TY - JOUR
T1 - A Gambling Just-In-Time Adaptive Intervention (GamblingLess: In-The-Moment)
T2 - Protocol for a Microrandomized Trial
AU - Dowling, Nicki A.
AU - Merkouris, Stephanie S.
AU - Youssef, George J.
AU - Lubman, Dan I.
AU - Bagot, Kathleen L.
AU - Hawker, Chloe O.
AU - Portogallo, Hannah J.
AU - Thomas, Anna C.
AU - Rodda, Simone N.
N1 - Funding Information:
This project is a collaboration between Deakin University and its partner organizations (University of Auckland, Turning Point, and 2and2 [app developers]), funded by the New South Wales Government’s Responsible Gambling Fund. The funding body played no role in the study design or writing of the manuscript.
Funding Information:
The development of the GamblingLess: In-The-Moment intervention is led by NAD (Deakin University) and is part of a suite of theoretically informed and evidence-based web-based and mobile gambling interventions (GamblingLess). NAD, with support from SSM and SNR, conceived the project, developed the methodology, and acquired funding. NAD wrote the first draft of the manuscript, with statistical advice from GJY. All the authors contributed to the final draft of the manuscript.
Funding Information:
Development and evaluation of GamblingLess: In-The-Moment was funded in June 2019 by the New South Wales Government’s Responsible Gambling Fund. The development of GamblingLess: In-The-Moment involved a multidisciplinary team comprising behavior change expertise from clinical and social psychology, implementation science, biostatistics and research design, and technology developers, consistent with recommendations for technology development [94]. GamblingLess: In-The-Moment is part of a suite of theoretically informed and evidence-based web-based and mobile gambling interventions (GamblingLess). The development of the treatment content was led by the NAD, a clinical psychologist, and the app was hosted on the Cogniss behavior change platform, which was created by 2and2, specialist developers of custom tech solutions for learning, health, and behavior change. Illustrative screenshots of JITAI are displayed in Figure 2.
Publisher Copyright:
© 2022 JMIR Publications. All rights reserved.
PY - 2022/8/1
Y1 - 2022/8/1
N2 - Background: The presence of discrete but fluctuating precipitants, in combination with the dynamic nature of gambling episodes, calls for the development of tailored interventions delivered in real time, such as just-in-time adaptive interventions (JITAIs). JITAIs leverage mobile and wireless technologies to address dynamically changing individual needs by providing the type and amount of support required at the right time and only when needed. They have the added benefit of reaching underserved populations by providing accessible, convenient, and low-burden support. Despite these benefits, few JITAIs targeting gambling behavior are available. Objective: This study aims to redress this gap in service provision by developing and evaluating a theoretically informed and evidence-based JITAI for people who want to reduce their gambling. Delivered via a smartphone app, GamblingLess: In-The-Moment provides tailored cognitive-behavioral and third-wave interventions targeting cognitive processes explicated by the relapse prevention model (cravings, self-efficacy, and positive outcome expectancies). It aims to reduce gambling symptom severity (distal outcome) through short-term reductions in the likelihood of gambling episodes (primary proximal outcome) by improving craving intensity, self-efficacy, or expectancies (secondary proximal outcomes). The primary aim is to explore the degree to which the delivery of a tailored intervention at a time of cognitive vulnerability reduces the probability of a subsequent gambling episode. Methods: GamblingLess: In-The-Moment interventions are delivered to gamblers who are in a state of receptivity (available for treatment) and report a state of cognitive vulnerability via ecological momentary assessments 3 times a day. The JITAI will tailor the type, timing, and amount of support for individual needs. Using a microrandomized trial, a form of sequential factorial design, each eligible participant will be randomized to a tailored intervention condition or no intervention control condition at each ecological momentary assessment across a 28-day period. The microrandomized trial will be supplemented by a 6-month within-group follow-up evaluation to explore long-term effects on primary (gambling symptom severity) and secondary (gambling behavior, craving severity, self-efficacy, and expectancies) outcomes and an acceptability evaluation via postintervention surveys, app use and engagement indices, and semistructured interviews. In all, 200 participants will be recruited from Australia and New Zealand. Results: The project was funded in June 2019, with approval from the Deakin University Human Research Ethics Committee (2020-304). Stakeholder user testing revealed high acceptability scores. The trial began on March 29, 2022, and 84 participants have been recruited (as of June 24, 2022). Results are expected to be published mid-2024. Conclusions: GamblingLess: In-The-Moment forms part of a suite of theoretically informed and evidence-based web-based and mobile gambling interventions. This trial will provide important empirical data that can be used to facilitate the JITAI's optimization to make it a more effective, efficient, and scalable tailored intervention.
AB - Background: The presence of discrete but fluctuating precipitants, in combination with the dynamic nature of gambling episodes, calls for the development of tailored interventions delivered in real time, such as just-in-time adaptive interventions (JITAIs). JITAIs leverage mobile and wireless technologies to address dynamically changing individual needs by providing the type and amount of support required at the right time and only when needed. They have the added benefit of reaching underserved populations by providing accessible, convenient, and low-burden support. Despite these benefits, few JITAIs targeting gambling behavior are available. Objective: This study aims to redress this gap in service provision by developing and evaluating a theoretically informed and evidence-based JITAI for people who want to reduce their gambling. Delivered via a smartphone app, GamblingLess: In-The-Moment provides tailored cognitive-behavioral and third-wave interventions targeting cognitive processes explicated by the relapse prevention model (cravings, self-efficacy, and positive outcome expectancies). It aims to reduce gambling symptom severity (distal outcome) through short-term reductions in the likelihood of gambling episodes (primary proximal outcome) by improving craving intensity, self-efficacy, or expectancies (secondary proximal outcomes). The primary aim is to explore the degree to which the delivery of a tailored intervention at a time of cognitive vulnerability reduces the probability of a subsequent gambling episode. Methods: GamblingLess: In-The-Moment interventions are delivered to gamblers who are in a state of receptivity (available for treatment) and report a state of cognitive vulnerability via ecological momentary assessments 3 times a day. The JITAI will tailor the type, timing, and amount of support for individual needs. Using a microrandomized trial, a form of sequential factorial design, each eligible participant will be randomized to a tailored intervention condition or no intervention control condition at each ecological momentary assessment across a 28-day period. The microrandomized trial will be supplemented by a 6-month within-group follow-up evaluation to explore long-term effects on primary (gambling symptom severity) and secondary (gambling behavior, craving severity, self-efficacy, and expectancies) outcomes and an acceptability evaluation via postintervention surveys, app use and engagement indices, and semistructured interviews. In all, 200 participants will be recruited from Australia and New Zealand. Results: The project was funded in June 2019, with approval from the Deakin University Human Research Ethics Committee (2020-304). Stakeholder user testing revealed high acceptability scores. The trial began on March 29, 2022, and 84 participants have been recruited (as of June 24, 2022). Results are expected to be published mid-2024. Conclusions: GamblingLess: In-The-Moment forms part of a suite of theoretically informed and evidence-based web-based and mobile gambling interventions. This trial will provide important empirical data that can be used to facilitate the JITAI's optimization to make it a more effective, efficient, and scalable tailored intervention.
KW - addiction
KW - ecological momentary intervention
KW - gambling
KW - intervention
KW - just-in-time adaptive intervention
KW - mHealth
KW - microrandomized trial
KW - mobile health
KW - mobile phone
KW - protocol
KW - relapse
KW - treatment
UR - http://www.scopus.com/inward/record.url?scp=85136888656&partnerID=8YFLogxK
U2 - 10.2196/38958
DO - 10.2196/38958
M3 - Article
AN - SCOPUS:85136888656
VL - 11
JO - JMIR Research Protocols
JF - JMIR Research Protocols
SN - 1929-0748
IS - 8
M1 - e38958
ER -