Maxime Lebeaupin

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: Early detection in the prevention of addictive behaviours remains a complex question in practice for most first-line health professionals, despite its importance in terms of public health. Several prevention measures have successfully included a screening stage followed by a brief intervention in case of risk-related use or referral to an addiction centre for problematic use. Even though early detection is highly recommended by the WHO, it is not performed in practice. Objective: To assess acceptability and feasibility of a web-based application, “Pulsio Santé”, for health service users and first-line prevention professionals. Methods: A mixed-method prospective pilot study was conducted in 2017 in two departments: The Nantes occupational health department responsible for monitoring the health of salaried personnel across the region, and the university department of preventive medicine with a health unit dedicated to university students. In each department, all health professionals (physicians and nurses) were invited to participate in the study. Subjects 18 or older seen by a health professional from one of the departments were eligible. The study procedure comprised 4 phases: 1) inclusion of participants by health professionals face-to-face, 2) self-automated web-based assessment report filled in by participants on their substance use with “Pulsio Santé” based on ASSIST questionnaire. Participants received a text message on their smartphone or by email, 3) if participants agreed, they could transfer results to their health professional. If not, messages appeared allowing them to get in touch with their general practitioner, should the assessment detect a risk. Two levels of feasibility and acceptability criteria were assessed. Two focus group sessions with health professionals were performed, exploring their points of view on the acceptability and feasibility of the web-based application. A multi-category content analysis was done. Results: 1474 people were eligible and 44 health professionals participated in the study. The first level of acceptability (% of people who agreed to receive a text message or an email) was 79.2% (1167 out of 1474). The second level of acceptability (% of participants who click on the self-assessment link) was 60.2% (703 out of 1167). The first level of feasibility (% of participants who completed their self-evaluation entirely) was 76.2% (536 out of 703). The second level of feasibility (% of participants who shared the results with their health professional) was 79.5% (426 out of 536). Health professionals highlighted obstacles to carry out the recommended interventions for people at risk based on their online screening. Conclusions: Our pilot study on a large sample showed good acceptability and feasibility of “Pulsio Santé” by health service users and professionals. The need for further studies more directly focused on the limitations emerged.

BACKGROUND Early detection in the prevention of addictive behaviors remains a complex question in practice for most first-line health care workers (HCWs). Several prevention measures have successfully included a screening stage followed by a brief intervention in case of risk-related use or referral to an addiction center for problematic use. Whereas early detection is highly recommended by the World Health Organization, it is not usually performed in practice. OBJECTIVE The aim of this study was to assess the acceptability and feasibility of a web-based app, called Pulsio Santé, for health service users and first-line prevention HCW and to carry out an exhaustive process of early detection of psychoactive substance use behaviors. METHODS A mixed methods prospective study was conducted in 2 departments: HCWs from the regional occupational health department and from the university department of preventive medicine dedicated to students were invited to participate. Participants 18 years or older who had been seen in 2017 by a HCW from one of the departments were eligible. The study procedure comprised 5 phases: (1) inclusion of the participants after a face-to-face consultation with an HCW; (2) reception of a text message by participants on their smartphone or by email; (3) self-assessment by participants regarding their substance use with the Pulsio Santé app; (4) if participants agreed, transfer of the results to the HCW; and (5) if participants declined, a message to invite them to get in touch with their general practitioner should the assessment detect a risk. Several feasibility and acceptability criteria were assessed by an analysis of a focus group with the HCW that explored 4 themes (usefulness and advantages, problems and limitations, possible improvements, and finally, integration into routine practice). RESULTS A total of 1474 people were asked to participate, with 42 HCWs being involved. The percentage of people who agreed to receive a text message or an email, which was considered as the first level of acceptability, was 79.17% (1167/1474). The percentage of participants who clicked on the self-assessment link, considered as the second level of acceptability, was 60.24% (703/1167). The percentage of participants who completed their self-evaluation entirely, which was considered as the first level of feasibility, was 76.24% (536/703). The percentage of participants who shared the results of their evaluation with the HCWs, considered as the second level of feasibility, was 79.48% (426/536). The qualitative study showed that there were obstacles on the side of HCWs in carrying out the recommended interventions for people at risk based on their online screening, such as previous training or adaptations in accordance with specific populations. CONCLUSIONS Quantitative results showed good acceptability and feasibility of the Pulsio Santé app by users and HCWs. There is a need for further studies more directly focused on the limitations highlighted by the qualitative results.