Alcohol use disorders-Mobile based Brief Intervention Treatment (AMBIT): Technological innovation to bridge the treatment gap for hazardous drinking.

Lead Research Organisation: Sangath
Department Name: Research

Abstract

The World Health Organization (WHO) defines three levels of problematic alcohol consumption, namely hazardous drinking (HD) (which puts a person at risk of developing health/social problems), harmful drinking (where health/social problems are already occurring), and alcohol dependence (where serious problems have already occurred). Although HD and harmful drinking affects a larger proportion of the population (and causes many more problems) than alcohol dependence (the 'prevention paradox'), in India health policy focuses mainly on institutional delivery of care for alcohol dependence. Extensive evidence globally demonstrates the effectiveness of Brief Interventions (BIs) in reducing drinking in HD. However, in India, the major barriers to providing such evidence-based psychosocial treatments are the lack/inequitable distribution of trained healthcare professionals and concerns about the cultural generalisability of psychosocial interventions developed in the West. One innovation to overcome the human resource barrier is to use mobile phone technology like SMS (Short Messaging Service) and interactive voice response (IVR) to deliver BIs to large numbers of HDs, quickly and at low cost, as demonstrated in interventions for smoking cessation. Furthermore, a growing body of evidence demonstrates that following a systematic methodology to culturally adapt psychosocial interventions increases acceptability by recipients and delivery agents, and feasibility of delivery.

The overall objective of AMBIT is to develop a contextually appropriate BI for HD that can be delivered using mobile phone technology to overcome barriers to access in low resource settings. The specific aims of AMBIT are to 1) Develop a BI package delivered using mobile phone technology, in partnership with our technology partner; 2) Examine if it is acceptable/feasible to deliver such an intervention in an Indian setting; 3) Conduct preliminary testing to see if the intervention helps in reducing drinking; and 4) Fine-tune procedures for the definitive testing of the effectiveness of the intervention. The aims of the programme will be achieved through a range of processes including identification of the existing evidence; development of the intervention in partnership with our technology partner and utilising feedback from a range of individuals and groups including Hazardous Drinkers; refinement of the intervention; and testing of its preliminary impact. The output of this treatment development process would be a contextually acceptable and feasible mobile-technology-delivered BI package which can then be tested in a larger trial. To summarise, we want to help hazardous drinkers to reduce levels of harm caused to them, their families and society in general, by transforming a way of helping (BIs) which has in the past been delivered face-to-face by healthcare workers into a much more accessible and widely available form, by using mobile phones (widely owned across India and other LMICs) and SMSs (widely used across India and other LMICs). HD is a big and growing problem, both in itself, and also because many people with HD will go on to develop even more problematic versions of AUD. If successfully developed and found to be cost-effective, our intervention can reach millions of people across the world (as mobile phone use has increased exponentially even across the developing world) and could be a real game changer in the field of public health.

Technical Summary

Hazardous drinking (HD), harmful drinking and dependent drinking reflecting progressively more serious forms of Alcohol Use Disorders. Despite the high public health burden of HD and harmful drinking in India, policy focuses predominantly on alcohol dependence which affects a much smaller proportion of the population. Extensive evidence demonstrates the effectiveness of Brief Interventions (BIs) in reducing alcohol consumption in HD. In India, the major barrier to making such evidence-based treatments accessible are the lack and inequitable distribution of trained healthcare professionals. One innovation to overcome this barrier is to use mobile phone technology like SMS to deliver BI to large numbers of HDs, quickly and at low cost, as successfully demonstrated for other behavior-change interventions such as those for smoking cessation. AMBIT's aims are to develop a contextually appropriate BI package that can be delivered using mobile phone technology. More specifically the aims include the following: 1) Develop and refine a BI package delivered using mobile phone technology; 2) Examine contextual acceptability/feasibility of the intervention; 3) Conduct preliminary evaluation of its impact on alcohol consumption; and 4) Fine-tune procedures for a RCT of the intervention. These aims will be achieved through identification of the evidence through systematic reviews; development of the intervention package for mobile phone delivery, based on that identified best evidence, and through participatory methods involving multiple stakeholders; iterative refinement of the intervention package and delivery platforms through data obtained from a treatment cohort with a before and after design; and preliminary testing of impact of the intervention and procedures for a definitive RCT through a pilot RCT. The output of this treatment development process would be a contextually acceptable and feasible mobile-technology-delivered BI package, ready for testing in a definitive RCT.

Planned Impact

The prevalence of hazardous drinking (HD) varies across India but a conservative estimate of 15% amongst males equates to approximately 94 million men with HD in India. Globally almost 80% of such men do not receive any treatment for their HD. Brief Interventions (BIs) delivered by healthcare workers are effective in reducing HD. However there is a critical shortage of healthcare workers in India: 2.08 per 1000 population, lower than WHO's critical shortage threshold of 2.28. Mobile phones, on the other hand, are almost ubiquitous-81% of the Indian population owns one. If this commonly available technological resource were to be used to deliver BI then we could increase access for HD to evidence based care.

Our project is the first step towards developing such a BI that can be delivered using mobile phone technology and it will make an impact on the following groups, in the following ways:

1)People with HD: The intervention aims to reduce drinking in HD. As users will be primary stakeholders in our project, they will play a role in the design and conduct of our research, in order to make it more relevant and acceptable. Consequently, the intervention will have an impact on health outcomes and quality of life of such drinkers, and an indirect positive impact on their family members by reducing stress, improving family finances etc.

2) Health care professionals and workers: Our intervention will generate findings relevant for clinical practice. One major reason why health workers do not intervene with HD is that they do not know what to do or how to help. If shown to be acceptable, feasible and effective, our intervention will provide health workers with a simple tool to help reduce drinking in HD. This intervention could be utilised in routine primary care as it will not require any training of health workers. In India, HD often come in contact with a range of health care professionals when they access healthcare services for a range of health problems; which would provide a window of opportunity for such professionals to link the drinker to our m-Health intervention.

3) Researchers: Researchers based in academia, government, non-governmental and the charity sector will be academic beneficiaries of our research. On a broader level, our research outputs will expand the evidence base for the use of m-Health interventions to increase access to healthcare in low resource settings, inform similar research efforts, and highlight recommendations for future research. 4) Policy makers and legislators: This group of 'decision makers' will benefit from our research, particularly on findings related to the effectiveness and cost-effectiveness of the psychosocial intervention (this evidence will be gleaned in the long term through a definitive trial).

We will adopt a multi-modal communication and engagement strategy with each of these groups, as relevant. These will include involvement of stakeholders in the research process, research and other publications, and networking in professional groups, and a preliminary policy brief.

In the shorter term, our project will lead to the development of a testable m-Health intervention for hazardous drinking, probably the first of its kind in a low and middle income country. If demonstrated to be cost effective in a definitive randomised controlled trial, our intervention will have several long term impacts. On a broader level it will contribute to the nation's health by dealing with a milder form of AUD and preventing its progression into a more severe form, and to the nation's wealth by increasing productivity in the workforce, a substantial proportion of which has drinking problems, especially in the heavy industrial sector. Finally, it will also increase the capacity of the heavily overstretched public health services in low resource settings by using technology to deliver an intervention which has traditionally been delivered by healthcare professionals.

Publications

10 25 50
 
Description The International Development Challenge Fund
Amount £42,570 (GBP)
Organisation University of Sussex 
Sector Academic/University
Country United Kingdom
Start  
 
Description Health and Wellness Camps 
Organisation Dhempe College of Arts and Science
Country India 
Sector Academic/University 
PI Contribution As part of AMBIT's case series, the research team is collaborating with educational institutions, workplaces and health centers in the state to conduct a health and wellness screening camp that will aid in the screening and recruitment of hazardous drinkers to participate in the study. The research team will recruit participants to receive the mobile-based intervention, following which the team will be conducting outcome assessment and In Depth interviews with participants to test the acceptability and feasibility of the research design.
Collaborator Contribution Our partners (educational institutions, workplaces and health centers) will contribute to this collaboration by creating awareness about the project and assisting with referring participants for screening.
Impact N/A
Start Year 2018
 
Description Health and Wellness Camps 
Organisation Government of India
Department INSTITUTE OF HOTEL MANAGEMENT, CATERING TECHNOLOGY AND APPLIED NUTRITION
Country India 
Sector Public 
PI Contribution As part of AMBIT's case series, the research team is collaborating with educational institutions, workplaces and health centers in the state to conduct a health and wellness screening camp that will aid in the screening and recruitment of hazardous drinkers to participate in the study. The research team will recruit participants to receive the mobile-based intervention, following which the team will be conducting outcome assessment and In Depth interviews with participants to test the acceptability and feasibility of the research design.
Collaborator Contribution Our partners (educational institutions, workplaces and health centers) will contribute to this collaboration by creating awareness about the project and assisting with referring participants for screening.
Impact N/A
Start Year 2018
 
Description Health and Wellness Camps 
Organisation John Distilleries
Country India 
Sector Private 
PI Contribution As part of AMBIT's case series, the research team is collaborating with educational institutions, workplaces and health centers in the state to conduct a health and wellness screening camp that will aid in the screening and recruitment of hazardous drinkers to participate in the study. The research team will recruit participants to receive the mobile-based intervention, following which the team will be conducting outcome assessment and In Depth interviews with participants to test the acceptability and feasibility of the research design.
Collaborator Contribution Our partners (educational institutions, workplaces and health centers) will contribute to this collaboration by creating awareness about the project and assisting with referring participants for screening.
Impact N/A
Start Year 2018
 
Description Health and Wellness Camps 
Organisation Kadamba Transport Corporation
Country India 
Sector Public 
PI Contribution As part of AMBIT's case series, the research team is collaborating with educational institutions, workplaces and health centers in the state to conduct a health and wellness screening camp that will aid in the screening and recruitment of hazardous drinkers to participate in the study. The research team will recruit participants to receive the mobile-based intervention, following which the team will be conducting outcome assessment and In Depth interviews with participants to test the acceptability and feasibility of the research design.
Collaborator Contribution Our partners (educational institutions, workplaces and health centers) will contribute to this collaboration by creating awareness about the project and assisting with referring participants for screening.
Impact N/A
Start Year 2018
 
Description Health and Wellness Camps 
Organisation Longuinhos Beach Resort
Country India 
Sector Private 
PI Contribution As part of AMBIT's case series, the research team is collaborating with educational institutions, workplaces and health centers in the state to conduct a health and wellness screening camp that will aid in the screening and recruitment of hazardous drinkers to participate in the study. The research team will recruit participants to receive the mobile-based intervention, following which the team will be conducting outcome assessment and In Depth interviews with participants to test the acceptability and feasibility of the research design.
Collaborator Contribution Our partners (educational institutions, workplaces and health centers) will contribute to this collaboration by creating awareness about the project and assisting with referring participants for screening.
Impact N/A
Start Year 2018
 
Description Health and Wellness Camps 
Organisation Mormugao Port Trust
Country India 
Sector Private 
PI Contribution As part of AMBIT's case series, the research team is collaborating with educational institutions, workplaces and health centers in the state to conduct a health and wellness screening camp that will aid in the screening and recruitment of hazardous drinkers to participate in the study. The research team will recruit participants to receive the mobile-based intervention, following which the team will be conducting outcome assessment and In Depth interviews with participants to test the acceptability and feasibility of the research design.
Collaborator Contribution Our partners (educational institutions, workplaces and health centers) will contribute to this collaboration by creating awareness about the project and assisting with referring participants for screening.
Impact N/A
Start Year 2018
 
Description Health and Wellness Camps 
Organisation Rosary College of Commerce & Arts
Country India 
Sector Academic/University 
PI Contribution As part of AMBIT's case series, the research team is collaborating with educational institutions, workplaces and health centers in the state to conduct a health and wellness screening camp that will aid in the screening and recruitment of hazardous drinkers to participate in the study. The research team will recruit participants to receive the mobile-based intervention, following which the team will be conducting outcome assessment and In Depth interviews with participants to test the acceptability and feasibility of the research design.
Collaborator Contribution Our partners (educational institutions, workplaces and health centers) will contribute to this collaboration by creating awareness about the project and assisting with referring participants for screening.
Impact N/A
Start Year 2018
 
Description Health and Wellness Camps 
Organisation V. M. Salgaocar College of Law
Country India 
Sector Academic/University 
PI Contribution As part of AMBIT's case series, the research team is collaborating with educational institutions, workplaces and health centers in the state to conduct a health and wellness screening camp that will aid in the screening and recruitment of hazardous drinkers to participate in the study. The research team will recruit participants to receive the mobile-based intervention, following which the team will be conducting outcome assessment and In Depth interviews with participants to test the acceptability and feasibility of the research design.
Collaborator Contribution Our partners (educational institutions, workplaces and health centers) will contribute to this collaboration by creating awareness about the project and assisting with referring participants for screening.
Impact N/A
Start Year 2018
 
Description Health and Wellness Screening Camp 
Organisation Govt.College of Arts Science & Commerce
Country India 
Sector Academic/University 
PI Contribution As part of the project's formative research efforts, the research team is collaborating with local colleges and industries in the state to conduct a health and wellness screening camp that will aid in the recruitment of hazardous drinkers that need to be interviewed as part of the study. The research team will be screening participants for hazardous drinking, once identified, the team will be conducting In Depth interviews with participants that provide consent and agree to contribute to the design and development of the treatment intervention.
Collaborator Contribution Our partners (educational institutions and local industries) will contribute this collaboration by creating awareness about the project and assisting with referring participants for screening.
Impact N/A
Start Year 2018
 
Description Health and Wellness Screening Camp 
Organisation Mormugao Port Trust
Country India 
Sector Private 
PI Contribution As part of the project's formative research efforts, the research team is collaborating with local colleges and industries in the state to conduct a health and wellness screening camp that will aid in the recruitment of hazardous drinkers that need to be interviewed as part of the study. The research team will be screening participants for hazardous drinking, once identified, the team will be conducting In Depth interviews with participants that provide consent and agree to contribute to the design and development of the treatment intervention.
Collaborator Contribution Our partners (educational institutions and local industries) will contribute this collaboration by creating awareness about the project and assisting with referring participants for screening.
Impact N/A
Start Year 2018
 
Description Health and Wellness Screening Camp 
Organisation Parvatibai Chowgule College of Arts & Science
Country India 
Sector Academic/University 
PI Contribution As part of the project's formative research efforts, the research team is collaborating with local colleges and industries in the state to conduct a health and wellness screening camp that will aid in the recruitment of hazardous drinkers that need to be interviewed as part of the study. The research team will be screening participants for hazardous drinking, once identified, the team will be conducting In Depth interviews with participants that provide consent and agree to contribute to the design and development of the treatment intervention.
Collaborator Contribution Our partners (educational institutions and local industries) will contribute this collaboration by creating awareness about the project and assisting with referring participants for screening.
Impact N/A
Start Year 2018
 
Description Health and Wellness Screening Camp 
Organisation Zuari Agro Chemicals Ltd
Country India 
Sector Private 
PI Contribution As part of the project's formative research efforts, the research team is collaborating with local colleges and industries in the state to conduct a health and wellness screening camp that will aid in the recruitment of hazardous drinkers that need to be interviewed as part of the study. The research team will be screening participants for hazardous drinking, once identified, the team will be conducting In Depth interviews with participants that provide consent and agree to contribute to the design and development of the treatment intervention.
Collaborator Contribution Our partners (educational institutions and local industries) will contribute this collaboration by creating awareness about the project and assisting with referring participants for screening.
Impact N/A
Start Year 2018
 
Description Technological partnership 
Organisation VIAMO
Sector Charity/Non Profit 
PI Contribution Our research team will provide content scripts for recording and delivering to the participants in the form of a mobile-based intervention, and collaborate with the partner to build engagement flow. The research team will recruit participants for the intervention and supply contact details to the partner organisation.
Collaborator Contribution The partner organisation will disseminate the mobile-based intervention to participants, monitor data, and ensure technical functionality. In addition to hosting messages on the service, the organisation will advise on content and design of the intervention and build engagement flow, and provide ongoing engagement optimisation. The partner will provide professional translation services and studio recording of messaging.
Impact Mobile- based intervention.
Start Year 2018
 
Title Mobile-based Brief Intervention 
Description This project aims to develop a contextually appropriate mobile-based brief intervention to reduce alcohol consumption in hazardous drinkers (HD), which will be delivered through Short message services (SMS) and Interactive Voice Response (IVR) calls over 8 weeks, around 1-2 times/week. The acceptability, feasibility and preliminary impact data is currently being tested though a case series. The findings of the case series will be further used to iteratively refine the intervention, delivery mechanism, and recruitment procedures. The final BI package and delivery mechanism will be tested in a pilot RCT. 
Type Health and Social Care Services
Current Stage Of Development Initial development
Year Development Stage Completed 2019
Development Status Under active development/distribution
Impact The intervention is developed to serve a poorly served target group, and to reduce the likelihood of worse drinking outcomes in the future. The research study will explore the preliminary effectiveness, acceptability and feasibility of this intervention, and thus, develop an evidence-base for technology-delivered psychosocial interventions in low resource settings. 
 
Title Mobile technology based Brief Intervention 
Description A technology platform has been developed to deliver a brief intervention through a mobile phone, for hazardous drinkers. The intervention delivery platform includes messages sent 2 times/week, over an 8 week period, through IVR or SMS, with reminders on alcohol self-monitoring, BI messages, behaviour modification nudges, and questions assessing self-reported behaviours. This technology component will continue to be adapted iteratively, including choices over language used, SMS/IVR and IVR voices. 
Type Of Technology New/Improved Technique/Technology 
Year Produced 2019 
Impact The technology intervention consists of SMS and IVR, which can be used to reach large numbers of HDs, quickly and at low cost. Using IVR, language/literacy barriers can be overcome, and people in remote areas accessed. The technology product is currently being developed and its impact is yet to be assessed. 
 
Description Paper presentation of formative research and case series 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact The work from the formative phase and case series was presented at an international conferences to share learnings on the development and preliminary testing of a mobile based intervention for alcohol use in India.
Year(s) Of Engagement Activity 2019
URL https://link.springer.com/article/10.1186/s13722-019-0157-1
 
Description Poster presentation of Formative research 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact The formative work on the development of contextually adapted technological interventions for alcohol use, stimulated interest among international researchers, including those from low and middle income countries due to its potential to overcome barriers of healthcare shortage in low resource settings
Year(s) Of Engagement Activity 2018
URL https://ascpjournal.biomedcentral.com/articles/10.1186/s13722-018-0121-5