Download Your Doctor: Implementation of a Digitally Mediated Personal Physician Presence to Enhance Patient Engagement With a Health-Promoting Internet Application.

BACKGROUND: Brief interventions delivered in primary health care are effective in reducing excessive drinking; online behavior-changing technique interventions may be helpful. Physicians may actively encourage the use of such interventions by helping patients access selected websites (a process known as "facilitated access"). Although the therapeutic working alliance plays a significant role in the achievement of positive outcomes in face-to-face psychotherapy and its development has been shown to be feasible online, little research has been done on its impact on brief interventions. Strengthening patients' perception of their physician's endorsement of a website could facilitate the development of an effective alliance between the patient and the app. OBJECTIVE: We describe the implementation of a digitally mediated personal physician presence to enhance patient engagement with an alcohol-reduction website as part of the experimental online intervention in a noninferiority randomized controlled trial. We also report the feedback of the users on the module. METHODS: The Download Your Doctor module was created to simulate the personal physician presence for an alcohol-reduction website that was developed for the EFAR-FVG trial conducted in the Italian region of Friuli-Venezia-Giulia. The module was designed to enhance therapeutic alliance and thus improve outcomes in the intervention group (facilitated access to the website). Participating general and family practitioners could customize messages and visual elements and upload a personal photo, signature, and video recordings. To assess the perceptions and attitudes of the physicians, a semistructured interview was carried out 3 months after the start of the trial. Participating patients were invited to respond to a short online questionnaire 12 months following recruitment to investigate their evaluation of their online experiences. RESULTS: Nearly three-quarters (23/32, 72%) of the physicians interviewed chose to customize the contents of the interaction with their patients using the provided features and acknowledged the ease of use of the online tools. The majority of physicians (21/32, 57%) customized at least the introductory photo and video. Barriers to usage among those who did not customize the contents were time restrictions, privacy concerns, difficulties in using the tools, and considering the approach not useful. Over half (341/620, 55.0%) of participating patients completed the optional questionnaire. Many of them (240/341, 70.4%) recalled having noticed the personalized elements of their physicians, and the majority of those (208/240, 86.7%) reacted positively, considering the personalization to be of either high or the highest importance. CONCLUSIONS: The use of a digitally mediated personal physician presence online was both feasible and welcomed by both patients and physicians. Training of the physicians seems to be a key factor in addressing perceived barriers to usage. Further research is recommended to study the mechanisms behind this approach and its impact. TRIAL REGISTRATION: Clinicaltrials.gov NCT 01638338; https://clinicaltrials.gov/ct2/show/NCT01638338 (Archived by WebCite at http://www.webcitation.org/6f0JLZMtq)

Information Interface - Volume 35, Issue 1 - January/February 2007

News and information about Himmelfarb Health Sciences Library of interest to users

How online communication and social media networking are used in alcohol use treatment

Understanding cultural shifts towards the increasing trend of seeking treatment offered through online communication and utilization of social networking sites has changed the way mental health professionals approach alcohol use treatment. This study illuminates the ways in which mental health professionals are currently exploring methods of counseling through online communication and social networking sites to improve their practice and reach more clients, thus helping increasing numbers of people while earning a greater profit. Through the research, numerous benefits and drawbacks of social networking and online communication used in mental health treatment are identified, particularly when working in alcohol use treatment. When communicating with clients online, there are a multitude of observations derived from researchers, particularly surrounding the quality of the therapeutic experience affecting practitioner and client alike. Utilizing a grounded theory approach in the research process allowed for the ability to arrive at a theoretical construct based upon the use of open and axial coding. The findings derived from the research argue that social networking and online communication are excellent tools utilized for the mass dissemination of information. Examples include: increased opportunities for networking between professionals, and an opportunity to advertise on a larger scale to increase overall exposure, awareness, and outreach to clients. The use of careful observation around the findings based on interviewing 15 therapists matching common criteria indicate that social networking and online communication are not the preferred, nor appear to be the most effective means of treatment by mental health professionals when working with those who struggle with alcohol use. The study informs the profession that there remains ample room for further research, particularly in regard to establishing legal as well as ethical guidelines to ensure proper use of technology by professionals practicing in the field of alcohol use treatment. The findings derived from the study support the importance of educating counselors practicing alcohol use treatment in an age where technology is continually changing and methods of communication online are evolving. In addition to those professionals who are currently practicing in the field, graduate students in preparation to become mental health professionals working in alcohol use treatment will benefit from being introduced to research findings to ensure effective treatment outcomes

Engagement with Digital Behaviour Change Interventions: Conceptualisation, Measurement and Promotion

Digital behaviour change interventions (DBCIs) can help people change various health behaviours; however, engagement is low on average and there is a positive association of engagement with intervention effectiveness. The extent to which this relationship is confounded or subject to reverse causality is unclear, and evidence-based models of how to promote engagement are lacking. Progress is hindered by the existence of multiple definitions and measures of engagement; this hampers attempts to aggregate data in meta-analyses. Using smartphone applications (apps) for smoking cessation and alcohol reduction as case studies, this thesis investigated how to conceptualise and measure engagement and identified factors that influence engagement with DBCIs in general, and with apps for smoking cessation and alcohol reduction in particular. Six studies using qualitative and quantitative methods were conducted. Study 1 was a systematic, interdisciplinary literature review, which synthesised existing conceptualisations and generated an integrative definition of engagement with behavioural and experiential dimensions, and a conceptual framework of factors that influence engagement with DBCIs. Studies 3 and 4 involved the development and evaluation of a self-report measure of the behavioural and experiential dimensions of engagement. Studies 2, 5 and 6 used mixed-methods to identify factors that influence engagement with apps for smoking cessation and alcohol reduction. Engagement with DBCIs can usefully be defined in both behavioural and experiential terms: the self-report measure demonstrated promising psychometric properties and was underpinned by two distinct factors, labelled ‘Experiential Engagement’ and ‘Behavioural Engagement’. Design features that support users’ motivation to change, foster their beliefs about the perceived usefulness and relevance of the technology, and spark their interest were found to be most important in the promotion of engagement with apps for smoking cessation and alcohol reduction. These findings can be used to inform the design of new, or modification of existing, apps for these behaviours

EXPERIENCES OF INDIVIDUALS WHO MAINTAIN ABSTINENCE FROM MOOD ALTERING SUBSTANCES USING SELF-DIRECTED, COGNITIVE-BASED RECOVERY SUPPORT GROUPS

The purpose of this study was to examine how individuals who utilize self- directed recovery support groups perceive the recovery process and how the described experiences of participants compare to 12-step recovery as reported in existing academic literature. Six individuals who have maintained sobriety for a minimum of one year participated in this qualitative study. The individuals also participated in SMART Recovery, Secular Organizations for Sobriety or Women for Sobriety within the past year, and did not participate in 12-step support groups for at least one year prior to the study’s approval date. Data collection included a demographic form and one 60-90 minute, audio-recorded interview, during which participants were asked primarily open questions about their respective experiences in sobriety. Data analysis consisted of a phenomenological procedure adapted from Moustakas (1994). The procedure revealed that participants perceive the recovery process as beginning with freedom and individual choice, continuing into a sense of community and belonging, proceeding with a journey of self-discovery, and culminating in the development of recovery maintenance tools. Participant experiences relate to 12-step recovery in terms of community and fellowship within recovery support groups. Participant experiences diverge from 12-step recovery in terms of spirituality and adherence to sequential steps or perceived programmatic rigidity. Participants maintain that sobriety is a “separate issue” and not necessarily related to spiritual/religious issues or to the attendance of recovery support group meetings. The findings suggest that individuals who use support groups such as SMART Recovery, Secular Organizations for Sobriety, and Women for Sobriety maintain abstinence through face-to-face or online support group meetings and by utilizing a variety of self-directed relapse prevention methods. Counselors are recommended to consider self-directed recovery support groups as a viable referral option for clients dealing with substance use issues. Further research is needed to gain more insight into how individuals use self-directed support groups and online recovery resources to maintain abstinence from mood altering substances

Reaching out : Internet-based self-assessment of problematic substance use with personalized feedback

Background: Effective treatment methods for reducing problematic substance use exist for delivery by professional treatment providers. However, they are highly underutilized since the vast majority of the substance users never seek professional help for their problematic use. In recent years, Internet-based interventions have been recognized as potentially effective tools for reaching individuals with problematic substance use and reducing such use. The aim of this thesis is to describe the development of eScreen.se, a Swedish Internet-based screening and brief intervention service for problematic alcohol and drug use, and to explore whether eScreen.se is an effective way of reaching problematic alcohol and drug users as well as an effective service for reducing their problematic substance use. Method: In a naturalistic study, eScreen.se users were studied with regard to their individual characteristics and utilization patterns during the first 20 months of public availability for eScreen.se (Study I). Using the same electronic screening instruments that are part of eScreen.se, the prevalence of problematic alcohol and illicit drug use was explored among 1861 individuals in a random sample from the Swedish general population (Study II). The effects of eScreen.se on reducing problematic substance use were explored in two randomized controlled trials, one with 634 problematic alcohol users (Study III) and the second with 202 illicit drug users (Study IV). In both trials, the interventions were compared to Internet-based assessment only. In the alcohol trial, eScreen.se was also compared to an online self-help intervention based on the principles of Cognitive-Behavioral Therapy (CBT) and Motivational Interviewing (MI), Alkoholhjalpen.se. Participants in both trials were followed up for 6 months (drugs) and 12 months (alcohol) after recruitment to the study. Results: Of the 2361 individuals that created an account at eScreen.se during the first 20 months of public availability, 51 percent were women, with a mean age of 23 years (SD=10) in the total sample. In total, 67 percent reported problematic alcohol use while 46 percent reported problematic use of illicit drugs. The highest prevalence of problematic use was found among 18- 24 year olds (76 percent for problematic alcohol use and 64 percent for illicit drug use), with small gender differences. Corresponding prevalence figures for the sample from the Swedish general population were 21 percent for problematic alcohol use and 3 percent for illicit drug use. The psychometric properties of the electronic tests used in eScreen.se were very good, with Cronbach's α values well above 0.80. The two randomized controlled trials showed that eScreen.se was associated with a decrease in substance use occurring in the first three months and maintained for up to 12 months. However, among individuals with problematic alcohol use, eScreen.se was equally effective to Internet-based assessment only and partial indications were found showing that the use of the more intensive service Alkoholhjalpen.se was more effective in reducing problematic alcohol use than the use of eScreen.se or assessment only. Partial indications also showed that the use of eScreen.se among illicit drug users was more effective in reducing drug-related problems than Internet-based assessment only, up to three months after recruitment to the study, with effects maintained up to six months. Use of eScreen.se was also associated with decreasing alcohol consumption and alcohol-related problems among drug users, up to six months after recruitment to the study. Conclusions: Through eScreen.se, an Internet-based screening and brief intervention service, professional instruments for identifying individuals with problematic substance use have been made available on a broad population basis. eScreen.se has been shown to be an important platform for reaching groups that are underrepresented in traditional treatment settings and the use of the service is associated with decreases in substance use including alcohol and illicit drugs

Engendering Spirits: Alcoholic Self-Help and Emphasized Femininity

Gender theorists have long posited that the social construction of gender encourages women to embody specific ideals of femininity. Any circumstance or situation, then, that threatens a woman’s ability or capacity to fulfill these ideals is regarded as abnormal and often receives large amount of interest. This thesis provides a critical analysis of the gendered practices used in conjunction with the ideas, messages, and advice given to women with alcohol dependence. By doing a qualitative content analysis, I explored how the concepts of emphasized femininity are presented in self-help literatureforalcohol dependent women. My findings show that gendered ideas about alcoholic recovery are mainly constructed through white, heterosexual, middle-class lenses that perpetuate feminine subordination