Feasibility of a Mobile Health App for Routine Outcome Monitoring and Feedback in SMART Recovery Mutual Support Groups: Stage 1 Mixed Methods Pilot Study.

Peter J Kelly,Kenny Lawson,Anthony Shakeshaft,Carla Treloar,Ryan Mcglaughlin,John F Kelly,Alison K Beck,Joanne Neale,Victoria Manning,Rebecca M Gray,Amanda L Baker,Leanne Hides,Frank P Deane,Kerrin Palazzi,Christopher Oldmeadow,Briony Larance,Angela Argent,Andrew Searles

doi:10.2196/25217

Abstract

BackgroundMutual support groups are an important source of long-term help for people impacted by addictive behaviors. Routine outcome monitoring (ROM) and feedback are yet to be implemented in these settings. SMART Recovery mutual support groups focus on self-empowerment and use evidence-based techniques (eg, motivational and behavioral strategies). Trained facilitators lead all SMART Recovery groups, providing an opportunity to implement ROM.ObjectiveThe aim of this stage 1 pilot study is to explore the feasibility, acceptability, and preliminary outcomes of a novel, purpose-built mobile health ROM and feedback app (SMART Track) in mutual support groups coordinated by SMART Recovery Australia (SRAU) over 8 weeks.MethodsSMART Track was developed during phase 1 of this study using participatory design methods and an iterative development process. During phase 2, 72 SRAU group participants were recruited to a nonrandomized, prospective, single-arm trial of the SMART Track app. Four modes of data collection were used: ROM data directly entered by participants into the app; app data analytics captured by Amplitude Analytics (number of visits, number of unique users, visit duration, time of visit, and user retention); baseline, 2-, and 8-week follow-up assessments conducted through telephone; and qualitative telephone interviews with a convenience sample of study participants (20/72, 28%) and facilitators (n=8).ResultsOf the 72 study participants, 68 (94%) created a SMART Track account, 64 (88%) used SMART Track at least once, and 42 (58%) used the app for more than 5 weeks. During week 1, 83% (60/72) of participants entered ROM data for one or more outcomes, decreasing to 31% (22/72) by the end of 8 weeks. The two main screens designed to provide personal feedback data (Urges screen and Overall Progress screen) were the most frequently visited sections of the app. Qualitative feedback from participants and facilitators supported the acceptability of SMART Track and the need for improved integration into the SRAU groups. Participants reported significant reductions between the baseline and 8- week scores on the Severity of Dependence Scale (mean difference 1.93, SD 3.02; 95% CI 1.12-2.73) and the Kessler Psychological Distress Scale-10 (mean difference 3.96, SD 8.31; 95% CI 1.75-6.17), but no change on the Substance Use Recovery Evaluator (mean difference 0.11, SD 7.97; 95% CI –2.02 to 2.24) was reported.ConclusionsFindings support the feasibility, acceptability, and utility of SMART Track. Given that sustained engagement with mobile health apps is notoriously difficult to achieve, our findings are promising. SMART Track offers a potential solution for ROM and personal feedback, particularly for people with substance use disorders who attend mutual support groups.Trial RegistrationAustralian New Zealand Clinical Trials Registry ACTRN12619000686101; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377336International Registered Report Identifier (IRRID)RR2-10.2196/15113

Highlights

BackgroundRoutine outcome monitoring (ROM) is central to evidence-based health care for a range of chronic conditions [1], including addictive behaviors [2,3]
Qualitative feedback from participants and facilitators supported the acceptability of SMART Track and the need for improved integration into the SMART Recovery Australia (SRAU) groups
SMART Track offers a potential solution for ROM and personal feedback, for people with substance use disorders who attend mutual support groups

Summary

Introduction

BackgroundRoutine outcome monitoring (ROM) is central to evidence-based health care for a range of chronic conditions [1], including addictive behaviors [2,3]. ROM and feedback have been implemented in a range of mental health [13] and addiction [14,15] treatment settings but not in mutual support groups. Mutual support is important for people experiencing addictive behaviors, given the often long-term and nonlinear process of recovery [16]. Unlike other clinically endorsed [2,3] models of mutual support for addictive behaviors (eg, 12-step approaches), SMART Recovery groups use a trained facilitator. This provides a unique opportunity to work with group facilitators to embed ROM and personal feedback as a standard component of the groups. Trained facilitators lead all SMART Recovery groups, providing an opportunity to implement ROM

Objectives

Methods

Results

Discussion

Conclusion