JMIR Publications

ABSTRACT

Background:

Background : Emergency department (ED) patients have high rates of risky alcohol use and an ED visit offers an opportunity to intervene. ED-based screening, brief intervention, and referral to treatment (SBIRT) reduces alcohol use and healthcare costs. Mobile health (mHealth) interventions may expand the impact of SBIRTs but are understudied in low-resource ED populations.

Objective:

Objectives: To assess the feasibility of and patient satisfaction with a text-based mHealth extension an ED screening program to reducing risky alcohol use in low-income, urban patients.

Methods:

Methods:

Research assistants (RAs) screened a convenience sample of ED patients in person for risky alcohol use via the Alcohol Use Disorders Identification Test (AUDIT). Patients who reported AUDIT scores ≥8 and <20 were informed of their AUDIT score and risk. RAs invited patients with text-message capable phones to receive mROAD (mobilizing to Reduce Overuse of Alcohol in the ED), a text-message based extension of the ED screening program. mROAD is a seven day program of twice daily text messages based on the NIH’s Rethinking Drinking. Subjects were allocated to control (daily sham text messages without specific guidance on behaviors: “Thanks for taking part!”), or to the mROAD intervention. Patients were interviewed at 30 days to assess acceptability, satisfaction, and changes in drinking behavior. Satisfaction was examined descriptively. Pre and post measurements of drinking behaviors and motivation were compared, as were differences in change scores between the intervention arms.

Results:

Results:

Of 1,028 patients screened, 95 (9.2%) exhibited risky alcohol use based on AUDIT and 24% of those patients (23/95) did not own a text-messaging capable phone, leaving 76% (72/95) eligible. Among eligible participants, 67% (48/72) agreed to enroll; 65% (31/48) achieved follow-up. Patients reported high satisfaction with mROAD. Changes in behavior were similar between the arms. Overall, the prior 30 day reported drinking days decreased by 5.0 (95%CI 1.7 to 8.3, p<0.005) and heavy drinking days decreased by 4.1 (95%CI 1.0 to 7.15, p=0.01). Patients reported an 11-point increase (95%CI 2.6 to 20, p=0.01, 10% overall increase) in motivation to change alcohol use via the Change Questionnaire.

Conclusions:

Conclusion: The mROAD trial was feasible with over three quarters of ED patients with risky alcohol use owned a text-message capable phone and two thirds of these were willing to participate; only one patient opted out of the intervention. Participants had an overwhelmingly favorable impression of mROAD, with greater than 90% reporting text-messages were a good way to teach, and 89% of intervention arm participants finding the messages motivating and enjoying the program. Both the mROAD and sham message groups showed promising changes in alcohol use and motivation to change. mROAD is a feasible intervention that may reduce rates of risky alcohol use in ED patients.