Ecological Momentary Assessment of Illicit Drug Use Compared to Biological and Self-Reported Methods

BACKGROUND:

The use of mHealth methods for capturing illicit drug use and associated behaviors have become more widely used in research settings, yet there is little research as to how valid these methods are compared to known measures of capturing and quantifying drug use.

OBJECTIVE:

We examined the concordance of ecological momentary assessment (EMA) of drug use to previously validated biological and audio-computer assisted self-interview (ACASI) methods.

METHODS:

The Exposure Assessment in Current Time (EXACT) study utilized EMA methods to assess drug use in real-time in participants' natural environments. Utilizing mobile devices, participants self-reported each time they used heroin or cocaine over a 4-week period. Each week, PharmChek sweat patch samples were collected for measurement of heroin and cocaine and participants answered an ACASI-based questionnaire to report behaviors and drug using events during the prior week. Reports of cocaine and heroin use captured through EMA were compared to weekly biological or self-report measures through percent agreement and concordance correlation coefficients to account for repeated measures. Correlates of discordance were obtained from logistic regression models.

RESULTS:

A total of 109 participants were a median of 48.5 years old, 90% African American, and 52% male. During 436 person-weeks of observation, we recorded 212 (49%) cocaine and 103 (24%) heroin sweat patches, 192 (44%) cocaine and 161 (37%) heroin ACASI surveys, and 163 (37%) cocaine and 145 (33%) heroin EMA reports. The percent agreement between EMA and sweat patch methods was 70% for cocaine use and 72% for heroin use, while the percent agreement between EMA and ACASI methods was 77% for cocaine use and 79% for heroin use. Misreporting of drug use by EMA compared to sweat patch and ACASI methods were different by illicit drug type.

CONCLUSIONS:

Our work demonstrates moderate to good agreement of EMA to biological and standard self-report methods in capturing illicit drug use. Limitations occur with each method and accuracy may differ by type of illicit drugs used.

Below:   Reported drug use as assessed by sweat patch (green bars), EMA (orange bars) or ACASI (blue bars) methods

Below:  Figure 2. Percent agreement by drug type and week comparing EMA, sweat patch, and ACASI methods. Panel A: Percent agreement between EMA/Sweat Patch methods (blue bars) and EMA/ACASI methods (green bars) by week for cocaine use. Panel B: Percent agreement between EMA/Sweat Patch methods (orange bars) and EMA/ACASI methods (yellow bars) by week for heroin use.

Purchase full article at:   http://goo.gl/cg7nLg

By:  Linas BS1, Genz A, Westergaard RP, Chang LW, Bollinger RC, Latkin C, Kirk GD.

• 1Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, MD, USA. Blinas@jhu.edu.
• JMIR Mhealth Uhealth. 2016 Mar 15;4(1):e27. doi: 10.2196/mhealth.4470. 

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A Pilot Test of a Mobile App for Drug Court Participants

The U.S. criminal justice system refers more people to substance abuse treatment than any other system. Low treatment completion rates and high relapse rates among addicted offenders highlight the need for better substance use disorder treatment and recovery tools. 

Mobile health applications (apps) may fill that need by providing continuous support. In this pilot test, 30 participants in a Massachusetts drug court program used A-CHESS, a mobile app for recovery support and relapse prevention, over a four-month period. Over the course of the study period, participants opened A-CHESS on average of 62% of the days that they had the app. Social networking tools were the most utilized services. 

The study results suggest that drug court participants will make regular use of a recovery support app. This pilot study sought to find out if addicted offenders in a drug court program would use a mobile application to support and manage their recovery.

Below:  A-CHESS mobile app user interface

Below:  Percentage of days in which participants used A-CHESS

Below:  Average number of times participants who used each service used it over the total study period

Below:  Social network map of all participants including staff

Below:  Social network map of drug court participants

Purchase full article at:   http://goo.gl/7kRKXZ

By:  Johnson K1, Richards S2, Chih MY3, Moon TJ4, Curtis H5, Gustafson DH1.

• 1Center for Health Enhancement Systems Studies, University of Wisconsin-Madison, Madison, WI, USA.
• 2Communications Coordinator, Population Health Institute, University of Wisconsin-Madison, Madison, WI, USA.
• 3Research Assistant, Center for Health Enhancement Systems Studies, University of Wisconsin-Madison, Madison, WI, USA.; Assistant Professor, University of Kentucky, Lexington, KY, USA.
• 4Honorary Fellow, Center for Health Enhancement Systems Studies, University of Wisconsin-Madison, Madison, WI, USA.
• 5Advocates, Inc., Ayer Concord Drug Court, Ayer, MA, USA. 
• Subst Abuse. 2016 Feb 14;10:1-7. doi: 10.4137/SART.S33390. eCollection 2016.

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mHealth Tool for Alcohol Use Disorders among Latinos in Emergency Department

Latino drinkers experience a disparate number of negative health and social consequences. Emergency Department Alcohol Screening Brief Intervention and Referral to Treatment (ED-SBIRT) is viable and effective at reducing harmful and hazardous drinking. However, barriers (e.g. readily available language translators, provider time burden, resources) to broad implementation remain and account for a major lag in adherence to national guidelines. We describe our approach to the design of a patient-centered bilingual Web-based mobile health ED-SBIRT App that could be integrated into a clinically complex ED environment and used regularly to provide ED-SBIRT for Spanish speaking patients.

Below:  AB-CASI Language Selection Screen

Below:  AB-CASI Frequency of Drinks Screen

Below:  Architecture of ED-SBIRT Mobile App Bilingual Text-to-Speech Generation

Below:  AB-CASI Ruler Screen

Full article at:   http://goo.gl/3r2GIa

By:  Fuad Abujarad and Federico E. Vaca

Department of Emergency Medicine Yale University, School of Medicine New Haven, Connecticut

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Willingness to Receive Text Message Appointment Reminders among Patients with HIV Infection in China

BACKGROUND:

Wireless communication technologies are increasingly being used in the fields of healthcare, with platforms such as mobile health (mHealth) being widely implemented in HIV care. The rapid expansion of mobile technologies, including smartphone applications (apps), provides a unique opportunity to effectively remind patients about regular follow-up appointments, thereby ensuring patient retention and resulting in a higher quality of care for HIV patients.

PURPOSE:

This study examines mobile phone users' usage patterns, application usage, and challenges associated with the use of a mobile phone reminder system in order to improve retention in HIV care among patients.

METHODS:

A cross-sectional descriptive study was conducted to collect data on the usage and patterns of communication technologies from 405 patients.

RESULTS:

This study included 384 of the 405 eligible patients, resulting in a response rate of 94.8%. A majority of participants (73.3%) indicated their willingness to receive reminders via a text message regarding their upcoming HIV clinical appointments. After adjusting for sociodemographic and clinical variables, multiple logistic regression models indicated that the willingness to receive reminder messages was independently associated with having a college-level education (AOR = 2.06, 95% CI [1.05, 4.04]) and with having prior experience with using electronic reminders (AOR = 4.01, 95% CI [1.51, 10.66]).

CONCLUSIONS / IMPLICATIONS FOR PRACTICE:

Protection of personal information was identified as the most important factor that must be addressed in order to increase patient willingness to use a cell phone reminder system. Our findings suggest that mobile technologies are a widely used and an acceptable method for improving quality of care for HIV patients.

Abstract at:   http://goo.gl/btSRIN

By:  Pa YH1, Chen YC2, Hung CK3, Liu HY1, Lai YY1, Ko NY4.

• 1MSN, RN, HIV Case Manager, Department of Nursing, National Cheng Kung University Hospital, Taiwan, ROC.
• 2MSN, RN, Doctoral Student, Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Taiwan, ROC.
• 3Undergraduate Program Student, Department of Nursing, College of Medicine, National Cheng Kung University, Taiwan, ROC.
• 4PhD, RN, Professor, Department of Nursing, College of Medicine, National Cheng Kung University, and Deputy Director, Department of Nursing, National Cheng Kung University Hospital, Taiwan, ROC. nyko@mail.ncku.edu.tw. 
• Hu Li Za Zhi. 2016 Feb;63(1):59-67. doi: 10.6224/JN.63.1.59.

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A Community-Engaged Approach to Developing an mHealth HIV/STI and Drug Abuse Preventive Intervention for Primary Care: A Qualitative Study

BACKGROUND:

Despite ongoing prevention efforts, HIV and other sexually transmitted infections (HIV/STIs) and drug use remain public health concerns. Urban adolescents, many of whom are underserved and racial minorities, are disproportionately affected. Recent changes in policy, including the Affordable Care Act, and advances in technology provide HIV/STI and drug abuse prevention scientists with unique opportunities to deliver mobile health (mHealth) preventive interventions in primary care.

OBJECTIVES:

The purpose of this community-engaged study was to develop an mHealth version of the Storytelling for Empowerment preventive intervention for primary care (hereinafter referred to as "S4E").

METHODS:

A total of 29 adolescents were recruited from a youth-centered primary care clinic in Southeast, Michigan, to participate in qualitative interviews. Participants were predominantly African American (n=19, 65.5%) and female (n=21, 72.4%) with a mean age of 16.23 (SD 2.09). The principles of community-based participatory research (CBPR), in conjunction with agile software development and the recommended core prevention principles of the National Institute on Drug Abuse (NIDA) were employed during S4E development. CBPR principles are aimed at improving the effectiveness of research by addressing locally relevant health problems, working with community strengths, and translating basic science into applied research. Complementing this approach, the NIDA prevention principles are derived from decades of drug abuse prevention research aimed at increasing the effectiveness and uptake of programs, through the development of culturally specific interventions and ensuring the structure, content, and delivery of the intervention fit the needs of the community. Data were analyzed using thematic analysis.

RESULTS:

A total of 5 themes emerged from the data: (1) acceptability of the mHealth app to adolescents in primary care, (2) inclusion of a risk assessment to improve clinician-adolescent HIV/STI and drug use communication, (3) incorporation of culturally specific HIV/STI and drug use content, (4) incorporation of interactive aspects in the app to engage youth, and (5) perspectives on the appearance of the app.

CONCLUSIONS:

There is a dearth of mHealth HIV/STI and drug abuse preventive interventions for primary care. Incorporating the principles of CBPR in conjunction with agile software development and NIDA-recommended core prevention principles may be helpful in developing culturally specific mHealth interventions. An important next step in this program of research is to examine the feasibility, acceptability, and efficacy of S4E on adolescent sexual risk and drug use behaviors, and HIV/STI testing. Implications for prevention research and primary care practice are discussed in the context of the Affordable Care Act and technological advances.

Full article at:   http://goo.gl/76lnRZ

By:   Cordova D1, Bauermeister JA, Fessler K, Delva J, Nelson A, Nurenberg R, Mendoza Lua F, Alers-Rojas F, Salas-Wright CP; Youth Leadership Council.

1School of Social Work, University of Michigan, Ann Arbor, MI, United States. cordovad@umich.edu.

 

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Percentage of US Adults Who Looked up Health Information on the Internet in the Past Year, by Type of Locality

Via:  http://goo.gl/BoVOj7  By:  https://twitter.com/cdcmmwr

Sexual & Reproductive Health & Rights & mHealth in Policy & Practice in South Africa

Information and Communications Technology (ICT) offers enormous opportunity and innovation to improve public health and health systems.This paper explores the intersections between mHealth and sexual and reproductive health and rights in both policy and practice. It is a qualitative study, informed by policy review and key informant interviews. Three case studies provide evidence of what is happening on the ground in relation to ICTs and reproductive health and rights. We argue that in terms of policy, there is little overlap between health rights and communication technology. In the area of practice, however, significant interventions address aspects of reproductive health. At present, the extent to which mHealth addresses the full range of reproductive justice and sexual and reproductive health and rights is limited, particularly in terms of government initiatives. The paper argues that mHealth projects tend to avoid contentious aspects of sexual health, while addressing favourable topics such as pregnancy and motherhood. The ways in which information is framed in mHealth mirrors current gaps within sexual and reproductive health and rights, where a limited and conservative lens predominates, and which may result in narrow programming and implementation of services...

The issues associated with sexual and reproductive rights – sexuality, abortion, gender-based violence, sex-positive messaging and teenage sexual pleasure – are, in addition, politicised, involve religious and moral values and receive polarised opposition. This polarisation is also reflected in government departmental practice. Representatives from the Department of Social Development emphasised their focus on South Africa’s sexual and reproductive rights commitments, in particular, the ready availability of contraception and preventing violence against women and children. In contrast, the Minister of Health prioritises health information systems and maternal health. As noted by one government representative, as a consequence there is “very little interface” between sexual and reproductive rights and ICTs and very little interaction between members of the National Department of Health and the Department of Social Development. Similarly, among researchers and implementers, SRHR experts have limited understanding of the current use of ICTs in health and implementers have only partial perspectives on SRHR. Their sectoral knowledge is accompanied by a complete lack of knowledge about policy, as one implementer of a mobile platform for youth and sexuality commented:

“The scary thing is how possible it is to do this without ever coming up against these policies. Anyone can put a sexual health and advice site up with no restrictions, no regulations.”

As several respondents working in the area of implementation pointed out, even in areas where there is good policy, implementation is challenging,24 and policy is not sufficiently correlated with need. South Africa’s ICT policy focuses on expanding broadband access, and on high-income country standards. It sees cell phones as automatically overcoming gender exclusions, yet some health researchers pointed out that adding more phones may not improve access. Rather, they argued, structural factors (such as poverty, unemployment, literacy, residence, and patriarchal relations) limit women’s use and access to ICTs.1, 37 As one respondent said: “Access [to ICTs] mirrors inequality offline”. Addressing inequality in women’s health is therefore not just about providing more phones. Rather, a transformative approach with dedicated programmes is needed...38, 39

Full article at: http://goo.gl/p050dV

By: Waldman L1, Stevens M2.

• 1Institute of Development Studies correspondence:
• 2WISH Associates and African Gender Institute, University of Cape Town.  

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Comparison of a User-Centered Design, Self-Management App to Existing mHealth Apps for Persons Living with HIV

There is preliminary evidence that mobile health (mHealth) apps are feasible, attractive, and an effective platform for the creation of self-management tools for persons living with HIV (PLWH). As a foundation for the current study, we conducted formative research using focus groups, participatory design sessions, and usability evaluation methods to inform the development of a health management app for PLWH. The formative research resulted in identification of the following functional requirements of a mHealth app for self-management: 

• communication between providers and peers,
• medication reminders, 
• medication log, 
• lab reports, 
• pharmacy information, 
• nutrition and fitness, 
• resources (eg, social services, substance use, video testimonials), 
• settings, and 
• search function.

 The purpose of this study was to conduct an ecological review of the existing apps for PLWH and to compare the functionality of existing apps with the app specifications identified in our formative work.

We searched two mobile app stores (Google Play and iTunes) and found a total of 5606 apps. We reviewed the apps, narrowed our search terms, and found a total of 112 apps. Of these, we excluded 97 (86.6%) apps that were either not in English (10/112, 8.9%), not HIV focused (32/112, 28.9%), or focused only on HIV prevention (2/112, 7.8%); targeted health care providers (26/112, 23.2%); provided information only on conference schedules and events (7/112, 6.3%), fundraisers (7/112, 6.3%), specific clinics (7/112, 6.3%), international or narrow local resources (3/112, 2.7%); or were identified in the first search but were no longer on the market at the next review (4/112, 3.6%). The 15 apps meeting inclusion criteria were then evaluated for inclusion of the nine functionalities identified in our earlier work.

Of the 15 apps that we included in our final review, none had all of the functionalities that were identified in our formative work. The apps that we identified included the following functionalities: 

• communication with providers and/or peers (4/15, 27%), 
• medication reminders (6/15, 40%), 
• medication logs (7/15, 47%), 
• lab reports (5/15, 33%), 
• pharmacy information (4/15, 27%), 
• resources (7/15, 47%), 
• settings (11/15, 73%), 
• and search function (6/15, 40%). 
• No apps included nutrition or fitness information. 

Currently, there are only a small number of apps that have been designed for PLWH to manage their health. Of the apps that are currently available, none have all of the desired functionalities identified by PLWH and experts in our formative research. Findings from this work elucidate the need to develop and evaluate mobile apps that meet PLWH's desired functional specifications.

Read more at: http://ht.ly/SuTYn

By: Schnall R1, Mosley JP, Iribarren SJ, Bakken S, Carballo-Diéguez A, Brown Iii W.
1Columbia University, School of Nursing, New York, NY, United States.

mHealth App for Marijuana Users: Satisfaction and Perceived Usefulness

The aim of this study was to describe the characteristics of cannabis users and their levels of satisfaction with Stop-cannabis, an app intended for cannabis users who want to stop or reduce their cannabis use or prevent relapse.

A cross-sectional online survey was administered to users of Stop-cannabis, a French-language app for iOS and Android devices. All app users were invited to participate in the survey via a message sent to the app.

For hundred and eighty-two users answered the survey. The app was used daily by 348 of the participants (around 70%). More than 80% of participants (397) considered the app to have helped them “a little” or “a lot” to stop or reduce cannabis consumption. Most of the users’ suggestions were related to the number or the quality of the messages sent by, or displayed in, the app.

This pilot study supports the feasibility of such an app and its perceived usefulness. A self-selection bias, however, limits the conclusions of the study. The efficacy of the app should be evaluated in a randomized controlled trial.

Below:  Screenshots of the welcome page, the Feedback page, and the main screen with the benefits of change

Read more at: http://ht.ly/SpFai

By: Grégoire Monney,1,2 Louise Penzenstadler,1 Olivia Dupraz,2 Jean-François Etter,2,3 and Yasser Khazaal1,3,*

²Faculty of Medicine, Institute of Global Health, University of Geneva, Geneva, Switzerland

³

1Department of Mental Health and Psychiatry, Geneva University Hospitals, Geneva, Switzerland

2Faculty of Medicine, Institute of Global Health, University of Geneva, Geneva, Switzerland

3Department of Psychiatry, University of Geneva, Geneva, Switzerland

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1Department of Mental Health and Psychiatry, Geneva University Hospitals, Geneva, Switzerland

Health Care Providers' Perspectives on a Weekly Text-Messaging Intervention to Engage HIV-Positive Persons in Care (WelTel BC1)

Though evidence shows that Mobile health (mHealth) interventions can improve adherence and viral load in HIV-positive persons, few have studied the health care providers' (HCP) perspective. 

We conducted a prospective mixed methods pilot study using the WelTel intervention wherein HIV-positive participants (n = 25) received weekly interactive text messages for 6 months. Text message response rate and topic data were collected to illustrate the HCP experience. The aim of this study is to explore intervention acceptability and feasibility from the HCP perspective through a baseline focus group and end of study interviews with HCP impacted by the intervention. Interview data were thematically coded using the Technology Acceptance Model. 

HCPs identified that the WelTel intervention engaged patients in building relationships, while organizing and streamlining existing mHealth efforts and dealing with privacy issues. HCPs recognized that although workload would augment initially, intervention benefits were many, and went beyond simply improving HIV viral load.

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Mobile Phone Text Message Reminders: Measuring Preferences of People with Antipsychotic Medication

Mobile technology use, including Short Messaging Service (SMS) text messaging, has increased in health care services. Preferences regarding the type or timing of text messages sent by healthcare providers to people with antipsychotic medication have not yet been fully investigated. This study examines the relationship between patients' demographic characteristics and the tailored messages they select. 

The study ("Mobile.Net", ISRCTN: 27704027) includes a structured analysis of a random sub-sample of participants who received messages for 12months. The data were collected in 24 sites and 45 psychiatric hospitals in Finland and analyzed with descriptive statistics and Poisson regression models. The study sample involved 562 people on antipsychotic medication, and a total of 2112 text messages (2 to 25 monthly) were analysed. 

Regarding message content, there was no significant variation in the proportions relating to 'medication', 'treatment appointments' or 'free time'. Monday was the most popular day to receive messages and morning was preferred to later in the day. Age was most closely associated with 'number of messages' and 'time of messages'. 

Older women and younger men preferred higher numbers of messages (p=0.0031). Participants preferred positive, encouraging and slightly humorous messages. 

The findings suggest that messages may be acceptable for difficult to access groups in follow-up. This type of intervention may be useful for various types of patients especially for younger males. To further support the evidence about factors related to message utilization and use, it is important to evaluate the effectiveness of text messages in psychiatric care.

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Perceptions, Attitudes, and Experience Regarding mHealth among Homeless Persons in New York City Shelters

Mobile health may be an effective means of providing access and education to the millions of homeless Americans. We conducted semi-structured interviews with 50 homeless people from different shelters in New York City to evaluate their perceptions, attitudes, and experiences regarding mobile health. Participants' average age was 51.66 (SD = 11.34) years; duration of homelessness was 2.0 (SD = 3.10) years. 

The majority had a mobile phone with the ability to receive and send text messages. Most participants attempted to maintain the same phone number over time. The homeless were welcoming and supportive of text messaging regarding health care issues, including appointment reminders, health education, or management of diseases considering their barriers and mobility, and believed it would help them access necessary health care. 

Overwhelmingly they preferred text reminders that were short, positively framed, and directive in nature compared to lengthy or motivational texts. The majority believed that free cell phone plans would improve their engagement with, help them navigate, and ultimately improve their access to care. 

These positive attitudes and experience could be effectively used to improve health care for the homeless. Policies to improve access to mobile health and adapted text messaging strategies regarding the health care needs of this mobile population should be considered.

Via: http://ht.ly/RBxCM HT https://twitter.com/NYULMC

Willingness to Receive Text Message Medication Reminders among Patients on Antiretroviral Treatment in North West Ethiopia

Below:  Conceptual framework

A total of 415 (98 % response rate) respondents participated in the interview. The majority of respondents 316 (76.1 %) owned a cellphone, and 161(50.9 %) were willing to receive text message medication reminders. Positively associated factors to the willingness were the following: Younger age group (AOR = 5.18, 95 % CI: [1.69, 15.94]), having secondary or higher education (AOR = 4.61, 95 % CI: [1.33, 16.01]), using internet (AOR = 3.94, 95 % CI: [1.67, 9.31]), not disclosing HIV status to anyone other than HCP (Health Care Provider) (AOR = 3.03, 95 % CI: [1.20, 7.61]), availability of radio in dwelling (AOR = 2.74 95 % CI: [1.27, 5.88]), not answering unknown calls (AOR = 2.67, 95 % CI: [1.34, 5.32]), use of cellphone alarm as medication reminder (AOR = 2.22, 95%CI [1.09, 4.52]), and forgetting to take medications (AOR = 2.13, 95 % CI: [1.14, 3.96]).

A high proportion of respondents have a cell phone and are willing to use it as medication reminders. Age, educational status and using internet were the main factors that are significantly associated with the willingness of patients to receive text message medication reminders.

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Iteratively Developing an mHealth HIV Prevention Program for Sexual Minority Adolescent Men

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