Toward Increasing Engagement in Substance Use Data Collection: Development of the Substance Abuse Research Assistant App and Protocol for a Microrandomized Trial Using Adolescents and Emerging Adults.
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BACKGROUND Substance use is an alarming public health issue associated with significant morbidity and mortality Adolescents and emerging adults are at particularly high risk because substance use typically initiates and peaks during this developmental period Mobile health apps are a promising data collection and intervention delivery tool for substance using youth as most teens and young adults own a mobile phone However engagement with data collection for most mobile health applications is low and often large fractions of users stop providing data after a week of use OBJECTIVE Substance Abuse Research Assistant SARA is a mobile application to increase or sustain engagement of substance data collection overtime SARA provides a variety of engagement strategies to incentivize data collection a virtual aquarium in the app grows with fish and aquatic resources occasionally funny or inspirational contents eg memes or text messages are provided to generate positive emotions We plan to assess the efficacy of SARA s engagement strategies over time by conducting a micro randomized trial where the engagement strategies will be sequentially manipulated METHODS We aim to recruit participants aged 14 24 years who report any binge drinking or marijuana use in the past month Participants are instructed to use SARA for 1 month During this period participants are asked to complete one survey and two active tasks every day between 6 pm and midnight Through the survey we assess participants daily mood stress levels loneliness and hopefulness while through the active tasks we measure reaction time and spatial memory To incentivize and support the data collection a variety of engagement strategies are used First predata collection strategies include the following 1 at 4 pm a push notification may be issued with an inspirational message from a contemporary celebrity or 2 at 6 pm a push notification may be issued reminding about data collection and incentives Second postdata collection strategies include various rewards such as points which can be used to grow a virtual aquarium with fishes and other treasures and modest monetary rewards up to US 12 US 1 for each 3 day streak also participants may receive funny or inspirational content as memes or gifs or visualizations of prior data During the study the participants will be randomized every day to receive different engagement strategies In the primary analysis we will assess whether issuing 4 pm push notifications or memes or gifs respectively increases self reporting on the current or the following day RESULTS The microrandomized trial started on August 21 2017 and the trial ended on February 28 2018 Seventy three participants were recruited Data analysis is currently underway CONCLUSIONS To the best of our knowledge SARA is the first mobile phone app that systematically manipulates engagement strategies in order to identify the best sequence of strategies that keep participants engaged in data collection Once the optimal strategies to collect data are identified future versions of SARA will use this data to provide just in time adaptive interventions to reduce substance use among youth TRIAL REGISTRATION ClinicalTrials gov NCT03255317 https clinicaltrials gov show NCT03255317 Archived by WebCite at http www webcitation org 70raGWV0e REGISTERED REPORT IDENTIFIER RR1 10 2196 9850