Alcohol misuse continues to be a major public health problem in the United States, contributing substantially to morbidity, mortality, and social costs. There is a solid body of evidence supporting screening and brief intervention (SBI) for alcohol misuse on both public health and cost-effectiveness grounds, and the practice is endorsed by the U.S. Preventive Health Services Task Force. However, efforts to incorporate SBI into mainstream medical practice have faced barriers due to severe constraints on time and personnel that characterize many modern healthcare delivery settings. Novel methods for seamlessly integrating SBI into mainstream medical practice are needed. The proposed Phase 1 STTR project seeks to establish the feasibility of designing key components of an innovative computerized SBI program that would be appropriate for use within a variety of healthcare settings. The formative research in the Phase 1 STTR will provide critical information to guide the design of a computerized micro-targeted personalized normative feedback product that could ultimately facilitate more rapid diffusion of alcohol SBI into the healthcare system.
The envisioned SBI product will be designed for use on headphone-equipped touch screen tablet computers. The entire screening and intervention session will take approximately 15 minutes so that a patient can complete the program while waiting to see their healthcare provider. The proposed brief intervention will be informed by established social-behavioral theories and will use promising micro-targeted normative feedback and norms misperception correction strategies. These techniques will compare the patient's reported behaviors and perceived norms to the actual estimated population norm for individuals that are similar to the patient in age, race, and sex. Normative comparison data will be obtained from ongoing, national-level epidemiological surveillance systems, analyzed for specific subpopulation-behavior combinations, and embedded within a special database in the software. The targeting of the reference group for behavioral norms feedback to match the patient on age, race, and sex is designed to increase the resonance of the normative comparison for the patient, and represents an unprecedented level of micro-targeting for a normative feedback intervention that can be readily """"""""scaled up"""""""" for use in a variety of medical contexts across the country. Key system components will be pilot tested by a sample of participants recruited from a local community-based health center (a typical consumer of the finished product). Participants'experiences with the technology will be explored via in-depth qualitative interviews, and the presentation refined based on user feedback.
