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Wallhed Finn S, Mejldal A, Nielsen AS. The impact of an annual mass media campaign on treatment seeking for alcohol use disorders in the Danish population: An interrupted time-series analysis. Drug Alcohol Depend 2023; 248:109910. [PMID: 37224672 DOI: 10.1016/j.drugalcdep.2023.109910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 04/13/2023] [Accepted: 04/28/2023] [Indexed: 05/26/2023]
Abstract
INTRODUCTION A minority of individuals with alcohol use disorder (AUD) seek treatment. In Denmark, a mass media campaign, "RESPEKT", aiming to increase treatment seeking, has been broadcasted nationwide since 2015. The campaign is unique from an international perspective. Similar interventions have, up until now, not been scientifically evaluated. AIM To investigate whether there was an association between campaign periods and treatment seeking for AUD. A secondary aim was to investigate possible gender differences. The hypotheses were that treatment seeking would increase during the campaign periods, and that men would increase their treatment seeking more compared to women. METHOD Study design: Interrupted time-series analysis. PARTICIPANTS Adults aged 18 years and above in the Danish population seeking AUD treatment. EXPOSURE Campaign periods year 2015-2018. OUTCOME Changes in treatment seeking defined as treatment entry respectively filled prescription of AUD pharmacotherapy. DATA National Alcohol Treatment Register on treatment entries for specialist addiction care and National Prescription Registry for filled prescriptions on AUD pharmacotherapies 2013-2018. ANALYSIS Segmented negative binomial regression, including the full cohort and stratified by sex. RESULTS The results show no association between campaign periods and treatment seeking. Nor were there any gender differences in treatment seeking. The hypotheses were not confirmed. CONCLUSION The campaign periods showed no association with treatment seeking. Eventual future campaigns should possibly focus on earlier steps of the treatment seeking process, as problem recognition, to increase treatment seeking. There is a great need to develop other ways to narrow the treatment gap for AUD.
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Affiliation(s)
- Sara Wallhed Finn
- Unit of Clinical Alcohol Research, University of Southern Denmark, J.B. Winsløws Vej 20, entrance. 220 B, Odense5000, Denmark; Department of Global Public Health, Karolinska Institutet, Sweden.
| | - Anna Mejldal
- Unit of Clinical Alcohol Research, University of Southern Denmark, J.B. Winsløws Vej 20, entrance. 220 B, Odense5000, Denmark; Open Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Anette Søgaard Nielsen
- Unit of Clinical Alcohol Research, University of Southern Denmark, J.B. Winsløws Vej 20, entrance. 220 B, Odense5000, Denmark
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Garnett C, Perski O, Beard E, Michie S, West R, Brown J. The impact of celebrity influence and national media coverage on users of an alcohol reduction app: a natural experiment. BMC Public Health 2021; 21:30. [PMID: 33407283 PMCID: PMC7789329 DOI: 10.1186/s12889-020-10011-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 12/06/2020] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Smartphone apps are increasingly used for health-related behaviour change and people discover apps through different sources. However, it is unclear whether users differ by mode of app discovery. Drink Less is an alcohol reduction app that received national media coverage in the UK caused by celebrity influence (a male TV and radio national broadcaster, aged 51). Our aim was to compare users who discovered the app before and after this coverage. METHODS A natural experiment assessing the impact of media coverage of Drink Less on users' socio-demographic and drinking characteristics, app engagement levels, and extent of alcohol reduction. The study period was from 17th May 2017 to 23rd January 2019, with media coverage starting on 21st August 2018. Users were 18 years or over, based in the UK and interested in drinking less. Interrupted time series analyses using Generalised Additive Mixed Models were conducted for each outcome variable aggregated at the weekly level. RESULTS In 66 weeks prior to the media coverage, 8617 users downloaded the app and 18,959 in 23 weeks afterwards. There was a significant step-level increase in users' mean age (B = 8.17, p < .001) and a decrease in the percentage of female users (B = -27.71, p < .001), though these effects dissipated non-linearly over time. No effect of media coverage was detected on employment type or on the percentage of at-risk drinkers, though the mean Alcohol Use Disorders Identification Test score was lower after the media coverage (B = -1.43, p = .031). There was a step-level increase in app engagement - number of sessions (B = 3.45, p = .038) and number of days used (B = 2.30, p = .005) - which continued to increase over time following quadratic trends. CONCLUSIONS Celebrity influence leading to national media coverage in the UK of the Drink Less app was associated with more people downloading the app who were male, older and engaged with the app; and did not appear to impact employment inequality.
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Affiliation(s)
- Claire Garnett
- Department of Behavioural Science and Health, University College London, London, WC1E 7HB, UK.
| | - Olga Perski
- Department of Behavioural Science and Health, University College London, London, WC1E 7HB, UK
| | - Emma Beard
- Department of Behavioural Science and Health, University College London, London, WC1E 7HB, UK
| | - Susan Michie
- Department of Clinical, Educational and Health Psychology, University College London, London, WC1E 6BT, UK
| | - Robert West
- Department of Behavioural Science and Health, University College London, London, WC1E 7HB, UK
| | - Jamie Brown
- Department of Behavioural Science and Health, University College London, London, WC1E 7HB, UK
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Bell L, Garnett C, Qian T, Perski O, Potts HWW, Williamson E. Notifications to Improve Engagement With an Alcohol Reduction App: Protocol for a Micro-Randomized Trial. JMIR Res Protoc 2020; 9:e18690. [PMID: 32763878 PMCID: PMC7442945 DOI: 10.2196/18690] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 05/13/2020] [Accepted: 05/27/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Drink Less is a behavior change app that aims to help users in the general adult population reduce hazardous and harmful alcohol consumption. The app includes a daily push notification, delivered at 11 am, asking users to "Please complete your mood and drinking diaries." Previous analysis of Drink Less engagement data suggests the current notification strongly influences how users engage with the app in the subsequent hour. To exploit a potential increase of vulnerability of excess drinking and opportunity to engage with the app in the evenings, we changed the delivery time from 11 am to 8 pm. We now aim to further optimise the content and sequence of notifications, testing 30 new evidence-informed notifications targeting the user's perceived usefulness of the app. OBJECTIVE The primary objective is to assess whether sending a notification at 8 pm increases behavioral engagement (opening the app) in the subsequent hour. Secondary objectives include comparing the effect of the new bank of messages with the standard message and effect moderation over time. We also aim to more generally understand the role notifications have on the overall duration, depth, and frequency of engagement with Drink Less over the first 30 days after download. METHODS This is a protocol for a micro-randomized trial with two additional parallel arms. Inclusion criteria are Drink Less users who (1) consent to participate in the trial; (2) self-report a baseline Alcohol Use Disorders Identification Test score of 8 or above; (3) reside in the United Kingdom; (4) age ≥18 years and; (5) report interest in drinking less alcohol. In the micro-randomized trial, participants will be randomized daily at 8 pm to receive no notification, a notification with text from the new message bank, or the standard message. The primary outcome is the time-varying, binary outcome of "Did the user open the app in the hour from 8 pm to 9 pm?". The primary analysis will estimate the marginal relative risk for the notifications using an estimator developed for micro-randomized trials with binary outcomes. Participants randomized to the parallel arms will receive no notifications (Secondary Arm A), or the standard notification delivered daily at 11 am (Secondary Arm B) over 30 days, allowing the comparison of overall engagement between different notification delivery strategies. RESULTS Approval was granted by the University College of London's Departmental Research Ethics Committee (CEHP/2016/556) on October 11, 2019, and The London School of Hygiene and Tropical Medicine Interventions Research Ethics Committee (17929) on November 27, 2019. Recruitment began on January 2, 2020, and is ongoing. CONCLUSIONS Understanding how push notifications may impact engagement with a behavior change app can lead to further improvements in engagement, and ultimately help users reduce their alcohol consumption. This understanding may also be generalizable to other apps that target a variety of behavior changes. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/18690.
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Affiliation(s)
- Lauren Bell
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Claire Garnett
- Research Department of Behavioural Science and Health, University College London, London, United Kingdom
| | - Tianchen Qian
- Department of Statistics, Harvard University, Cambridge, MA, United States
| | - Olga Perski
- Research Department of Behavioural Science and Health, University College London, London, United Kingdom
| | - Henry W W Potts
- Institute of Health Informatics, University College London, London, United Kingdom
- Health Data Research UK, London, United Kingdom
| | - Elizabeth Williamson
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Health Data Research UK, London, United Kingdom
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Perski O, Jackson SE, Garnett C, West R, Brown J. Trends in and factors associated with the adoption of digital aids for smoking cessation and alcohol reduction: A population survey in England. Drug Alcohol Depend 2019; 205:107653. [PMID: 31675544 PMCID: PMC6905148 DOI: 10.1016/j.drugalcdep.2019.107653] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 09/10/2019] [Accepted: 09/11/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Digital smoking cessation and alcohol reduction aids are widely available in England. To estimate their public health impact, researchers need to consider their adoption in the target population. We assessed adoption rates, and characteristics of adopters, of digital smoking cessation and alcohol reduction aids in England. METHODS 3655 smokers and 2998 high-risk drinkers (defined as a score of >4 on the Alcohol Use Disorders Identification Test-Consumption; AUDIT-C) who had made a past-year quit/reduction attempt were surveyed as part of the Smoking and Alcohol Toolkit Studies between January 2015-October 2018. Respondents provided information on socio-demographic characteristics and whether they had used a digital aid in a recent quit/reduction attempt. RESULTS 2.7 % (95 % CI 2.2%-3.0%) of smokers and 3.6 % (95 % CI 2.9%-4.0%) of drinkers who had made a past-year quit/reduction attempt (26.9 % and 15.3 %, respectively) had used a digital aid. Survey year was not significantly associated with use in smokers or drinkers. None of the baseline characteristics were significantly associated with the use of a digital aid in smokers. Drinkers with high motivation to reduce alcohol consumption (ORadj = 2.49, 95 % CI 1.63-3.77, p < .001) and higher AUDIT scores (ORadj = 1.07, 95 % CI 1.03-1.11, p < .001) had greater odds of adoption. CONCLUSIONS Digital smoking cessation and alcohol reduction aids are rarely used by smokers or high-risk drinkers attempting to quit/cut down in England, indicating that most of the target population is not being reached. Despite overall digital access improving, adoption rates remained similarly low between 2015-2018.
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Affiliation(s)
- Olga Perski
- Department of Behavioral Science and Health, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK.
| | - Sarah E Jackson
- Department of Behavioral Science and Health, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK
| | - Claire Garnett
- Department of Behavioral Science and Health, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK
| | - Robert West
- Department of Behavioral Science and Health, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK.
| | - Jamie Brown
- Department of Behavioral Science and Health, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK.
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Davies EL, Maier LJ, Winstock AR, Ferris JA. Intention to reduce drinking alcohol and preferred sources of support: An international cross-sectional study. J Subst Abuse Treat 2019; 99:80-87. [DOI: 10.1016/j.jsat.2019.01.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 11/23/2018] [Accepted: 01/14/2019] [Indexed: 12/11/2022]
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Garnett C, Perski O, Tombor I, West R, Michie S, Brown J. Predictors of Engagement, Response to Follow Up, and Extent of Alcohol Reduction in Users of a Smartphone App (Drink Less): Secondary Analysis of a Factorial Randomized Controlled Trial. JMIR Mhealth Uhealth 2018; 6:e11175. [PMID: 30552081 PMCID: PMC6315249 DOI: 10.2196/11175] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 08/28/2018] [Accepted: 08/28/2018] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Digital interventions for alcohol can help achieve reductions in hazardous and harmful alcohol consumption. The Drink Less app was developed using evidence and theory, and a factorial randomized controlled trial (RCT) suggested that 4 of its intervention modules may assist with drinking reduction. However, low engagement is an important barrier to effectiveness, and low response to follow up is a challenge for intervention evaluation. Research is needed to understand what factors influence users' level of engagement, response to follow up, and extent of alcohol reduction. OBJECTIVE This study aimed to investigate associations between user characteristics, engagement, response to follow up, and extent of alcohol reduction in an app-based intervention, Drink Less. METHODS This study involved a secondary data analysis of a factorial RCT of the Drink Less app. Participants (N=672) were aged 18 years or older, lived in the United Kingdom, and had an Alcohol Use Disorders Identification Test score >7 (indicative of excessive drinking). Sociodemographic and drinking characteristics were assessed at baseline. Engagement was assessed in the first month of use (number of sessions, time on app, number of days used, and percentage of available screens viewed). Response to follow up and extent of alcohol reduction (change in past week consumption) were measured after 1 month. Associations were assessed using unadjusted and adjusted linear or logistic regression models. RESULTS Age (all unstandardized regression coefficients [B] >.02, all P<.001) and post-16 educational qualifications (all B>.18, all P<.03) were positively associated with all engagement outcomes. Age (odds ratio [OR] 1.04, P<.001), educational qualifications (OR 2.11, P<.001), and female gender (OR 1.58, P=.02) were positively associated with response to follow up. Engagement outcomes predicted response to follow up (all OR>1.02, all P<.001) but not the extent of alcohol reduction (all -.14.07). Baseline drinking characteristics were the only variables associated with the extent of alcohol reduction among those followed up (all B>.49, all P<.001). CONCLUSIONS Users of the alcohol reduction app, Drink Less, who were older and had post-16 educational qualifications engaged more and were more likely to respond at 1-month follow up. Higher baseline alcohol consumption predicted a greater extent of alcohol reduction among those followed up but did not predict engagement or response to follow up. Engagement was associated with response to follow up but was not associated with the extent of alcohol reduction, which suggests that the Drink Less app does not have a dose-response effect. TRIAL REGISTRATION International Standard Randomised Controlled Trial Number ISRCTN40104069; http://www.isrctn.com/ISRCTN40104069 (Archived by WebCite at http://www.webcitation.org/746HqygIV).
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Affiliation(s)
- Claire Garnett
- Department of Behavioural Science and Health, University College London, London, United Kingdom
| | - Olga Perski
- Department of Behavioural Science and Health, University College London, London, United Kingdom
- Department of Clinical, Education and Health Psychology, University College London, London, United Kingdom
| | - Ildiko Tombor
- Department of Behavioural Science and Health, University College London, London, United Kingdom
| | - Robert West
- Department of Behavioural Science and Health, University College London, London, United Kingdom
| | - Susan Michie
- Department of Clinical, Education and Health Psychology, University College London, London, United Kingdom
| | - Jamie Brown
- Department of Behavioural Science and Health, University College London, London, United Kingdom
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Orlemann T, Reljic D, Zenker B, Meyer J, Eskofier B, Thiemt J, Herrmann HJ, Neurath MF, Zopf Y. A Novel Mobile Phone App (OncoFood) to Record and Optimize the Dietary Behavior of Oncologic Patients: Pilot Study. JMIR Cancer 2018; 4:e10703. [PMID: 30459139 PMCID: PMC6280033 DOI: 10.2196/10703] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 07/26/2018] [Accepted: 08/14/2018] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Catabolism and tumor-specific therapy lead to reduced nutrient intake and weight loss in cancer patients. Maintaining a specific individualized diet can be challenging for the patient as the nutritional counseling options are limited. Monitoring of nutrient intake and frequent feedback are, however, vital for successful nutritional therapy because they support the patient's compliance and realization of dietary therapeutic goals. OBJECTIVE This study aimed at investigating the feasibility and applicability of a novel mobile phone app to assess and evaluate dietary behaviors in oncologic patients. METHODS To determine dietary habits and food preferences in oncologic patients, initially 1400 nutritional records were evaluated and analyzed. The results provided the basis for creating a nutritional mobile phone app. Key requirements for the app included simple handling, recording the daily intake, and a comparison of nutrient targets and current status. In total, 39 cancer patients were recruited for the study; 15 patients dropped out prior to the study. All patients received a nutritional anamnesis, nutritional analysis, and nutritional counseling. Individual energy and nutrient aims were defined. The intervention group (n=12) additionally used the app. Weight and body composition of each group were evaluated after 4 weeks. RESULTS The app group gained significantly more weight (P=.045; mean weight 1.03 kg vs -1.46 kg). Also, skeletal muscle mass showed a significant increase in the app group (P=.009; mean skeletal muscle mass 0.58 kg vs -0.61 kg) compared with the control group. There was no significant difference between groups relating to the daily protein intake (P=.06). Additionally, there was a decrease in macronutrient intake during the study period in the control group. CONCLUSIONS Our study indicates that patients who track their daily dietary habits using a mobile phone app are more likely to reach their nutritional goals than the control patients. Further large-scale studies are needed to confirm these initial findings and test the applicability on a broader basis.
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Affiliation(s)
- Till Orlemann
- Hector Center for Nutrition, Exercise, and Sports, Department of Internal Medicine 1, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Dejan Reljic
- Hector Center for Nutrition, Exercise, and Sports, Department of Internal Medicine 1, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Björn Zenker
- Embedded Systems Institute, Department of Informatics, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Julia Meyer
- Hector Center for Nutrition, Exercise, and Sports, Department of Internal Medicine 1, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Bjoern Eskofier
- Machine Learning and Data Analytics Lab, Department of Computer Science, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Jana Thiemt
- Machine Learning and Data Analytics Lab, Department of Computer Science, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Hans Joachim Herrmann
- Hector Center for Nutrition, Exercise, and Sports, Department of Internal Medicine 1, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Markus Friedrich Neurath
- Department of Internal Medicine 1, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Yurdagül Zopf
- Hector Center for Nutrition, Exercise, and Sports, Department of Internal Medicine 1, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
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