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 (Preprint)

Abstract

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. CLINICALTRIAL ClinicalTrials.gov NCT03255317; https://clinicaltrials.gov/show/NCT03255317 (Archived by WebCite at http://www.webcitation.org/70raGWV0e) REGISTERED REPORT IDENTIFIER RR1-10.2196/9850

Translating strategies for promoting engagement in mobile health: A proof-of-concept microrandomized trial.

“…In fact, some participants noted that the inspirational meme/gifs were better than the humorous ones, which were not viewed as particularly funny. Although we vetted the memes/gifs with similar-aged youth, and despite preliminary testing indicating that youth liked and perceived the memes/gifs as rewarding (Rabbi et al, 2020), the results suggest that this type of content may have a short shelf life, may be ineffective due to the high circulation in daily life, and/or would benefit from greater personalization due to individual differences.…”

“…The reinforcer included a visual summary line graph of past 7 days of data (e.g., stress, tapping speed). Both reinforcers were iteratively developed and preliminary tested prior to the MRT, with initial results indicating that they were both well liked and perceived as rewarding by the target population (Rabbi et al, 2020).…”

Engagement With a Remote Symptom-Tracking Platform Among Participants With Major Depressive Disorder: Randomized Controlled Trial

“…Visualization can also help users manage uncertainty by attending to information about themselves [20]. A combination of qualitative and single-arm evaluation studies supports the perceived value of data visualization [21,22] and progress viewing [19] in encouraging symptom-tracking completion. Provision of contact details directly within an app can allow the user to directly and immediately access support, if required.…”

“…Notifications can include tailored content, such as insights into the benefits of self-monitoring, which serves to simultaneously motivate the user to respond to the notification and engage them in future tasks [18]. Second, visual incentives, such as graphs, can be embedded into the app to reflect on patterns in user progress and spark intrinsic motivation to complete future tasks [19]. Visualization can also help users manage uncertainty by attending to information about themselves [20].…”

The microrandomized trial for developing digital interventions: Experimental design and data analysis considerations.

“…In this section, we define the causal excursion effect, a causal effect useful in the optimization of JITAI components (e.g., Klasnja et al, 2019; Rabbi et al, 2020). We relate these causal effects to potential primary and secondary hypotheses using HeartSteps.…”