RESUMO
BACKGROUND: Many people who experience harm and problems from gambling do not seek treatment from gambling treatment services because of personal and resource barriers. Mobile health (mHealth) interventions are widely used across diverse health care areas and populations. 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 who are potential end users of a cognitive behavioral therapy mHealth intervention to inform design, features, and functions. METHODS: Drawing on a mixed methods approach, we used creators and domain experts to review the GAMBLINGLESS web-based program and convert it into an mHealth prototype. Each module was reviewed against the original evidence base to maintain its intended fidelity and conceptual integrity. Early wireframes, design ideas (look, feel, and function), and content examples were developed to initiate discussions with end users. Using a cocreation process with a young adult, a Maori, and a Pasifika peoples group, all with experiences of problem or harmful gambling, we undertook 6 focus groups: 2 cycles per group. In each focus group, participants identified preferences, features, and functions for inclusion in the final design and content of the mHealth intervention. RESULTS: Over 3 months, the GAMBLINGLESS web-based intervention was reviewed and remapped from 4 modules to 6. This revised program is based on the principles underpinning the transtheoretical model, in which it is recognized that some end users will be more ready to change than others. Change is a process that unfolds over time, and a nonlinear progression is common. Different intervention pathways were identified to reflect the end users' stage of change. In all, 2 cycles of focus groups were then conducted, with 30 unique participants (13 Maori, 9 Pasifika, and 8 young adults) in the first session and 18 participants (7 Maori, 6 Pasifika, and 5 young adults) in the second session. Prototype examples demonstrably reflected the focus group discussions and ideas, and the features, functions, and designs of the Manaaki app were finalized. Attributes such as personalization, cultural relevance, and positive framing were identified as the key. 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. Developing and demonstrating the effectiveness of new modalities to provide treatment and support are required. mHealth has the potential to deliver interventions directly to the end user. Weaving the underpinning theory and existing evidence of effective treatment with end-user input into the design and development of mHealth interventions 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.
RESUMO
AIM: To describe the association between cigarette smoking and maternal factors amongst a cohort of Pacific mothers. METHOD: Mothers of a cohort of 1398 Pacific infants born in Middlemore Hospital, Auckland, New Zealand during 2000 were interviewed when their infants were 6 weeks old (n=1376) and followed up at 12 months (n=1219). This paper is based on all mothers who were interviewed at both data points. Mothers participated in a 1-hour interview that included questions about the number of cigarettes smoked yesterday, and the number of other people living in the same home who currently smoke cigarettes. Cross tabulations and logistic regression models were applied to investigate the association between maternal smoking and health, demographic, social, cultural, and educational factors. RESULTS: At the 6 weeks data point, 24.5% of mothers reported smoking, and at the 12-month follow-up, 29.8% of mothers smoked. From the 6 weeks measurement point more mothers started smoking (9.6%) than stopped (4.4%). Variables associated with smoking at 12 months after birth were: age (less than 20 years), non-Tongan ethnicity, non-partnered or de facto marital status, New Zealand-born, low income, full-time parenting, English fluency, non-separationalism, living with other smokers, size of house is too small, and overcrowding. After controlling for confounding variables, English fluency and cultural alignment to mainstream New Zealand culture remained statistically significant. Formal education qualifications, parity, and type of house they lived in were not significantly associated with smoking. CONCLUSION: Many Pacific mothers in this cohort were smoking around the time of birth and continued to smoke a year after giving birth. These findings demonstrate the need to explore acculturation issues surrounding smoking behaviour and smoking cessation for Pacific women in New Zealand. A qualitative research design may assist in advancing a more effective response to cigarette smoking amongst Pacific mothers.
