Successful Organizational Strategies to Sustain Use of A-CHESS: A Mobile Intervention for Individuals With Alcohol Use Disorders.
BACKGROUND
Mobile health (mHealth) services are growing in importance in health care research with the advancement of wireless networks, tablets, and mobile phone technologies. These technologies offer a wide range of applications that cover the spectrum of health care delivery. Although preliminary experiments in mHealth demonstrate promising results, more robust real-world evidence is needed for widespread adoption and sustainment of these technologies.


OBJECTIVE
Our aim was to identify the problems/challenges associated with sustained use of an mHealth addiction recovery support app and to determine strategies used by agencies that successfully sustained client use of A-CHESS.


METHODS
Qualitative inquiry assessed staff perceptions about organizational attributes and strategies associated with sustained use of the mobile app, A-CHESS. A total of 73 interviews of clinicians and administrators were conducted. The initial interviews (n=36) occurred at the implementation of A-CHESS. Follow-up interviews (n=37) occurred approximately 12 and 24 months later. A coding scheme was developed and Multiuser NVivo was used to manage and analyze the blinded interview data.


RESULTS
Successful strategies used by treatment providers to sustain A-CHESS included (1) strong leadership support, (2) use of client feedback reports to follow up on non-engaged clients, (3) identify passionate staff and incorporate A-CHESS discussions in weekly meetings, (4) develop A-CHESS guidelines related to client use, (5) establish internal work groups to engage clients, and (6) establish a financial strategy to sustain A-CHESS use. The study also identified attributes of A-CHESS that enhanced as well as inhibited its sustainability.


CONCLUSIONS
Mobile apps can play an important role in health care delivery. However, providers will need to develop strategies for engaging both staff and patients in ongoing use of the apps. They will also need to rework business processes to accommodate the changes in communication frequency and style, learn to use app data for decision making, and identify financing mechanisms for supporting these changes.
University of Wisconsin - Madison, Center for Health Systems Research and Analysis, Madison, WI, United States. jhfordii@wisc.edu.
James H
http://orcid.org/0000-0003-3045-2414
JH
Ford
Esra
http://orcid.org/0000-0001-7046-006X
E
Alagoz
Susan
http://orcid.org/0000-0002-9496-178X
S
Dinauer
Kimberly A
http://orcid.org/0000-0002-2179-5688
KA
Johnson
Klaren
http://orcid.org/0000-0002-5208-0458
K
Pe-Romashko
David H
http://orcid.org/0000-0001-6359-7017
DH
Gustafson
D000288:Administrative Personnel; D000328:Adult; D019973:Alcohol-Related Disorders / Q000534:rehabilitation*; D003695:Delivery of Health Care; D005260:Female; D006282:Health Personnel; D006302:Health Services Research; D006801:Humans; D008297:Male; D008875:Middle Aged; D063731:Mobile Applications; D015397:Program Evaluation; D036301:Qualitative Research; D017216:Telemedicine / Q000191:economics / Q000379:methods / Q000458:organization & administration*; D055815:Young Adult
client; engagement; funding; implementation; mHealth; staff; substance abuse disorder; sustainability