Smartphone Alcohol Use Disorder Recovery Apps: Cross-sectional Survey of Behavioral Intention to Use

BackgroundAlcohol use disorder (AUD) carries a huge health and economic cost to society. Effective interventions exist but numerous challenges limit their adoption, especially in a pandemic context. AUD recovery apps (AUDRA) have emerged as a potential complement to in-person interventions. They are easy to access and show promising results in terms of efficacy. However, they rely on individual adoption decisions and remain underused. ObjectiveThe aim of this survey study is to explore the beliefs that determine the intention to use AUDRA. MethodsWe conducted a cross-sectional survey study of people with AUD. We used the Unified Theory of Acceptance and Use of Technology, which predicts use and behavioral intention to use based on performance expectancy, effort expectancy, social influence, and facilitating conditions. Participants were recruited directly from 2 sources; first, respondents at addiction treatment facilities in Ontario, Canada, were contacted in person, and they filled a paper form; second, members from AUD recovery support groups on social media were contacted and invited to fill an internet-based survey. The survey was conducted between October 2019 and June 2020. ResultsThe final sample comprised 159 participants (124 involved in the web-based survey and 35 in the paper-based survey) self-identifying somewhat or very much with AUD. Most participants (n=136, 85.5%) were aware of AUDRA and those participants scored higher on performance expectancy, effort expectancy, and social influence. Overall, the model explains 35.4% of the variance in the behavioral intention to use AUDRA and 11.1% of the variance in use. Social influence (P=.31), especially for women (P=.23), and effort expectancy (P=.25) were key antecedents of behavioral intention. Facilitating conditions were not significant overall but were moderated by age (P=.23), suggesting that it matters for older participants. Performance expectancy did not predict behavioral intention, which is unlike many other technologies but confirms other findings associated with mobile health (mHealth). Open-ended questions suggest that privacy concerns may significantly influence the use of AUDRA. ConclusionsThis study suggests that unlike many other technologies, the adoption of AUDRA is not mainly determined by utilitarian factors such as performance expectancy. Rather, effort expectancy and social influence play a key role in determining the intention to use AUDRA

Evaluation of an Online System for Routine Outcome Monitoring: Cross-sectional Survey Study

BackgroundThe use of routine outcome monitoring (ROM) in the treatment of mental health has emerged as a method of improving psychotherapy treatment outcomes. Despite this, very few clinicians regularly use ROM in clinical practice. Online ROM has been suggested as a solution to increase adoption. ObjectiveThe aim of this study is to identify the influence of moving ROM online on client completion rates of self-reported outcome measures and to identify implementation and utilization barriers to online ROM by assessing clinicians’ views on their experience using the online system over previous paper-based methods. MethodsClient completion rates of self-reported outcome measures were compared pre- and postimplementation of an online system of ROM. In addition, a survey questionnaire was administered to 324 mental health service providers regarding their perception of the benefits with an online system of ROM. ResultsClient completion rates of self-reported measures increased from 15.62% (427/2734) to 53.98% (1267/2347) after they were moved online. Furthermore, 57% (56/98) of service providers found the new system less time-consuming than the previous paper-based ROM, and 64% (63/98) found that it helped monitor clients. However, the perceived value of the system remains in doubt as only 23% (23/98) found it helped them identify clients at risk for treatment failure, and only 18% (18/98) found it strengthened the therapeutic alliance. ConclusionsAlthough the current study suggests mixed results regarding service providers’ views on their experience using an online system for ROM, it has identified barriers and challenges that are actionable for improvement