Final report

The New Zealand Ministry of Health Professor Chris Bullen

National Institute for Health Innovation (NIHI)

& Centre for Addiction Research (CFAR)

Faculty of Medical and Health

Acknowledgments:

The authors wish to thank the problem gambling practitioners and clients who participated in the focus groups. Without their generosity this project would not have been possible. We also thank the Ministry of Health (Minimising Gambling Team, Mental Health Service Improvement, Sector Capability and Implementation) at the New Zealand Ministry of Health who commissioned this work.

Professor Chris Bullen, Director, National Institute for Health Innovation (NIHI)

School of Population Health, Faculty of Medical and Health Sciences

University of Auckland

Private Bag 92019, Auckland, New Zealand

Phone: +64 9 3737 599 Email: c.bullen@auckland.ac.nz

This report was prepared under contract to the New Zealand Ministry of Health. The copyright in this article is owned by the Crown and administered by the Ministry. The views of the authors do not necessarily represent the views or policy of the New Zealand Ministry of Health. The Ministry makes no warranty, express or implied, nor assumes any liability of responsibility for use of or reliance on the contents of this report.

Bullen C, Rossen F, Newcombe D, Whittaker R, Strydom J (2015). Smartphone-based Problem Gambling Evaluation and Technology Testing Initiative (‘SPGETTI’) Feasibility Study: Final Report. National Institute for Health Innovation & Centre for Addiction Research. Prepared for the Ministry of Health. Auckland, New Zealand: Auckland UniServices Limited, The University of Auckland.

Reports from Auckland UniServices Limited should only be used for the purposes for which they were commissioned. If it is proposed to use a report prepared by Auckland UniServices Limited for a different purpose or in a different context from that intended at the time of commissioning the work, then UniServices should be consulted to verify whether the report is being correctly interpreted. In particular it is requested that, where quoted, conclusions given in UniServices reports should be stated in full.

CONTENTS

EXECUTIVE SUMMARY 7

LAY SUMMARY 8

INTRODUCTION & BACKGROUND 10

PHASE ONE: Technical Assessment and Field Studies 14

1.1Aims and Objectives 14

1.2Methods 14

1.3Results 15

PHASE TWO: Focus Group DISCUSSIOns 16

1.4Aims and Objectives 16

1.5Methods 16

1.5.1Recruitment and Sample 16

Inclusion and Exclusion Criteria 17

1.5.2Procedures 17

1.5.3Measures 18

1.5.4Data Analysis 18

1.6Ethics 18

1.7Results 18

1.7.1Initial Response to the Concept 19

1.7.2Scenario Number One 21

1.7.3Scenario Number Two 24

1.7.4Scenario Number Three 27

1.7.5Scenario Number Four 28

1.7.6Scenario Number Five 30

1.7.7Access to Smartphones, Data and Phone Credit 32

1.7.8Concerns about Privacy 34

1.7.8.1Storage and Privacy of Data 35

1.7.9Social Networking and Accessing the App Through Other Devices 37

1.7.10Customisation / Personalisation of the App 39

1.7.10.1General Customisation 39

1.7.10.2Triggers for Gambling 39

1.7.10.3Language of Choice 40

1.7.10.4Motivating Factors, Goals and Needs, Severity of Problem and Stage of Recovery 41

1.7.11Miscellaneous Topics of Discussion 43

1.7.11.1Reliance on assistance from third parties 43

1.7.11.2Facilitation of peer support networks 44

1.7.11.3Self-control and empowerment vs enforcement 44

1.7.11.4Positive reinforcement 45

1.7.11.5Sharing information from the App with other people 45

1.7.11.6Therapeutic relationship with human beings (counsellors) versus an ‘App’ 48

1.7.11.7Cultural implications 48

1.7.11.8Potential for cellphone ‘addiction’ and crossover with gambling via the internet / smartphones / PCs 50

1.7.11.9Potential for the App to access bank accounts & credit cards to limit access to money 51

1.7.11.10Potential for the App to notify host responsibility or security at a venue 54

1.7.11.11Limitations of the App 56

1.7.12Closing Response to the Concept 57

DISCUSSION 61

1.8Issues for consideration for future problem gambling research 62

1.9Strengths and limitations 62

Conclusions 64

REFERENCES 65

APPENDICES 67

EXECUTIVE SUMMARY

This report presents results from the SPGETTI (Smartphone-based Problem Gambling Evaluation and Technology Testing Initiative) study. The aim of the study was to test the feasibility of a smartphone application that supports people with a gambling problem who are seeing counsellors and accessing services to receive ‘just in time’ and ‘at the right place’ support, specifically to avoid relapse and remain abstinent from harmful gambling on Electronic Gambling Machines (EGMs or more colloquially, ‘pokies’). Key research questions we sought to address in this project were:

1. 
   What is the technical feasibility of a smartphone-based intervention for reducing problem gambling harm?
   
2. 
   How acceptable will such an intervention be to people with problem gambling?
   

Methods

This study consisted of two phases. The first phase was a technical assessment of the reliability, coverage and use of different mobile phone operating systems. We also piloted the application in the field. The second phase involved assessing end-user interest and acceptability, through focus group discussions with problem gambling practitioners and individuals with experience of problem gambling (recruited through our partner organisations in the problem gambling sector).

Results

Technical assessment - The basic system we prototyped was reliable and sufficiently accurate to be considered, with further refinement, as a potentially useful intervention. Focus groups – Our analysis of participant responses indicates that in the main the concept of a support tool readily available and using technology was supported by both problem gambling practitioners and consumers from all priority population groups (specifically Māori and people of Pacific and Asian ethnic groups). Some concerns were noted that would need to be addressed in any further refinement of this idea. These included privacy, confidentiality and ownership of data; and, the hypothetical potential to trigger gambling in some situations. Ideas for additional features and future development from the focus groups were ‘alerts’ for host responsibility and/or security at a gambling venue; and blocking access to bank accounts and/or credit cards. An issue related to the conduct of the research project was the difficulty experienced in recruiting sufficient numbers of participants in all the focus groups.

Conclusions

We conclude from this small feasibility study that the use of a smartphone-based app with location-tracking capability is both technically feasible and broadly acceptable in principle to a range of people with significant gambling problems, including those in priority population groups (Māori, Pacific and Asian peoples). On this basis we consider that a second stage of development is needed, to incorporate the key learning from this study, including refinement of content and intensive testing with end-users through an interactive approach to development; leading to a trial of its efficacy as a support tool.

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