Feasibility of a Mobile Health App for Routine Outcome Monitoring and Feedback in SMART Recovery Mutual Support Groups: Stage 1 Mixed Methods Pilot Study (Preprint)
Authors: Kelly Peter J , Beck Alison K , Deane Frank P , Larance Briony , Baker Amanda L , Hides Leanne , Manning Victoria , Shakeshaft Anthony , Neale Joanne , Kelly John F , Oldmeadow Christopher , Searles Andrew , Palazzi Kerrin , Lawson Kenny , Treloar Carla , Gray Rebecca M , Argent Angela , McGlaughlin Ryan 
Published: October 2021

BACKGROUND

Mutual support groups are an important source of long-term help for people impacted by addictive behaviors. Routine outcome monitoring (ROM) and feedback are yet to be implemented in these settings. SMART Recovery mutual support groups focus on self-empowerment and use evidence-based techniques (eg, motivational and behavioral strategies). Trained facilitators lead all SMART Recovery groups, providing an opportunity to implement ROM.

OBJECTIVE

The aim of this stage 1 pilot study is to explore the feasibility, acceptability, and preliminary outcomes of a novel, purpose-built mobile health ROM and feedback app (<i>SMART Track</i>) in mutual support groups coordinated by SMART Recovery Australia (SRAU) over 8 weeks.

METHODS

<i>SMART Track</i> was developed during phase 1 of this study using participatory design methods and an iterative development process. During phase 2, 72 SRAU group participants were recruited to a nonrandomized, prospective, single-arm trial of the <i>SMART Track</i> app. Four modes of data collection were used: ROM data directly entered by participants into the app; app data analytics captured by Amplitude Analytics (number of visits, number of unique users, visit duration, time of visit, and user retention); baseline, 2-, and 8-week follow-up assessments conducted through telephone; and qualitative telephone interviews with a convenience sample of study participants (20/72, 28%) and facilitators (n=8).

RESULTS

Of the 72 study participants, 68 (94%) created a <i>SMART Track</i> account, 64 (88%) used <i>SMART Track</i> at least once, and 42 (58%) used the app for more than 5 weeks. During week 1, 83% (60/72) of participants entered ROM data for one or more outcomes, decreasing to 31% (22/72) by the end of 8 weeks. The two main screens designed to provide personal feedback data (<i>Urges</i> screen and <i>Overall Progress</i> screen) were the most frequently visited sections of the app. Qualitative feedback from participants and facilitators supported the acceptability of <i>SMART Track</i> and the need for improved integration into the SRAU groups. Participants reported significant reductions between the baseline and 8- week scores on the Severity of Dependence Scale (mean difference 1.93, SD 3.02; 95% CI 1.12-2.73) and the Kessler Psychological Distress Scale-10 (mean difference 3.96, SD 8.31; 95% CI 1.75-6.17), but no change on the Substance Use Recovery Evaluator (mean difference 0.11, SD 7.97; 95% CI –2.02 to 2.24) was reported.

CONCLUSIONS

Findings support the feasibility, acceptability, and utility of <i>SMART Track</i>. Given that sustained engagement with mobile health apps is notoriously difficult to achieve, our findings are promising. <i>SMART Track</i> offers a potential solution for ROM and personal feedback, particularly for people with substance use disorders who attend mutual support groups.

CLINICALTRIAL

Australian New Zealand Clinical Trials Registry ACTRN12619000686101; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377336

INTERNATIONAL REGISTERED REPORT

RR2-10.2196/15113