JMIR Publications

ABSTRACT

Background:

US military veterans who screen positive for hazardous drinking during primary care visits may benefit from a mobile app. Step Away is an evidence-based mobile intervention system for self-management of hazardous drinking. However, Step Away was not designed for veterans, and differences between veterans and civilians could limit the reach and effectiveness of the app with this population.

Objective:

The primary objective of this study was to repurpose Step Away to address the needs and preferences of the veteran primary care population. A secondary objective was to evaluate the perceived utility of integrating Step Away with phone support from peer providers. The Method for Program Adaptation through Community Engagement (M-PACE) model was used to guide the adaptation process. This model can serve as a generalizable approach that other researchers and intervention developers can follow to systematically tailor mHealth tools for a new population.

Methods:

Veteran patients who screened positive for hazardous drinking during a primary care visit (n=12) and peer providers employed by the US Veterans Health Administration (n=11) were recruited to systematically review Step Away and provide feedback on its content and presentation via online surveys and a semi-structured interview. Participants were also queried on the utility of integrating Step Away with peer phone support. Participant feedback was reviewed through an iterative process by key stakeholders who adjudicated which suggested modifications to the app could enhance engagement and effectiveness with veterans while maintaining program integrity.

Results:

Usability ratings of the individual modules of Step Away were uniformly positive across patients and peers, as was the perceived utility of the app overall and its integration with peer phone support. Personalized feedback on the health consequences and costs of drinking, options for customization, and the measurement-based care capabilities of the app, were viewed as facilitators of engagement. Conversely, lengthy text, small font, and a lack of interactive features were viewed as potential barriers with the older primary care population. Modifications to create a veteran version of the app (“Stand Down: Think Before You Drink”) included altering the appearance of the app to incorporate more veteran-centric content; adding links and options for resources and activities for veterans; and reducing the amount of text and adding veteran-specific references and common concerns and triggers for drinking in this population.

Conclusions:

The M-PACE model provided a systematic approach to repurpose Step Away to fit the needs and preferences of veteran primary care patients who engage in hazardous drinking. Quantitative and qualitative findings indicated strong support for integration of the app with peer phone support. Stand Down in combination with peer phone support may serve as an innovative, low-cost means of expanding access to care for veterans who engage in hazardous drinking. Clinical Trial: Not applicable.