ehealth treatment and health promotion: alcohol and other drugs David Kavanagh Queensland University

1
e-health treatment and health promotion alcohol
and other drugsDavid KavanaghQueensland
University of Technology1 December, 2009

• CRICOS No. 00213J

2
Substance use is a prime target for internet
interventions

• Large numbers of people affected
• Too many for standard services

3
Substance misuse involveslarge numbers

• 5 (800k) with substance use disorders
• (last 12 months, ABS 2008)
• More at risk of disorders
• 21 smokers
• (ABS 2007)

4
Substance use disorders affect large numbers

• 5 (800k) with substance use disorders
• (last 12 months, ABS 2008)

5
Substance use disorders affect large numbers

• 5 (800k) with substance use disorders
• (last 12 months, ABS 2008)
• 21 smokers
• (ABS 2007)

6
Regular Drinking at Risk(Men gt 28/week women gt
14) 2007 Australian household survey
10
9
7
Binge drinking at least monthly (Men gt 6/ Women
gt 4)2007 Australian household survey
(On 2007 guidelines, underestimates risk
higher limit for men.)
24
17
9
8
Substance use is a prime target for internet
interventions

• Large numbers of people affected
• Too many for standard services
• Especially young people
• who are early adopters of technology

9
Regular Drinking at Risk(Men gt 28/week women gt
14) 2007 Australian household survey
16
9
10
Binge drinking at least monthly (Men gt 6/ Women
gt 4)2007 Australian household survey
44
35
9
11
16-30 is peak time for substance use disorder
Australian Bureau of Statistics (2008)
12
Substance use is a prime target for internet
interventions

• Large numbers of people affected
• Too many for standard services
• Especially young people
• Who are early adopters of technology
• Brief, face-to-face treatments work
• In fact, its often hard to do better

13
Meta-analysis alcohol

• Rank Order studies studies
• (Quality x Outcome)
• Brief Intervention 68 31
• 2. Motivation enhancement 71 17
• Miller Wilbourne (2002) Addiction 97, 265-277

14
Substance use is a prime target for internet
interventions

• Large numbers of people affected
• Too many for standard services
• Especially young people
• Who are early adopters of technology
• Brief, face-to-face treatments work
• In fact, its hard to do better
• Bibliotherapy and mailed treatments work

15
Study 2(Kavanagh, Sitharthan, Spilsbury,
Vignaendra,1999)(10 gm Units/Week)Uses
participants at 2 months, persons own average
substituted for missing data.
16
Study 2(Kavanagh, Sitharthan, Spilsbury,
Vignaendra,1999)(10 gm Units/Week)Uses
participants at 2 months, persons own average
substituted for missing data.
?
Brief S-M, Wait received Full
17
Study 2(Kavanagh, Sitharthan, Spilsbury,
Vignaendra,1999)(10 gm Units/Week)Uses
participants at 2 months, persons own average
substituted for missing data.
?
?
Brief S-M, Wait received Full
Extended S-M received Full
18
Internet intervention does appear to work
19

• Courseslimited effect
• Assessment feedback ? lt use/problems, esp. in
  short term
• Motivational intervention improves impact
• Full interventionssignificant, sustained results

20
Courses have limited impact

• Croom et al (2009)
• college freshmen online course vs control
• gt knowledge, lt drinking games, not other drinking
  
• Bersamin et al. (2007)
• college students (regular drinkers)
• Course vs control
• heavy drinking less often, lt drunkenness, -
  consequences.

21
Randomised Controlled TrialsNormative
assessment feedback

• Neighbours et al. (2009)
• alcohol, 21st Bday, college students
• feedback, norms, harm reduction info
• BAC (.10) lt assessment alone (.13)
• Bewick et al. (2008)
• college students
• feedback, norms vs control
• lt alcohol per occasion, not units/week
• Walters et al. (2007) college students with
  heavy episodic drinking
• Feedback vs assessment only
• lt drinks/wk, max BAC at 8 weeks, at 16 wks both
  fell equally
• No effect on light drinkers, abstainers
• Chiauzzi et al. (2005) college students

22
Non-College samples

• Finfgeld-Connett et al. (2008)
• rural women misusing alcohol
• RCT Info, decision making, bulletin board, chat
  vs standard care
• No difference in alcohol use
• Riper et al. (2007)
• 261 adult problem drinkers
• Multi-component intervention vs. psychoed online
• At 6 months 17 within limits vs 5
• 44 drinks/week ? 29 drinks vs 44 drinks ? 41
  drinks
• Cunningham et al. (2005)
• problem drinkers
• Assessment feedback self-help book vs feedback
  alone
• lt alcohol use at 3 mths

23
Randomised Controlled TrialsMotivational
Intervention

• Kypri et al (2008)
• college students
• Web-based MI 1, 6 mth boosters vs Single MI vs
  Info pamphlet
• Both web treatments ? lt alcohol use lt acad
  problems to 12/12

24
Smoking

• Stretcher et al (2005)
• 3791 people buying nicotine patches in UK and
  Ireland
• Web-based cessation guide, 3 newsletters, email
  support messages, tailored advice to support
  person vs non-tailored advice
• 6-week continuous abstinence 29 vs 24
• An et al. (2008)
• 517 college students
• Control link to online smoking resources,
  competition for smoke-free prize
• vs. this plus
• 10/wk for 20 visits to report health
  lifestyle, do quiz, view online magazine with
  cessation messages
• peer email support (50 prize if write back)
• 30 day abstinence 41 vs 23 Control

25
Internet interventions should have advantages
over mailed ones

• Immediate feedback
• Should be more reinforcing?
• Opportunity for multimedia, less writing
• Should reduce reliance on reading?
• Entertainment aspects should increase retention?
• Potential email, SMS interface
• Increase retention if cue access?
• Improved monitoring
• Cueing of strategy use should increase
  generalisation

26
Are they living up to expectations?

• Better retention?
• Better outcomes?
• Better engagement of young people?
• Less skewed education profile?
• Highly accepted?

27
Quality of existing sites 2009
28
Expert review of alcohol other drug sites

• 157 sites identified on Google search
• 56 sites evaluated
• Priority to
• greater focus on AOD
• Younger target audience
• More interactivity
• Australian, or high-prominence international
• Evaluated by 2/5 raters
• Any differences resolved by discussion
• (Proudfoot, Drennan et al., 2009)

29
Rating areas

• Description
• Homepage
• Clarity of purpose/ Scope/ Clarity of target
  population/ Trustworthiness
• Usability
• Ease of navigation, site use / Accessibility
• Interactivity (incl bulletin board/forum/online
  discussion)
• Questions/prompts for input
• Clarity/ Utility, relevance
• Quality of personal feedback
• Clarity/ Utility, relevance
• Attractiveness

30
Rating areas Addiction researchers

• Nature of intervention
• Information
• Accuracy, currency
• Comprehensiveness
• Balance
• Clarity
• Relevance to target group

31
Findings

• Site quality acceptable
• means 7.0-8.8 / 10
• But not reflecting current tech capabilities
• Content ratings
• Relevant to audience 7.2 (2.2)
• Current 7.1 /10 (1.9)
• Clear 7.0 (1.8)
• But less strong on
• Balance 6.4 (2.7)
• Comprehensiveness 5.6 (2.3)

32
Findings

• Sites generally of reasonable tech quality
• Few take full advantage of technology
• Language often too complex
• Little advice on what treatments work
• Intervention rarely given online

33
Observations and qualitative data9 Groups

• Observation of website use
• Max of 6.5 min on a site
• less if young
• 2 min if not 1st site accessed

34
Observations free search (9 groups)

• Average time on a website
• 16-24 418 400 312 248
• 25-65 530 530 418 242

35
Also, marketing issues
36
Online Consumer survey, n 3008Preference if
had a problem...

• Alcohol, Other drugs
• 18 18 Internet telephone support
• 19 18 Self-help, no therapist support
• 22 26 Internet face-to-face support
• 35 34 Internet email support
• (Klein et al. 2009)

37
What would use (Yes)

• Downloadable fact sheets (58)
• Portal giving advice on websites (50)
• Online tests with feedback (46)
• Systems tailoring information to user (43)
• ...
• (Chat room 10)
• (Own online support group 9)

38
Focus groups

• Cautious, somewhat negative
• Impersonal
• Skeptical re validity of assessment, effects of
  treatment
• Need for ongoing support
• Positive comments re
• Initial stepe.g. screening
• Where anonymity needed
• Thought it was likely to require more motivation

39
(No Transcript)
40
(No Transcript)