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Collier ES, Blomqvist J, Bendtsen M. Satisfaction with a digital support tool targeting alcohol consumption: perspectives from participants in a randomized control trial. Alcohol Alcohol 2024; 59:agad070. [PMID: 37930790 PMCID: PMC10783947 DOI: 10.1093/alcalc/agad070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 09/26/2023] [Accepted: 10/02/2023] [Indexed: 11/07/2023] Open
Abstract
AIM Intervention design may be improved through evaluating the feedback from those who have been exposed to such interventions. As such, here the perspectives of the intervention group from a recent randomized control trial investigating the effectiveness of a digital alcohol intervention, in terms of perceived suitability and usefulness of the support tool they engaged with, were investigated. METHODS Respondents (N=475; 45% of the intervention group) answered five quantitative questions addressing user experience, completed the 10-item System Useability Scale, and were offered the opportunity to write free-text feedback. Quantitative measures were analysed using ordinal and linear regression with baseline characteristics as predictors, and free-text responses were evaluated using content analysis. RESULTS Overall, respondents were positive towards the intervention in terms of it fitting their needs, the usefulness of the tools included, and the usefulness of text message content. The intervention was perceived as more helpful by respondents with lower total weekly alcohol consumption, higher self-reported confidence in their ability to reduce their drinking, and the perceived importance there of, at baseline. The free-text comments revealed the value of reminders as prompts to reflect on one's own drinking behaviour. Nonetheless, criticisms of the intervention were voiced, primarily highlighting the repetitive nature of the reminders and the lack of individuation in advice. Some also feltlike the intervention was impersonal and targeted only a specific drinking pattern. CONCLUSIONS Experiences of the intervention group in this trial were generally positive, though there may be demand for more individualised, targeted intervention design.
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Affiliation(s)
- Elizabeth S Collier
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Division of Bioeconomy and Health, Department of Material and Surface Design, RISE Research Institutes of Sweden, Stockholm, Sweden
| | - Jenny Blomqvist
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Marcus Bendtsen
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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2
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Åsberg K, Eldh AC, Löf M, Bendtsen M. "Simply complicated": Uncovering the processes of lifestyle behavior change among college and university students with access to a digital multiple lifestyle intervention. Digit Health 2024; 10:20552076241245905. [PMID: 38601184 PMCID: PMC11005484 DOI: 10.1177/20552076241245905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2024] [Indexed: 04/12/2024] Open
Abstract
Background One approach to promoting healthy lifestyle behaviors is to target students with digital interventions. One of these is the digital intervention Buddy. This study aimed to understand why college and university students' chose to participate in a digital multiple lifestyle behavior intervention trial (Buddy), and their subsequent experiences of the behavior-change process. Methods College and university students taking part in a trial of the Buddy intervention were individually interviewed after completing the 4-month intervention. Participants were guided to narrate their experiences and actions that followed signing up. Altogether, 50 interviews were conducted via telephone. The verbatim transcribed texts were analyzed qualitatively. Results The analysis generated seven personas, which illustrated the students' different levels of engagement with the intervention and the behavior-change process. These were: the Occupied, the Kickstarter, the Aimless, the Reflective, the Goal-oriented, the Compliant, and the Personally developed. Buddy worked best for students who had clear ideas about what they wanted to change and why, and who were aware of their needs, and those who could translate information and reflection into action and had the mental and physical energy needed to make changes. Conclusions The progress of behavior change depends on the interaction between the digital mode of delivery, the intervention materials of Buddy, the individual's expectations, needs, and skills, and their current life situation. This suggests that designing lifestyle interventions could benefit from more often considering the various personas' different intentions, knowledge, and contexts. By doing so, interventions are likely to emerge that can better match different needs in the target population.
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Affiliation(s)
- Katarina Åsberg
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Ann Catrine Eldh
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Marie Löf
- Department of Biosciences and Nutrition, Karolinska Institute, Stockholm, Sweden
| | - Marcus Bendtsen
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Collier ES, Blomqvist J, Crawford J, McCambridge J, Bendtsen M. Exploratory mixed methods analysis of self-authored content from participants in a digital alcohol intervention trial. Subst Abuse Treat Prev Policy 2023; 18:60. [PMID: 37898782 PMCID: PMC10613385 DOI: 10.1186/s13011-023-00569-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 10/19/2023] [Indexed: 10/30/2023] Open
Abstract
BACKGROUND Digital interventions readily permit data capture of participant engagement with them. If future interventions are intended to be more interactive, tailored, or a useful resource offered to users, it may be valuable to examine such data. One module available in a digital alcohol intervention recently tested in a randomised control trial offered participants the opportunity to self-author prompts that were sent to them by a text message at a time of their choosing. This study thus aimed to evaluate these self-authored prompts to increase knowledge on how individuals negotiate behaviour change and assess whether intervention content can be improved in the future. METHODS The self-authored prompts were evaluated qualitatively using a combination of content and thematic analysis. The identified themes and subcategories are exemplified using anonymized quotes, and the frequency that each identified theme was coded for among the prompts was calculated. Associations between baseline characteristics and the odds of authoring a prompt at all, as well as a prompt within each theme, were investigated using logistic regression. RESULTS Five themes were identified (Encouragement Style, Level of Awareness, Reminders of reasons to reduce/quit, Strategies to reduce/quit, and Timescale), all with several subcategories. The prompts module was more likely to be used by women and older individuals, as well as those for whom reducing alcohol consumption was perceived as important, or who felt they had the know-how to do so. Participants who had immediate access to the support tool (intervention group) were more than twice as likely to author a prompt (OR = 2.36; probability of association > 99%) compared to those with 4-month delayed access (control group). CONCLUSIONS Individuals who engaged with the prompts module showed evidence of using the information provided in the support tool in an active way, with several showing goal setting and making plans to change their drinking behaviour. Individuals also used this opportunity to remind themselves of personal and specific reasons they wanted to change their drinking, as well as to encourage themselves to do so.
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Affiliation(s)
- Elizabeth S Collier
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, 581 83, Sweden.
- Division of Bioeconomy and Health, Perception and Design Unit, RISE Research Institutes of Sweden, Stockholm, 114 28, Sweden.
| | - Jenny Blomqvist
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, 581 83, Sweden
| | - Joel Crawford
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, 581 83, Sweden
| | - Jim McCambridge
- Department of Health Sciences, University of York, York, United Kingdom
| | - Marcus Bendtsen
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, 581 83, Sweden
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Sandhu S, Wilson E, Chattopadhyay K. Perceptions and Experiences of Undergraduate Students Regarding Social Media as a Tool for Government COVID-19-Related Messages: A Qualitative Study in Nottingham, UK. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6903. [PMID: 37887641 PMCID: PMC10606761 DOI: 10.3390/ijerph20206903] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 10/02/2023] [Accepted: 10/04/2023] [Indexed: 10/28/2023]
Abstract
The rise of social media has given way to its use as a form of public health communication. Previous research has shown social media-based interventions to be effective, particularly for university students. Social media was used as a tool for public health messaging during the COVID-19 pandemic; however, there is a lack of information regarding the experiences and perceptions of such messaging and its effectiveness among UK university students. A qualitative study was conducted to explore the perceptions and experiences of public health messaging on social media during the pandemic, as well as the effects of such messaging. Fourteen semi-structured interviews with undergraduate students at the University of Nottingham, UK, were conducted. Five main themes were identified: effects of COVID-19 on university students, use of social media by university students, COVID-19 messaging on social media, effects of public health messaging on social media in compliance with COVID-19 guidelines, and improving public health messaging for the future. This study provides a novel insight into the experiences and perceptions of undergraduate students at a UK university regarding public health messaging on social media during the COVID-19 pandemic.
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Affiliation(s)
- Sanvir Sandhu
- Nottingham Centre for Public Health and Epidemiology, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK; (E.W.); (K.C.)
- Centre for Interprofessional Education and Learning, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham NG7 2UH, UK
| | - Emma Wilson
- Nottingham Centre for Public Health and Epidemiology, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK; (E.W.); (K.C.)
- Nottingham Centre for Evidence Based Healthcare, University of Nottingham, Nottingham NG7 2RD, UK
| | - Kaushik Chattopadhyay
- Nottingham Centre for Public Health and Epidemiology, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK; (E.W.); (K.C.)
- Nottingham Centre for Evidence Based Healthcare, University of Nottingham, Nottingham NG7 2RD, UK
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Müssener U, Henriksson P, Gustavsson C, Henriksson H, Tyrberg MJ, Johansson S, Alfredsson Ågren K. Promoting Healthy Behaviors Among Adolescents and Young Adults With Intellectual Disability: Protocol for Developing a Digital Intervention With Co-Design Workshops. JMIR Res Protoc 2023; 12:e47877. [PMID: 37505807 PMCID: PMC10422167 DOI: 10.2196/47877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 06/07/2023] [Accepted: 06/07/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Intellectual disability (ID) is a neurodevelopmental disorder associated with a poorer health profile and higher mortality. Young people with ID have more sedentary lifestyles than their typically developing peers. Consequently, this group is at significant risk of developing lifestyle diseases (ie, noncommunicable diseases) later in life. Increasing physical activity and eating a healthier diet have been argued to be effective ways to improve the health of adolescents and young adults with ID. Digital interventions are a viable option for improving health behaviors. OBJECTIVE This research protocol describes a co-design approach using workshops to develop a digital intervention that promotes healthy behaviors, including increasing physical activity and eating a healthier diet, among adolescents and young adults with ID. METHODS A participatory design using a co-design approach will be applied as a strategy to include potential users of the digital intervention and other stakeholders in the research process, comprising research design, data collection, and data analysis. A total of 7 to 10 workshops will be conducted aimed at developing a digital intervention and will include procedures for assessing needs; facilitators and barriers to health promotion; physical, mental, and social well-being; participation; and relationships. The workshops will include 12 to 18 stakeholders with experience of clinical practice and research related to young people with ID, including relatives, as well as adolescents and young adults (aged 16-25 years) with mild to moderate ID. Participants will perform a mixture of individual and group work using whiteboards, sticky notes, felt-tip pens, cards, balls, stickers, and wireframe templates. Data analysis will take place concurrently with data collection as an iterative process. Transcribed data from the audio and video recordings of the groups' discussions will be analyzed following a qualitative methodological procedure. RESULTS This study protocol provides a systematic record of the scientific methodologies used when developing the digital intervention and provides insights into the potential practical solutions and challenges when following a co-design approach in which relatives and professionals, as well as adolescents and young adults with ID, are included as research partners. Recruitment of participants started in April 2023. Data collection, analysis, and reporting will be completed in December 2023. CONCLUSIONS This study will explore the effectiveness of workshops at gathering rich, reliable, and valid data in a co-design approach with participants. The results will provide increased knowledge in how to use technology to develop novel, evidence-based, and scalable interventions that adolescents and young adults with ID can and want to use to motivate physical activity and a healthier diet. The project will provide a simple and cognitively accessible digital solution for promoting lifestyle behaviors tailored to the needs of adolescents and young adults with ID. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/47877.
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Affiliation(s)
- Ulrika Müssener
- Department of Health, Medicine, and Caring Sciences, Linköping University, Linköping, Sweden
| | - Pontus Henriksson
- Department of Health, Medicine, and Caring Sciences, Linköping University, Linköping, Sweden
| | - Catharina Gustavsson
- Center for Clinical Research Dalarna, Uppsala University, Falun, Sweden
- School of Health and Welfare, Dalarna University, Falun, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Hanna Henriksson
- Department of Health, Medicine, and Caring Sciences, Linköping University, Linköping, Sweden
| | - Mårten J Tyrberg
- Centre for Clinical Research, Uppsala University, Uppsala, Sweden
- Region Västmanland, Västmanland Hospital, Västerås, Sweden
| | - Stefan Johansson
- Division of Media Technology and Interaction Design, School of Electrical Engineering and Computer Science, Kungliga Tekniska Högskolan, Stockholm, Sweden
- Department of Design Sciences, Lund University, Lund, Sweden
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Åsberg K, Lundgren O, Henriksson H, Henriksson P, Bendtsen P, Löf M, Bendtsen M. Multiple lifestyle behaviour mHealth intervention targeting Swedish college and university students: protocol for the Buddy randomised factorial trial. BMJ Open 2021. [PMCID: PMC8719203 DOI: 10.1136/bmjopen-2021-051044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Introduction The time during which many attend college or university is an important period for developing health behaviours, with potentially major implications for future health. Therefore, it is concerning that many Swedish students excessively consume alcohol, have unhealthy diets, are not physical active and smoke. The potential of digital interventions which integrate support for change of all of these behaviours is largely unexplored, as are the dismantled effects of the individual components that make up digital lifestyle behaviour interventions. Methods and analysis A factorial randomised trial (six factors with two levels each) will be employed to estimate the effects of the components of a novel mHealth multiple lifestyle intervention on alcohol consumption, diet, physical activity and smoking among Swedish college and university students. A Bayesian group sequential design will be employed to periodically make decisions to continue or stop recruitment, with simulations suggesting that between 1500 and 2500 participants will be required. Multilevel regression models will be used to analyse behavioural outcomes collected at 2 and 4 months postrandomisation. Ethics and dissemination The study was approved by the Swedish Ethical Review Authority on 2020-12-15 (Dnr 2020-05496). The main concern is the opportunity cost if the intervention is found to only have small effects. However, considering the lack of a generally available evidence-based multiple lifestyle behaviour support to university and college students, this risk was deemed acceptable given the potential benefits from the study. Recruitment will begin in March 2021, and it is expected that recruitment will last no more than 24 months. A final data set will, therefore, be available in July 2023, and findings will be reported no later than December 2023. Trial registration number ISRCTN23310640; Pre-results.
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Affiliation(s)
- Katarina Åsberg
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Oskar Lundgren
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Hanna Henriksson
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Pontus Henriksson
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Preben Bendtsen
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Medical Specialist, Motala Hospital, Motala, Sweden
| | - Marie Löf
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden
| | - Marcus Bendtsen
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Bendtsen M, Seiterö A, Bendtsen P, Henriksson H, Henriksson P, Thomas K, Löf M, Müssener U. mHealth intervention for multiple lifestyle behaviour change among high school students in Sweden (LIFE4YOUth): protocol for a randomised controlled trial. BMC Public Health 2021; 21:1406. [PMID: 34271882 PMCID: PMC8283383 DOI: 10.1186/s12889-021-11446-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 07/01/2021] [Indexed: 11/25/2022] Open
Abstract
Background National surveys in Sweden demonstrate that the majority of young people do not engage in health promoting behaviours at levels recommended by the Public Health Agency of Sweden. The objective of this study is to estimate the effectiveness of a novel mHealth intervention named LIFE4YOUth, which targets multiple lifestyle behaviours (alcohol, diet, physical activity, and smoking) among high school students in Sweden. Methods A 2-arm parallel groups single blind randomised controlled trial (1:1) will be employed to estimate the effectiveness of the novel mHealth intervention. Students will be recruited at high schools throughout Sweden, and will be included if they fulfil one of six criteria relating to unhealthy behaviours with respect to alcohol, diet, physical activity and smoking. Eligible participants will be randomised to either receive the novel intervention immediately, or to be placed on a waiting list for 4 months. The intervention consists of a combination of recurring screening, text messages, and an interactive platform which is adaptable to individual preferences. Outcome measures with respect to alcohol, diet, physical activity and smoking will be assessed through questionnaires at 2 and 4 months post randomisation. Discussion The findings of this trial could be generalised to a diverse high-school student population as our recruitment encompass a large proportion of schools throughout Sweden with various educational profiles. Furthermore, if effective, the mHealth intervention has good potential to be able to be scaled up and disseminated at high schools nationally. Trial registration Registered prospectively on 2020-05-20 in ISRCTN (ISRCTN34468623). Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11446-9.
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Affiliation(s)
- Marcus Bendtsen
- Department of Health, Medicine and Caring Sciences, Linköping University, 581 83, Linköping, Sweden.
| | - Anna Seiterö
- Department of Health, Medicine and Caring Sciences, Linköping University, 581 83, Linköping, Sweden
| | - Preben Bendtsen
- Department of Health, Medicine and Caring Sciences, Linköping University, 581 83, Linköping, Sweden.,Department of Medical Specialist, Motala, Sweden
| | - Hanna Henriksson
- Department of Health, Medicine and Caring Sciences, Linköping University, 581 83, Linköping, Sweden
| | - Pontus Henriksson
- Department of Health, Medicine and Caring Sciences, Linköping University, 581 83, Linköping, Sweden.,Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden
| | - Kristin Thomas
- Department of Health, Medicine and Caring Sciences, Linköping University, 581 83, Linköping, Sweden
| | - Marie Löf
- Department of Health, Medicine and Caring Sciences, Linköping University, 581 83, Linköping, Sweden.,Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden
| | - Ulrika Müssener
- Department of Health, Medicine and Caring Sciences, Linköping University, 581 83, Linköping, Sweden
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Dawson J, Tong A, Matus Gonzalez A, Campbell KL, Craig JC, Lee VW. Patients' experiences and perspectives of a mobile phone text messaging intervention to improve dietary behaviours in haemodialysis. Nutr Diet 2021; 78:516-523. [PMID: 33870612 DOI: 10.1111/1747-0080.12667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 02/22/2021] [Accepted: 03/02/2021] [Indexed: 11/30/2022]
Abstract
AIM Dietary requirements for people on haemodialysis are complex and often poorly adhered to. Mobile phone text messaging offers a simple strategy to enhance current nutritional care. KIDNEYTEXT was a 6-month pilot randomised controlled trial that evaluated the feasibility and impact of mobile phone text messages to alter participants' dietary behaviours. The aim of this study was to elicit the perspectives of people on haemodialysis regarding acceptability of mobile phone text messages targeting dietary behaviours. METHODS Semi-structured interviews were conducted with participants in the intervention arm of the KIDNEYTEXT study. Participants were purposively sampled and interviews were conducted in-person or over the phone. Transcripts were thematically analysed using principles of grounded theory. RESULTS Interviews were conducted with 25 participants. Four major themes were identified: building awareness (reinforcement of information, simple and comprehensible, guiding choices, accessible information enhancing motivation, gaining skills in management), valuing care (boosting self-esteem, in-person care bolstered by reminders), activating change (adjusting lifestyle, gaining control of electrolytes and fluid, striving to improve overall health), waning attention and motivation (lack of personalisation limiting change, maintaining the status quo, reverting back to old habits). CONCLUSIONS Participants perceived that the KIDNEYTEXT intervention enabled participants to build on their knowledge through the dissemination of simple and actionable content. Participants appreciated frequent reminders of how to improve their diet and felt that this increased contact motivated them to alter some dietary behaviours. Future trials should consider strategies to enhance personalisation to further motivate dietary change.
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Affiliation(s)
- Jessica Dawson
- Faculty of Medicine and Health, Sydney Medical School, Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Allison Tong
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Andrea Matus Gonzalez
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Katrina L Campbell
- Healthcare Excellence and Innovation, Metro North Hospital and Health Service, Brisbane, Queensland, Australia.,Menzies Health Institute, Griffith University, Brisbane, Queensland, Australia
| | - Jonathan C Craig
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Vincent W Lee
- Faculty of Medicine and Health, Sydney Medical School, Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Department of Renal Medicine, Westmead Hospital, Sydney, New South Wales, Australia
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Leightley D, Rona RJ, Shearer J, Williamson C, Gunasinghe C, Simms A, Fear NT, Goodwin L, Murphy D. Evaluating the Efficacy of a Mobile App (Drinks:Ration) and Personalized Text and Push Messaging to Reduce Alcohol Consumption in a Veteran Population: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2020; 9:e19720. [PMID: 33006569 PMCID: PMC7568221 DOI: 10.2196/19720] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 08/10/2020] [Accepted: 08/11/2020] [Indexed: 01/30/2023] Open
Abstract
Background Alcohol misuse is higher in the UK Armed Forces than in the general population. Previous research has shown that interventions delivered via smartphones are efficacious in promoting self-monitoring of alcohol use, have utility in reducing alcohol consumption, and have a broad reach. Objective This single-blinded randomized controlled trial (RCT) aims to assess the efficacy of a 28-day brief alcohol intervention delivered via a smartphone app (Drinks:Ration) in reducing weekly self-reported alcohol consumption between baseline and 3-month follow-up among veterans who drink at a hazardous or harmful level and receive or have received support for mental health symptoms in a clinical setting. Methods In this two-arm, single-blinded RCT, a smartphone app that includes interactive features designed to enhance participants’ motivation and personalized messaging is compared with a smartphone app that provides only government guidance on alcohol consumption. The trial will be conducted in a veteran population that has sought help through Combat Stress, a UK veteran’s mental health charity. Recruitment, consent, and data collection will be carried out automatically through the Drinks:Ration platform. The primary outcome is the change in self-reported weekly alcohol consumption between baseline (day 0) and 3-month follow-up (day 84) as measured using the Time-Line Follow back for Alcohol Consumption. Secondary outcome measures include (1) change in the baseline to 3-month follow-up (day 84) Alcohol Use Disorder Identification Test score and (2) change in the baseline to 3-month follow-up (day 84) World Health Organization Quality of Life-BREF score to assess the quality of adjusted life years. Process evaluation measures include (1) app use and (2) usability ratings as measured by the mHealth App Usability Questionnaire. The primary and secondary outcomes will also be reassessed at the 6-month follow-up (day 168) to assess the longer-term benefits of the intervention, which will be reported as a secondary outcome. Results The study will begin recruitment in October 2020 and is expected to require 12 months to complete. The study results will be published in 2022. Conclusions This study assesses whether a smartphone app is efficacious in reducing self-reported alcohol consumption in a veteran population that has sought help through Combat Stress using personalized messaging and interactive features. This innovative approach, if successful, may provide a means to deliver a low-cost health promotion program that has the potential to reach large groups, in particular those who are geographically dispersed, such as military personnel. Trial Registration ClinicalTrials.gov NCT04494594; https://clinicaltrials.gov/ct2/show/NCT04494594 International Registered Report Identifier (IRRID) PRR1-10.2196/19720
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Affiliation(s)
- Daniel Leightley
- King's College London, King's Centre for Military Health Research, London, United Kingdom
| | - Roberto J Rona
- King's College London, King's Centre for Military Health Research, London, United Kingdom
| | - James Shearer
- King's College London, King's Health Economics, London, United Kingdom
| | | | - Cerisse Gunasinghe
- King's College London, Department of Psychological Medicine, London, United Kingdom
| | - Amos Simms
- Academic Department of Military Mental Health, King's College London, London, United Kingdom.,British Army, London, United Kingdom
| | - Nicola T Fear
- King's College London, King's Centre for Military Health Research, London, United Kingdom.,Academic Department of Military Mental Health, King's College London, London, United Kingdom
| | - Laura Goodwin
- University of Liverpool, Department of Psychological Sciences, Liverpool, United Kingdom
| | - Dominic Murphy
- King's College London, King's Centre for Military Health Research, London, United Kingdom.,Combat Stress, Leatherhead, United Kingdom
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10
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Burner E, Zhang M, Terp S, Ford Bench K, Lee J, Lam CN, Torres JR, Menchine M, Arora S. Feasibility and Acceptability of a Text Message-Based Intervention to Reduce Overuse of Alcohol in Emergency Department Patients: Controlled Proof-of-Concept Trial. JMIR Mhealth Uhealth 2020; 8:e17557. [PMID: 32496203 PMCID: PMC7303828 DOI: 10.2196/17557] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 03/25/2020] [Accepted: 03/28/2020] [Indexed: 01/12/2023] Open
Abstract
Background Emergency department (ED) patients have high rates of risky alcohol use, and an ED visit offers an opportunity to intervene. ED-based screening, brief intervention, and referral to treatment (SBIRT) reduces alcohol use and health care costs. Mobile health (mHealth) interventions may expand the impact of SBIRTs but are understudied in low-resource ED populations. Objective The objective of this study was to assess the feasibility of and patient satisfaction with a text-based mHealth extension of an ED screening program to reduce risky alcohol use in low-income, urban patients. Methods Research assistants screened a convenience sample of ED patients in person for risky alcohol use via the Alcohol Use Disorders Identification Test (AUDIT). Patients who reported AUDIT scores ≥8 and <20 were informed of their AUDIT score and risk. RAs invited patients with SMS text message–capable phones to receive mROAD (mobilizing to Reduce Overuse of Alcohol in the ED), an SMS text message–based extension of the ED screening program. mROAD is a 7-day program of twice-daily SMS text messages based on the National Institutes of Health’s Rethinking Drinking campaign. Participants were allocated to a control group (daily sham text messages without specific guidance on behaviors, such as “Thanks for taking part!”) or to the mROAD intervention group. Patients were interviewed at 30 days to assess acceptability, satisfaction, and changes in drinking behavior. Satisfaction was examined descriptively. Pre and post measurements of drinking behaviors and motivation were compared, as were differences in change scores between the intervention arms. Results Of 1028 patients screened, 95 (9.2%) exhibited risky alcohol use based on AUDIT, and 23/95 (24%) of those patients did not own an SMS text messaging–capable phone; this left 72/95 (76%) eligible patients. Among eligible participants, 48/72 (67%) agreed to enroll; 31/48 (65%) achieved follow-up (18/24 (75%) in the intervention group and 13/24 (55%) in the control group). Participants who completed follow-up reported high satisfaction. Changes in behavior were similar between the arms. Overall, the number of drinking days reported in the prior 30 days decreased by 5.0 (95% CI 1.7-8.3; P=.004), and the number of heavy drinking days decreased by 4.1 (95% CI 1.0 to 7.15, P=.01). Patients reported an 11-point increase (95% CI 2.6-20, P=.01, 10% overall increase) in motivation to change alcohol use via the Change Questionnaire. The were no statistical differences in drinking days, heavy drinking days, or motivation to change between the arms. Conclusions The mROAD trial was feasible. Over three-quarters of ED patients with risky alcohol use owned a text message–capable phone, and two-thirds of these patients were willing to participate; only 1 patient opted out of the intervention. Although 35% of patients were lost to follow-up at 30 days, those patients who did follow up had favorable impressions of the program; more than 90% reported that SMS text messages were a “good way to teach,” and 89% of intervention arm participants enjoyed the program and found that the messages were motivating. Both the mROAD and sham message groups showed promising changes in alcohol use and motivation to change. mROAD is a feasible intervention that may reduce rates of risky alcohol use in ED patients. Trial Registration ClinicalTrials.gov NCT02158949; https://clinicaltrials.gov/ct2/show/NCT02158949
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Affiliation(s)
- Elizabeth Burner
- Department of Emergency Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States.,Los Angeles County + University of Southern California Medical Center, Los Angeles, CA, United States
| | - Mark Zhang
- Department of Emergency Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States.,Los Angeles County + University of Southern California Medical Center, Los Angeles, CA, United States
| | - Sophie Terp
- Department of Emergency Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States.,Los Angeles County + University of Southern California Medical Center, Los Angeles, CA, United States.,Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, United States
| | - Kelsey Ford Bench
- Department of Emergency Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States.,Los Angeles County + University of Southern California Medical Center, Los Angeles, CA, United States
| | - Joshua Lee
- Department of Emergency Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States.,Los Angeles County + University of Southern California Medical Center, Los Angeles, CA, United States
| | - Chun Nok Lam
- Department of Emergency Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States.,Los Angeles County + University of Southern California Medical Center, Los Angeles, CA, United States
| | - Jesus R Torres
- School of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Michael Menchine
- Department of Emergency Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States.,Los Angeles County + University of Southern California Medical Center, Los Angeles, CA, United States.,Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, United States
| | - Sanjay Arora
- Department of Emergency Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States.,Los Angeles County + University of Southern California Medical Center, Los Angeles, CA, United States.,Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, United States
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Bendtsen M, McCambridge J. Reducing Alcohol Consumption Among Risky Drinkers in the General Population of Sweden Using an Interactive Mobile Health Intervention: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2019; 8:e13119. [PMID: 30998221 PMCID: PMC6495288 DOI: 10.2196/13119] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 02/28/2019] [Accepted: 03/03/2019] [Indexed: 12/25/2022] Open
Abstract
Background Harmful use of alcohol continues to be a leading contributor to premature deaths globally. Not only does harmful drinking have consequences for the individuals consuming at increased levels, but it may also result in a range of negative consequences for their family members and friends. Interventions delivered via mobile phones (mobile health [mHealth] interventions) could potentially support risky drinkers seeking help to reduce their alcohol consumption. Objective This protocol describes a randomized controlled trial that aims to validly estimate the effect of a novel mHealth intervention targeting risky drinkers in the general population of Sweden. Nested within the trial are 3 substudies that focus on methodological and user satisfaction research questions. Methods A 2-arm parallel group randomized controlled trial will be employed to estimate the effect of the novel intervention. Participants will be recruited through Web advertisements and social media. The inclusion criteria are as follows: 18 years or older, ownership of a mobile phone, and being classified as a risky drinker according to Swedish guidelines. Participants allocated to the intervention group will receive a novel mHealth intervention. The intervention consists of weekly screening, personalized feedback on current consumption, functions allowing for planning of future consumption, as well as a series of messages delivered throughout the week. Participants allocated to the control group will receive a short message regarding negative consequences of alcohol consumption and a hyperlink that offers more information. Following 2 and 4 months after randomization, both groups will be asked to complete follow-up questionnaires (2-month interval being primary). Primary outcomes are weekly alcohol consumption and heavy episodic drinking. Participants in the control group will be given access to the novel intervention after completing the 4-month follow-up. The trial includes 3 substudies: We will explore whether the mode of presenting information before participants giving informed consent affects participation rates and recall of trial parameters, investigate if the content of the short message received by the control group affects study outcomes and requests for more information, and explore user satisfaction with the intervention and reactions of the control group. Results Participant recruitment is planned to begin in April 2019 and to last for a maximum of 24 months. The first dataset will be available approximately 2 months after the final participant has been recruited, and the final dataset will be available approximately 2 months later. No participants had been recruited at the time of submitting this protocol. Conclusions If found effective, the intervention has the potential to reduce negative consequences of alcohol consumption for individuals. The technology has been designed to have potential for extensive reach among those who may benefit. Trial Registration ISRCTN Registry ISRCTN48317451; http://www.isrctn.com/ISRCTN48317451 (Archived by WebCite at http://www.webcitation.org/779tKLsu3) International Registered Report Identifier (IRRID) PRR1-10.2196/13119
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Affiliation(s)
- Marcus Bendtsen
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Jim McCambridge
- Department of Health Sciences, University of York, York, United Kingdom
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