JMIR Publications

ABSTRACT

Background:

The presence of discrete but fluctuating precipants, in combination with the complex and dynamic nature of gambling episodes, calls for the development of tailored interventions delivered in real-time, such as Just-In-Time Adaptive Interventions (JITAIs). JITAIs leverage mobile and wireless technologies to address dynamically changing individual needs by providing the type and amount of support required, at the right time, and only when needed. They have the added benefit of reaching underserved populations by providing accessible, convenient, and low-burden support. Despite these benefits, few JITAIs targeting gambling behaviour are available.

Objective:

This project aims to redress this gap in gambling service provision by developing and evaluating a theoretically-informed and evidence-based JITAI for people who want to reduce their gambling. Delivered via a smartphone app, GAMBLINGLESS: IN-THE-MOMENT provides tailored cognitive-behavioural and third-wave interventions targeting cognitive processes explicated by the relapse prevention model (cravings, self-efficacy, positive outcome expectancies). It aims to reduce gambling symptom severity (distal outcome) through short term reductions in the likelihood of gambling episodes (primary proximal outcome) via improvements in craving intensity, self-efficacy, or expectancies (secondary proximal outcomes). The primary aim is to explore the degree to which the delivery of a tailored intervention at a time of cognitive vulnerability reduces the probability of a subsequent gambling episode.

Methods:

GAMBLINGLESS: IN-THE-MOMENT interventions are delivered to gamblers who are in a state of receptivity (available for treatment) and report a state of cognitive vulnerability via Ecological Momentary Assessments (EMAs) three times a day. This JITAI will tailor the type, timing, and amount of support to individual needs. Using a micro-­‐randomised trial (MRT), a form of sequential factorial design, each eligible participant will be randomised to a tailored intervention condition or no intervention control condition at each EMA across a 28-day period. The MRT will be supplemented by: (i) a six-month within-group follow-up evaluation to explore longer-term effects on primary (gambling symptom severity) and secondary (gambling behaviour, craving severity, self-efficacy, expectancies) outcomes; and (ii) an acceptability evaluation via post-intervention surveys, app usage and engagement indices, and qualitative interviews. A total of 200 participants will be recruited from Australia and New Zealand.

Results:

The trial will provide important empirical data that can be used to facilitate the optimisation of this JITAI to make it a more effective, efficient, and scalable intervention.

Conclusions:

GAMBLINGLESS: IN-THE-MOMENT forms part of a suite of theoretically-informed and evidence-based online and mobile gambling interventions. The development and evaluation of this JITAI will will inform the development of an optimised version that can facilitate access to real-time support tailored to individual needs. Clinical Trial: This trial has been approved by the Deakin University Human Research Ethics Committee (2020-304) and has been registered with the Australian New Zealand Clinical Trials Registry (ACTRN12622000490774).