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

Abstract

BackgroundSubstance 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.ObjectiveSubstance 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.MethodsWe 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.ResultsThe 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.ConclusionsTo 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 str...

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“…Other intervention features may have increased responsivity, such as delivering text messages directly to an AYA’s personal phone and adding gamification elements (eg, earning points for responding to messages) [43]. Future research can systematically test the causal effects of various message delivery schedules, as well as different engagement strategies (eg, gamification and incentives), on increasing an individual’s responsivity to text messages over time [43,50].…”

“…Other intervention features may have increased responsivity, such as delivering text messages directly to an AYA’s personal phone and adding gamification elements (eg, earning points for responding to messages) [43]. Future research can systematically test the causal effects of various message delivery schedules, as well as different engagement strategies (eg, gamification and incentives), on increasing an individual’s responsivity to text messages over time [43,50]. In addition to analyzing responsivity to specific text message content, analysis of additional text message components, such as who sent the text message, when was it delivered, and how frequently were text messages sent, will help elucidate salient user patterns and preferences [15].…”

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Daily text message assessments of 6‐mercaptopurine adherence and its proximal contexts in adolescents and young adults with leukemia: A pilot study

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