Testing a new smart phone app (“Smart Track”) for adults with experience of addictive behaviour(s): Exploring the experience and attitudes of SMART Recovery participants and facilitators about using the app to self-monitor progress

BRIEF NAME Routine Outcome Monitoring and Feedback Tool: Smart Track App WHY Routine Outcome Monitoring (ROM), or the systematic assessment of progress throughout treatment is an important mechanism for monitoring the effectiveness of service provision (Burgess, Pirkis & Coombs, 2015). ROM data can be used to generate feedback, and to help identify whether or not a client is progressing as expected, thereby allowing progress to be reinforced and / or treatment plans to be revised as needed (Lambert et al., 2005). This study is designed to measure the feasibility and acceptability of using a digital platform (a Smart Phone App called “Smart Track”) with adults attending SMART Recovery Groups in NSW for the purpose of ROM and Feedback. Smart Track was developed by the research team during the first phase of this study using an iterative process informed by a) existing ROM tools, b) qualitative feedback from SMART Recovery participants and facilitators, c) clinical and research expertise from the members of the expert advisory and steering committees and d) the technological and creative expertise of the development team employed to work on this study (GHO, Sydney; www.ghosydney.com). App development was guided by the ‘Person-Based’ approach (Yardley et al., 2015), ‘The Behavioral Intervention Technology (BIT) Model’ (Mohr et al., 2014) and the ‘Integrate, Design, Assess, and Share (IDEAS)’ framework (Munmah et al., 2016). WHAT: ROM Items Smart Track has been designed to provide multidimensional assessment and feedback across the following domains: group attendance; goal setting/attainment; values; self-efficacy; quality of life; self-care; mental health; quantity, frequency and impact of addictive behaviour(s); socialsupport; financial stability; optimism and the frequency, strength and duration of urges). The proposed ROM item set included in the app is detailed in Supplementary Table 1 as a function of target domain and assessment frequency. Participants will be encouraged to complete the ROM items once per week, ideally within the 24hours preceding attendance at a SMART Recovery group. Participants will be encouraged to use the app for at least two months (i.e. for the time between baseline and 2-month follow-up assessment). WHAT: Feedback Participants will be presented with a summary of recent progress (written and visual) within all of the domains assessed. Based on participant responses to individual ROM items and/ or subscale scores, tailored visual cues (e.g. colours and arrows) will be used to provide a ‘snapshot’ of progress within each domain (e.g. current score range and/ or direction of progress). Participants can also select one or more domain(s) to receive more detailed feedback (written and visual). The written feedback will comprise encouraging statements, self-reflection questions and/ or self-management suggestions. Visual feedback will consist of a graph illustrating participant progress over time. WHAT: Additional features Inconsistent engagement (patient and/ or clinician) has long been identified as a challenge to both ROM and feedback (e.g.Duncan and Murray, 2012) and the mHealth literature (e.g. Berrouiguet et al., 2016) more broadly. Therefore, in addition to the core ROM and feedback functionality, several additional features have been included with a view to enhance engagement including: customisable support(s) and personal motivation(s); helpful resources; self-management tips and motivational statements; self-reflection entries and an interactive urge log (See supplementary Table 2). WHO/ HOW Consistent with recommendations for improving ROM uptake (Boswell et al., 2015), SMART Recovery facilitators at each study site will assume the role of ‘local champions’ of Smart Track. The research team will work with facilitators to orient them to the app, such that they are confident in managing day-to-day questions about ROM completion and troubleshooting any difficulties that may arise. SMART Recovery facilitators will also prompt, encourage and support study participants to regularly complete the ROM questions before and/ or after group. Research staff will also be available (remotely and/ or in-person) to orient participants to Smart Track and (as needed) help troubleshoot difficulties associated with app use. Smart Track will be accessible across iOS (9.0 and above) and Android (4.4 and above) platforms. A lower fidelity version will also be accessible via tablet (for those who do not have a Smart Phone, but wish to participate). Participants will be encouraged to complete the ROM items weekly across the eight week duration of the study. However, it is ultimately up to the individual whether/ how often they access the various features of the app (i.e. consistent with aims of exploring feasibility and acceptability). WHERE Potential participants will use SMART Track before, after and or between SMART Recovery groups held in NSW, Australia. A full list of study sites will be reported in the outcomes paper. SMART Recovery groups are held in the community as well as inpatient, outpatient and clinical health organisations including private, public and not for profit mental health, drug and alcohol and general health services. Online meetings are also available.