Development of Smartrek a Theory Driven Mobile App to Prevent Alcohol Use Among College Students

Friday, 28 July 2017

Donna Kazemi, PhD, MSN
School of Nursing, University of North Carolina at Charlotte, Charlotte, NC, USA

Development of Smartrek a Theory Driven mobile app to Prevent Alcohol Use among College Students based on Motivational Intervention: Adaptation, Design, Testing




Background Hazardous alcohol consumption use and its related consequences is a foremost global public health issue facing individuals, families, and society contributing to significant morbidity among youth college students. More than one third of college students report engaging in heavy episodic drinking (4+/5+ drinks in a single sitting for females/males) at least once in the past two weeks, and 8% (females) to 20% (males) consume at least twice on a binge (i.e., 8+/10+ drinks) Alarming numbers of college students drink heavily, often in binges, bringing negative consequences such as blackout, rape, HIV-related sexual risk-taking, academic failure, suicide and violence The most recent survey conducted by the 2015 National College Health Association found that among the 34,208 students who responded, 63% reported drinking in the last 30 days. Alcohol is the most commonly used substance, with one out of three young adults reporting binge drinking Binge drinking is associated with substantial negative consequences including annual rates of 646,000 physical assaults, 97,000 sexual assaults, 599,000 unintentional injuries, and 1,825 deaths. Excessive alcohol use is one of the greatest societal medical burdens with an annual cost exceeding $250 billion per year.

Today’s college students are the first generation raised in a media environment; known as ‘Net Generation’, they have always had access to digital technologies In the United States, 91% of adults use a mobile phone with over 50% owning Smartphones. Those in “Generation Z” who have extensive access to digital technology view communication using this technology. Technologies such as mobile apps, text messaging and online chat increase receptivity to new information and verbalization in this age group. Mobile apps represent a novel growing market, and environment in which to disseminate health behavior change interventions. App features are delivered as individual components (e.g., text only) or in combination. New technologies, such as smartphones, offer more efficient delivery to college students, who access their phones multiple times a day

Given the familiarity and comfort that students have with mobile phones and their willingness to adopt new trends, there are exciting opportunity to use mHealth to deliver interventions. One approach to reducing high-risk drinking is Motivational Intervention (MI), a person-centered approach to strengthening motivation for change. MI is an empirically supported, evidence-based intervention for students aged 18-25 that uses a directive but non-confrontational approach with personalized feedback to resolve ambivalence and reduce alcohol misuse and its harms. A growing body of research demonstrates the effectiveness of computerized MI deliveries. Computerized interventions simulate face-to-face interventions by giving personalized feedback on characteristics related to behavior change. In addition, web interventions that incorporate personalized feedback and harm reduction strategies have shown some promise with mandated college students and could be of use with students during the summer months. The widespread use of evidence-based Brief Motivational Interviewing (BMI) on campuses has been hindered by logistical issues and the financial costs of implementation. Interventions have been developed to reduce alcohol use among student that would be related in real-life, real-time situations. There is mounting evidence that mobile-based technology is a promising approach for reducing substance use and warrants further investigation.

Objective: The objectives of this current study were 1) to translate the motivational intervention to mobile delivery, 2) based on the translations to design and develop a smartphone (SP) application (or “app”) to deliver a modified intervention through mobile phones and use electronic communications (e.g., text messaging) for interactions and 3) once development of the app was completed, we then tested the app by conducting theater testing and field testing to determine acceptability with the college population. Thus we designed an innovative app by refining the original MI to address drinking by college students and tested college students’ responses to and acceptance of delivery of our adapted app.

We aim to develop a mobile app intervenient based on in motivational interviewing that will 1) development of a mobile intervention that would be applied in real-life, real-time environments to reduce hazardous drinking amongst college students. We developed a smartphone (SP) application (or “app”) to deliver a modified intervention through mobile phones and use electronic communications (e.g., text messaging) for interactions. 2) Once modifications are complete, we examined the feasibility of the intervention by conducting theater testing and field testing to determine acceptability with the college population.

Methods: Using components of intervention mapping as a guide we designed a Smartphone app by translating Motivational Intervention techniques conducted in three phases, 1) first in phase 1 we adapted the MI constructs for mobile delivery and developed preliminary app designs, 2) then based on the preliminary designs we developed the app and system server, and 3) finally in phase 3 we tested the app by conducting theater and field testing (n=20) to determine feasibility and acceptability among college students.

Results: The components of motivational interviewing (MI) and MI spirit were integrated into the SmarTrek features (e.g., engaging, focusing, evoking, planning, acceptance, compassion, and partnership). A suite of mobile features was developed based on ME and EMI constructs which enable effective change of the students drinking behaviors. The mobile app features that were developed within this framework included integrated tools of surveys and assessments, personalized feedback reports, real-time email communication (Coach), motivational text messaging, and educational games. SmarTrek average overall usability score was 5.97 out of 7 (SD=1.20, Cronbach's α=0.916). Looking at the three sub-scales, the usefulness of the APP was measured using 4 items and the average score was 5.68 (SD=1.06, α=0.781). Ease of use was measured using 15 items and the average score was 6.03 (SD=1.24, α=0.951). The satisfactory was measured using 7 items and the average score was 6.02 (SD=1.20, α=0.648). 90% of the participants would like to recommend the APP to friends; 50% of the participants agreed/strongly agree that they drank less while using the APP; 60% at least agreed on a positive effect of the APP; 80% of the participants would like to continue using the strategies learned and 40% participants thought they were motivated to reduce drinking while using the APP.

Conclusion: SmarTrek was developed and tested with multiple features to deliver BMI to college students with risky alcohol behaviors. The integration of theory into SmarTrek a mHealth self-monitoring app provides support for future research to feasibly assimilate theoretical constructs into existing hazardous drinking among college students. This important work would best be accomplished by a global multi-disciplinary collaboration to include nurses, health service providers, computer scientists, mathematicians, internet technical specialists, government/community services, and public citizens.