BACKGROUND
Many people experiencing harms and problems from gambling do not seek treatment from gambling treatment services due to numerous personal and resource barriers. Mobile health (mHealth) interventions are widely used across a diverse range of health care areas and by various population groups, but there are few in the gambling harm field, despite their potential as an additional modality for the delivery of treatment.
OBJECTIVE
This study aims to understand the needs, preferences and priorities of people experiencing gambling harms or problems who are potential end-users of a cognitive behavioural therapy (CBT) mHealth intervention (based on the GAMBLINGLESS web-based 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 mobile phone-based intervention. Each module was reviewed against the original evidence-base to ensure that the changes maintained the fidelity and conceptual integrity intended and to ensure that there were no gaps. Early wireframes, design ideas (look, feel and function) and content examples were to be developed using multi-modalities, to help 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. During 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 than unfolds over time, a non-linear progression is common, and that different intervention options may be required by end-users across the stages 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 sessions. Using prototype examples that demonstrably reflected the focus group discussions and ideas, the features, functions and designs for the Manaaki app were finalised. Aspects such as personalisation, cultural relevance, and being positively framed 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 harms may not seek help from current treatment providers and as such, finding new modalities to provided 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 does provide a foundation for framing the mechanism, context and content of the intervention and arguably provides a greater chance of demonstrating effectiveness.
The Evolution of Gambling-Related Harm Measurement: Lessons from the Last Decade