Feasibility and acceptability of an audio computer-assisted self-interview version of the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) in primary care patients

ABSTRACT

Background: This study explores the feasibility and acceptability of a computer self-administered approach to substance use screening from the perspective of primary care patients. Methods: Forty-eight patients from a large safety net hospital in New York City completed an audio computer-assisted self-interview (ACASI) version of the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) and a qualitative interview to assess feasibility and acceptability, comprehension, comfort with screening questions, and preferences for screening mode (interviewer or computer). Qualitative data analysis organized the participants' feedback into major themes. Results: Participants overwhelmingly reported being comfortable with the ACASI ASSIST. Mean administration time was 5.2 minutes (range: 1.6–14.8 minutes). The major themes from the qualitative interviews were (1) ACASI ASSIST is feasible and acceptable to patients, (2) Social stigma around substance use is a barrier to patient disclosure, and (3) ACASI screening should not preclude personal interaction with providers. Conclusions: The ACASI ASSIST is an appropriate and feasible approach to substance use screening in primary care. Because of the highly sensitive nature of substance use, screening tools must explain the purpose of screening, assure patients that their privacy is protected, and inform patients of the opportunity to discuss their screening results with their provider.

KEYWORDS:

• ACASI
• ASSIST
• prevention
• screening
• substance use

Acknowledgments

The authors would like to acknowledge the research staff: Arianne Ramautar, Derek Nelsen, Rubina Khan, Andrew Wallach, Barbara Porter, and Valerie Perel.

Author contributions

Dr. Spear conducted the data analysis and wrote the manuscript with assistance from Dr. McNeely. Dr. McNeely was the study principal investigator. She designed the study, led data collection, and assisted with data analysis and writing the manuscript. Maya Fiellin and Brian Gilberti assisted with modification of the study instruments, data collection, transcription and translation, and assisted with writing. Dr. Shedlin advised on study design, assisted with development of the interview guides, led 2 of the focus groups, and assisted with analysis and writing.

Funding

The research and manuscript development were funded by the following grants: NIH/NIDA K23 DA030395 and NIH/NCATS UL1 TR000038. The funding agencies were not involved in the research reported in the paper nor the development of the manuscript. The authors declare that they have no conflicts of interest.