Exploring Fit in an mHealth Effectiveness-Implementation Trial: A Qualitative Study (Preprint)

Abstract

BACKGROUND Implementation frameworks like the EPIS model emphasize the importance of the “fit” between an intervention and its context, which includes the needs of its target population, as well as the culture, resources, and capabilities of the implementing organization. Even though lack of fit is a major barrier to implementation, fit has not often been a focus of implementation research. OBJECTIVE This paper uses fit as a lens to examine the implementation of Tula, an mHealth app aimed at reducing risky drinking days among individuals meeting the criteria for mild to moderate alcohol use disorder, in a 3-arm (app alone; app plus peer mentoring; app plus health coaching) RCT. METHODS Semi-structured interviews with 18 trial participants and 7 Tula implementers were conducted. Trial participants were pulled equally from each arm of the trial, and represented participants who demonstrated both high and low engagement with the application. Implementers consisted of a project manager, 4 peer mentors, and 2 health coaches. Interviews with participants focused on their motivations, opinions, and experiences of the intervention and their perception of their drinking behavior following the intervention, including how their use of the app worked to change that behavior. Interviews with implementers were centered on their roles, theories of change, perceptions of intervention, and areas for improvement. All interviews were analyzed using rapid qualitative analysis with both deductive and inductive components. RESULTS We identified areas of both fit and misfit. For example, there was a good fit between implementers’ theories of change and participants’ description of how change occurred. Fit was improved by the versatility of the app, which allowed participants to customize their experiences. Conversely, misfit was noted in the app’s inability to cultivate connection for many participants and a disjunction between the role of peer mentors in the intervention and their broader professional ethos. CONCLUSIONS Focusing on fit provides a useful guide to enhance future iterations of the Tula app that lead to better sustainment of the intervention. CLINICALTRIAL NCT04011644 (ClinicalTrials.gov). Registered 08 July 2019. Available at: https://clinicaltrials.gov/study/NCT04011644 INTERNATIONAL REGISTERED REPORT RR2-10.2196/31109