BACKGROUND
Many people experiencing harms and problems from gambling do not seek treatment from gambling treatment services due to numerous personal and resource barriers. mHealth interventions are widely used across a diverse range of health care areas and by various population groups. However, there are few in the gambling harm field, despite their potential as an additional modality for delivering treatment and support.
OBJECTIVE
This study aims to understand the needs, preferences and priorities of people experiencing gambling harms and are potential end-users of a cognitive behavioural therapy (CBT) mHealth intervention to inform design, features and functions.
METHODS
Drawing on a mixed-methods approach, we used the creators and domain experts to review the GAMBLINGLESS web-based online program and convert it into a prototype for a mHealth intervention. Each module was reviewed against the original evidence base to maintain the fidelity and conceptual integrity intended. Early wireframes, design ideas (look, feel and function) and content examples were developed using multi-modalities to initiate discussions and ideas with end-users. Using an iterative co-creation process with a Young Adult, a Māori and a Pasifika Peoples group, all with experiences of problem or harmful gambling, we undertook six focus groups; two cycles per group. Each focus group, participants identified preferences, features, and functions for inclusion in a final design of the mHealth intervention and its content.
RESULTS
Over three months, the GAMBLINGLESS web-based intervention was reviewed and remapped from four modules to six. This revised program is based on the principles underpinning the Transtheoretical Model, in which it is recognised that some end-users will be more ready to change than others. Change is a process that unfolds over time, and a non-linear progression is common. Different intervention option pathways were identified to reflect the end-users stage of change. Two cycles of focus groups were then conducted, with a total of 30 unique participants (13 Māori, 9 Pasifika and 8 Young Adults) at the first sessions and 18 participants (7 Māori, 6 Pasifika and 5 Young Adults) at the second session. Prototype examples demonstrably reflected the focus group discussions and ideas, and features, functions and designs for the Manaaki app were finalised. Aspects such as personalisation, cultural relevance, and positive framing were key attributes identified. Congruence of the final app attributes with the conceptual frameworks of the original program was also confirmed.
CONCLUSIONS
Those who experience gambling-related harms may not seek help from current treatment providers or access current tools. Developing and demonstrating the effectiveness of new modalities to provide treatment and support are needed. mHealth has the potential to deliver interventions direct to the end-user. Weaving underpinning theory and existing evidence of effective treatment with end-user input into the design and development of the mHealth intervention does not guarantee success. However, it provides a foundation for framing the intervention's mechanism, context, and content and arguably provides a greater chance of demonstrating effectiveness.
CLINICALTRIAL
New Zealand Health and Disability Ethics Committee reference 19/STH/100