Acceptability and feasibility of a mobile behavioral economic health intervention to reduce alcohol use in adults in rural areas

• Published in: Drug and alcohol dependence reports Vol. 11; p. 100225
• Main Authors: Bayrakdarian, Natalie D., Bonar, Erin E., Duguid, Isabelle, Hellman, Lauren, Salino, Sarah, Wilkins, Chelsea, Jannausch, Mary, McKay, James R., Staton, Michele, Dollard, Katherine, Nahum-Shani, Inbal, Walton, Maureen A., Blow, Frederic C., Coughlin, Lara N.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01-06-2024; Elsevier
• Subjects: Alcohol use; Behavioral economic; Episodic future thinking; Full Length Report; Mobile health; Mobile intervention; Rural; Rural; Episodic future thinking; Mobile intervention; Behavioral economic; Mobile health; Alcohol use
• ISSN: 2772-7246; 2772-7246
• DOI: 10.1016/j.dadr.2024.100225

At-risk alcohol use is associated with increased adverse health consequences, yet is undertreated in healthcare settings. People residing in rural areas need improved access to services; however, few interventions are designed to meet the needs of rural populations. Mobile interventions can provide feasible, low-cost, and scalable means for reaching this population and improving health, and behavioral economic approaches are promising.
We conducted a pilot randomized controlled trial focused on acceptability and feasibility of a mobile behavioral economic intervention for 75 rural-residing adults with at-risk alcohol use. We recruited participants from a large healthcare system and randomized them to one of four virtually-delivered conditions reflecting behavioral economic approaches: episodic future thinking (EFT), volitional choice (VC), both EFT and VC, or enhanced usual care control (EUC). The intervention included a telephone-delivered induction session followed by two weeks of condition-consistent ecological momentary interventions (EMIs; 2x/day) and ecological momentary assessments (EMAs; 1x/day). Participants completed assessments at baseline, post-intervention, and two-month follow-up, and provided intervention feedback.
All participants completed the telephone-delivered session and elected to receive EMI messages. Average completion rate of EMAs across conditions was 92.9%. Among participants in active intervention conditions, 89.3% reported the induction session was helpful and 80.0% reported it influenced their future drinking. We also report initial alcohol use outcomes.
The behavioral economic intervention components and trial procedures evaluated here appear to be feasible and acceptable. Next steps include determination of their efficacy to reduce alcohol use and public health harms.
•We piloted mobile-delivered interventions to meet the needs of rural populations.•Mobile-delivered behavioral economic interventions appear acceptable and feasible.•Preliminary efficacy outcomes show promise in reducing alcohol use and consequences.•Preliminary efficacy outcomes were similar across all active conditions.