled using various state and federal resources. Results Development/implementation barriers were addressed, facilitators were identified, and the website was implemented; 83% of SUD treatment facilities were indexed on the website, and average website user time was 7 min. From February to October 2018, there were 29,000 visitors, and 30,000 unique searches. The most common website query was a friend or family member seeking long-term residential or outpatient treatment facilities accepting Medicaid or Medicare. Conclusions FindHelpNowKY.org has the potential to fill a critical need for timely access to available SUD treatment in the state. The website may be a valuable resource for health professionals that can enhance clinical workflow and reduce staff time conducting phone and website searches for available SUD treatment. The website is a promising tool for assessing current SUD treatment capacity vs. SUD treatment need. The FindHelpNow model can be used by other states to increase timely access to SUD treatment.
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Affiliation(s)
- Terry Lee Bunn
- Kentucky Injury Prevention and Research Center, University of Kentucky, 333 Waller Ave., Suite 242, Lexington, KY, 40504, USA. .,Department of Preventive Medicine and Environmental Health, University of Kentucky, College of Public Health, 111 Washington Ave, Lexington, KY, 40536, USA.
| | - Dana Quesinberry
- Kentucky Injury Prevention and Research Center, University of Kentucky, 333 Waller Ave., Suite 242, Lexington, KY, 40504, USA
| | - Tyler Jennings
- Kentucky Injury Prevention and Research Center, University of Kentucky, 333 Waller Ave., Suite 242, Lexington, KY, 40504, USA
| | - Amber Kizewski
- Kentucky Injury Prevention and Research Center, University of Kentucky, 333 Waller Ave., Suite 242, Lexington, KY, 40504, USA
| | - Heather Jackson
- Kentucky Injury Prevention and Research Center, University of Kentucky, 333 Waller Ave., Suite 242, Lexington, KY, 40504, USA
| | - Sarah McKee
- Kentucky Injury Prevention and Research Center, University of Kentucky, 333 Waller Ave., Suite 242, Lexington, KY, 40504, USA
| | - Sarah Eustice
- Kentucky Injury Prevention and Research Center, University of Kentucky, 333 Waller Ave., Suite 242, Lexington, KY, 40504, USA
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13
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Calvo RA, Dinakar K, Picard R, Christensen H, Torous J. Toward Impactful Collaborations on Computing and Mental Health. J Med Internet Res 2018; 20:e49. [PMID: 29426812 PMCID: PMC5889813 DOI: 10.2196/jmir.9021] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 12/14/2017] [Accepted: 12/16/2017] [Indexed: 12/26/2022] Open
Abstract
We describe an initiative to bring mental health researchers, computer scientists, human-computer interaction researchers, and other communities together to address the challenges of the global mental ill health epidemic. Two face-to-face events and one special issue of the Journal of Medical Internet Research were organized. The works presented in these events and publication reflect key state-of-the-art research in this interdisciplinary collaboration. We summarize the special issue articles and contextualize them to present a picture of the most recent research. In addition, we describe a series of collaborative activities held during the second symposium and where the community identified 5 challenges and their possible solutions.
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Affiliation(s)
- Rafael Alejandro Calvo
- Wellbeing Supportive Technology Lab, School of Electrical and Information Engineering, University of Sydney, Sydney, Australia
| | - Karthik Dinakar
- Massachusetts Institute of Technology Media Lab, Cambridge, MA, United States
| | - Rosalind Picard
- Massachusetts Institute of Technology Media Lab, Cambridge, MA, United States
| | | | - John Torous
- Division of Clinical Informatics, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States.,Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
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14
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Johnson NA, Kypri K, Latter J, Dunlop A, Brown A, Saitz R, Saunders JB, Attia J, Wolfenden L, Doran C, McCambridge J. Effect of electronic brief intervention on uptake of specialty treatment in hospital outpatients with likely alcohol dependence: Pilot randomized trial and qualitative interviews. Drug Alcohol Depend 2018; 183:253-260. [PMID: 29306817 DOI: 10.1016/j.drugalcdep.2017.11.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 10/25/2017] [Accepted: 11/20/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND A large proportion of hospital outpatients are alcohol dependent (AD) but few are engaged in treatment for their drinking. Brief intervention, designed to raise patients' awareness of their drinking, might encourage uptake of referral to specialty treatment. We assessed the feasibility of conducting a randomized trial evaluating the effectiveness of electronic brief intervention on the uptake of specialty treatment in hospital outpatients with likely AD. METHODS This study was conducted in the outpatient department of a large public hospital in Newcastle, Australia. We randomly assigned adults who scored ≥10 on the AUDIT-C and were not currently receiving treatment for their drinking to electronic brief intervention (comprising an assessment of their drinking and personalized feedback) and referral (n = 59), or to referral alone (n = 64). We pre-specified two co-primary outcomes as the proportions of patients who (1) accepted and (2) attended a Drug and Alcohol outpatient clinic appointment. We interviewed 15 study participants to investigate why they had declined the appointment and what sort of help they might prefer to receive. RESULTS Ten patients (five in each group) accepted an appointment, and one patient (control) attended. Most interviewees' did not see their drinking as a problem or were confident they could manage it by themselves. Those who identified a preferred source of help expressed a preference for treatment by a GP. CONCLUSION Uptake of specialty treatment in hospital outpatients with likely AD was low regardless of whether they received brief intervention. Accordingly, a large randomized trial does not appear to be feasible.
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Affiliation(s)
- Natalie A Johnson
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, 2308, Australia.
| | - Kypros Kypri
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Joanna Latter
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Adrian Dunlop
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, 2308, Australia; Hunter New England Local Health District Drug and Alcohol Clinical Services, Newcastle, NSW, 2300, Australia
| | - Amanda Brown
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, 2308, Australia; Hunter New England Local Health District Drug and Alcohol Clinical Services, Newcastle, NSW, 2300, Australia
| | - Richard Saitz
- Department of Community Health Sciences, Boston University School of Public Health, Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Boston University School of Medicine and the Grayken Center for Addiction, Boston Medical Center, Boston, MA, 02118, USA
| | - John B Saunders
- Centre for Youth Substance Abuse Research, University of Queensland, Herston, 4006, Australia
| | - John Attia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, 2308, Australia; Department of General Medicine, John Hunter Hospital, New Lambton Heights, NSW, 2305, Australia; Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, 2308, Australia; Hunter New England Local Health District Population Health, Wallsend, NSW, 2287, Australia
| | - Christopher Doran
- Centre for Indigenous Health Equity Research, Central Queensland University, Brisbane, 4000, Australia
| | - Jim McCambridge
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK
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