A randomized clinical trial of mobile phone motivational interviewing for alcohol use problems in Kenya.

Abstract

To test the effectiveness of a motivational interviewing (MI) intervention using the mobile phone among adults with alcohol use problems. A randomized clinical trial of mobile MI and standard in-person MI with 1- and 6-month follow-up, including a 1-month waitlist control followed by mobile MI. A primary health center in rural Kenya. Three hundred adults screening positive for alcohol use problems were randomized and received immediate mobile MI (n=89), in-person MI (n=65) or delayed mobile MI (n=76) for waiting-list controls 1month after no treatment, with 70 unable to be reached for intervention. One MI session was provided either immediately by mobile phone, in-person at the health center or delayed by 1month and then provided by mobile phone. Alcohol use problems were repeatedly assessed using the Alcohol Use Disorder Identification Test (AUDIT) and the shorter AUDIT-C. The primary outcome was difference in alcohol score 1month after no intervention for waiting-list control versus 1month after MI for mobile MI. The secondary outcomes were difference in alcohol score for in-person MI versus mobile MI one and 6months after MI. For our primary outcome, average AUDIT-C scores were nearly three points higher (difference=2.88, 95% confidence interval=2.11, 3.66) for waiting-list controls after 1month of no intervention versus mobile MI 1month after intervention. Results for secondary outcomes supported the null hypothesis of no difference between in-person and mobile MI at 1 month (Bayes factor=0.22), but were inconclusive at 6months (Bayes factor=0.41). Mobile phone-based motivational interviewing may be an effective treatment for alcohol use problems among adults visiting primary care in Kenya. Providing mobile motivational interviewing may help clinicians in rural areas to reach patients needing treatment for alcohol use problems.