A randomized clinical trial of mobile phone motivational interviewing for alcohol use problems in Kenya

Abstract

Aim To test the effectiveness of a motivational interviewing (MI) intervention using the mobile phone among adults with alcohol use problems. Design A randomized clinical trial of mobile MI and standard in-person MI with 1-and 6-month follow-up, including a 1-month waitlist control followed by mobile MI. Setting A primary health center in rural Kenya. Participants Three hundred adults screening positive for alcohol use problems were randomized and received immediate mobile MI (n = 89), in-person MI (n = 65) or delayed mobile MI (n = 76) for waiting-list controls 1 month after no treatment, with 70 unable to be reached for intervention. Intervention and comparator One MI session was provided either immediately by mobile phone, in-person at the health center or delayed by 1 month and then provided by mobile phone.Measurements Alcohol use problems were repeatedly assessed using the Alcohol Use Disorder Identification Test (AU-DIT) and the shorter AUDIT-C. The primary outcome was difference in alcohol score 1 month after no intervention for waiting-list control versus 1 month after MI for mobile MI. The secondary outcomes were difference in alcohol score for in-person MI versus mobile MI one and 6 months after MI. Findings For our primary outcome, average AUDIT-C scores were nearly three points higher (difference = 2.88, 95% confidence interval = 2.11, 3.66) for waiting-list controls after 1 month of no intervention versus mobile MI 1 month after intervention. Results for secondary outcomes supported the null hypothesis of no difference between in-person and mobile MI at 1 month (Bayes factor = 0.22), but were inconclusive at 6 months (Bayes factor = 0.41). Conclusion Mobile phone-based motivational interviewing may be an effective treatment for alcohol use problems among adults visiting primary care in Kenya. Providing mobile motivational interviewing may help clinicians in rural areas to reach patients needing treatment for alcohol use problems.

Commentary on Harder et al. (2020): Ensuring the sustainability of mHealth in low‐ and middle‐income countries—how do we cure ‘pilotitis’?

“…To ensure that impacts are sustained, researchers should consider the wider technological, human resource and health system needs .Harder et al . add to the rapidly growing literature supporting the use of digital technology to reduce heavy drinking . The authors find that motivational interviewing‐based alcohol interventions delivered by mobile phone perform as well as their face‐to‐face alternatives, at least in the short term.…”

Effectiveness of eHealth Interventions for HIV Prevention and Management in Sub-Saharan Africa: Systematic Review and Meta-analyses

“…2 Studies measured intention to carry out HIV prevention behaviours; both found significant improvement among those in the eHealth intervention arm compared with control [42,44]. 1 Study assessed the impact of eHealth interventions on other outcomes which found that alcohol use was significantly reduced among participants in the intervention arm compared to control [24].…”

A Systematic Review of Substance Use and Substance Use Disorder Research in Kenya

“…4. Only one study evaluated digital strategies for delivering substance use interventions (99) yet the feasibility of such strategies has been demonstrated for other mental disorders in Kenya (144). Moreover, the time is ripe for adopting such an approach to substance use treatment given the fact that the country currently has a mobile subscriptions penetration of greater than 90% (145).…”

“…The number of sessions ranged from one(103,107) to six (100-102,106). Most of the individual level interventions targeted harmful alcohol use (n=9)(99)(100)(101)(102)104,106,107,109,110). One study targeted khat use among men(103), while another the use of multiple substances(105).…”

“…All interventions had a positive impact on substance use except the study that used the contingency management approach(104). The interventions were delivered in various settings as follows: community settings (n=6)(99,(102)(103)(104)109,110) of which one was delivered in a HIV prevention drop in center (102), HIV treatment or testing out-patient clinics (n=3)(101,106,107), alcohol and drug abuse rehabilitation facility (n=1) (100), and within a college (n=1) (105). One study described the process of culturally adapting a CBT intervention for alcohol use, for use among a population of PLHIV (106).…”