Prevention of Alcohol and Substance Abuse: mhealth Based Peer-mentoring Among Students

Abstract

Background: The use of alcohol and substance abuse is rising in Kenyan institutions of higher learning. The University of Nairobi trains peer-mentors to reach out to and counsel students on the effects of and prevention of substance use while in college. There is, however, an inadequate implementation and evaluation system for this method. This study introduced a mHealth-based tool to the practice of peer mentoring to assist peer mentors in decision making while undertaking their duties. The use of mHealth-based tools also enabled the provision of real-time feedback of the peer-mentoring processes, therefore, facilitating better support-supervision and overall implementation evaluation of the Alcohol and Drug Abuse prevention program at a university-wide level. Study Objective: To design a mHealth-based decision support tool for peer-mentoring and apply it to students at the University of Nairobi. Methodology: The study was in three phases. Phase one was a baseline survey. Phase two was to design the mHealth tool prototype and implement it and in phase three we had focus group discussions with peer mentors for purposes of the mHealth tool evaluation. In the first phase, a cross-sectional baseline survey determined students’ attitudes toward, and prevalence of substance use/abuse. Using population proportion sampling we recruited 406 study respondents. Data collection used World Health Organization (WHO) standardized tools for alcohol and substance use screening. In the second phase, we designed a mHealth-based prototype based on Open Data Kit (ODK) technology and then implemented the tool on two university campuses using a quasi-experimental study design. The participants were a total of 100 mentors, 51 in the mHealth group and 49 in the control group. They were selected purposively from two geographically separated University of Nairobi (UoN) campuses. 17 | 207 Use of mHealth-based peer mentoring to prevent alcohol and substance abuse among students. One campus had an experimental group of peer mentors. These mentors used mHealth-based decision support tool for intervention in peer mentoring to screen for substance use, provide structured brief intervention and treatment referral. The other campus had the comparative control group which used the standard UoN practice of using a paper-based tool to deliver the same program. Both groups were followed up for 6 months with support supervision meetings held twice per month. In phase three of the study, a qualitative assessment of the second phase was done whereby mentors during focussed group discussions shared their experiences of the peer mentoring process. We had four groups of eight to ten peer mentors. These groups were randomly selected from the pool of peer mentors on both campuses. mHealth ODK-based prototype: The mHealth-based peer mentoring prototype was built using the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) and Alcohol Use Disorder Identification Test (AUDIT) which are WHO approved tools for substance use disorders screening in the general population. Various ODK system features including, Select, Integer, and Calculate were used to design and program the mHealth-based decision support for substance use screening, intervention and referral tool. The peer mentor assessed their mentee’s alcohol and substance use based on screen-by-screen questions that were programed in the mHealth-based peer mentoring app. The mHealth-based peer mentoring app had inbuilt algorithms that were programed to calculate the student's specific alcohol and substance use scores, these scores then determined the pathway for care. Possible programmed intervention options included information dissemination, basic brief therapeutic intervention, referral and linkage to care and support as well as follow-up sessions. Data Analysis: Statistical software STATA was used for descriptive and inferential data analysis. Thematic content analysis was done for qualitative data using Nvivo.............