A Web-Based Therapeutic Program (We Can Do This) for Reducing Methamphetamine Use and Increasing Help-Seeking Among Aboriginal and Torres Strait Islander People: Protocol for a Randomized Wait-List Controlled Trial

Abstract

BackgroundMethamphetamine use is of deep concern to Aboriginal and Torres Strait Islander communities, but access to culturally appropriate treatment resources and services is limited. Web-based programs have potential as flexible and cost-effective additions to the range of treatment options available to Aboriginal people. The We Can Do This online intervention is designed to incorporate evidence-based therapies in a culturally relevant format using narratives from Aboriginal people to contextualize the therapeutic content.ObjectiveThe goal of the research will be to test the effectiveness of the online intervention in a wait-list controlled randomized trial across multiple sites in urban, regional, and remote locations.MethodsParticipants will be Aboriginal and Torres Strait Islander people aged 16 years and over who have used methamphetamine at least weekly for the previous 3 months. They will be recruited online and via health services. During the intervention phase, participants will have access to the online intervention for 6 weeks with optional telephone or face-to-face support provided by participating health services. The primary outcome measure will be the number of days the participant used methamphetamine over the past 4 weeks compared to wait-list controls, assessed at baseline, 1, 2, and 3 months. Secondary outcomes will include help-seeking, readiness to change, severity of dependence, and psychological distress. Any important changes to the protocol will be agreed upon by the trial management committee and communicated to all relevant parties, including trial site representatives and the trial registry.ResultsRecruitment will commence in July 2019, and results are expected in early 2021. This research is funded by National Health and Medical Research Council project grant #1100696. The primary sponsor for the trial is the South Australian Health and Medical Research Institute. A trial management committee with representation from the participating health services, chief investigators, other Aboriginal experts, and consumers will oversee procedures, trial conduct, analysis, and reporting of the results.ConclusionsThe trial of this online intervention builds on existing research supporting the effectiveness of Web-based therapies for a range of psychological and other health-related issues including substance use. If successful, the We Can Do this online intervention will increase the range of options available to Aboriginal people seeking to reduce or stop methamphetamine use. It may provide a pathway into treatment for people who may otherwise be disengaged with health services for a range of reasons and will be a culturally appropriate, evidence-based resource for health practitioners to offer their clients.Trial RegistrationAustralian New Zealand Clinical Trials Registry ACTRN12619000134123p; https://www.anzctr.org.au/ Trial/Registration/TrialReview.aspx?id=376088&isReview=trueInternational Registered Report Identifier (IRRID)PRR1-10.2196/14084

A web-based application for reducing methamphetamine use amongst Aboriginal and Torres Strait Islander people: A wait-list control randomised trial. (Preprint)

“…Participants' mean (SD) age was 33.9 (8.7) years. They had been using methamphetamine from a median age of 21 years (IQR 18-28 years) and had used methamphetamine on a median (IQR) of 20 [13][14][15][16][17][18][19][20][21][22][23][24][25] days in the past 4 weeks. Eighty-two per cent smoked tobacco (92% of these, daily).…”

“…The details of the web-app have been reported elsewhere. [21] In brief, We Can Do This comprised seven modules that were co-designed with clinicians, representatives of Aboriginal Community Controlled Health Services and people with experience of use. Psychoeducational material, interactive exercises, planning and goal setting exercises were drawn from cognitive behavioural therapy, motivational interviewing, acceptance commitment therapy and narrative approaches.…”

“…Content was presented with films based on real narratives developed from qualitative interviews, and cultural content provided by advisors from diverse Aboriginal nations. [21] Our primary hypothesis was that participants who use the web-app regularly for six weeks would have significantly reduced days of methamphetamine use in the last four weeks at one-, two-and three-months post-intervention, compared to wait-listed participants with access to treatment as usual (TAU) including information about harm-minimisation and where to access support. We also hypothesised change on secondary outcomes at three-month follow-up would include increased helpseeking, decreased psychosocial distress and fewer days out of role.…”

“…If the system identified that a participant had not logged in for seven days, this triggered a text message with a prompt to log in and a link to the web-app. [21]…”

Methamphetamine and emerging drugs of concern: A training needs analysis of Australian alcohol and other drug helplines

“…Additional population-specific resources for helpline staff should be developed in partnership with experienced stakeholders. Population-specific interventions have been shown to reduce methamphetamine use amongst LGBTI people [39], while an evaluation of an online intervention aimed at Aboriginal and Torres Strait Islander people who use methamphetamine is underway [40]. There is very limited evidence on the effectiveness of AOD interventions and resources developed for culturally diverse communities, but an acknowledgement that differing cultural perspectives greatly influence AOD treatment engagement and that culturally appropriate resources are needed [41,42].…”