A Smartphone App and Personalized Text Messaging Framework (InDEx) to Monitor and Reduce Alcohol Use in Ex-Serving Personnel: Development and Feasibility Study

Abstract

BackgroundSelf-reported alcohol misuse remains high in armed forces personnel even after they have left service. More than 50% of ex-serving personnel meet the criteria for hazardous alcohol use; however, many fail to acknowledge that they have a problem. Previous research indicates that interventions delivered via smartphone apps are suitable in promoting self-monitoring of alcohol use, have a broad reach, and may be more cost-effective than other types of brief interventions. There is currently no such intervention specifically designed for the armed forces.ObjectiveThis study sought to describe the development of a tailored smartphone app and personalized text messaging (short message service, SMS) framework and to test the usability and feasibility (measured and reported as user engagement) of this app in a hard-to-engage ex-serving population.MethodsApp development used Agile methodology (an incremental, iterative approach used in software development) and was informed by behavior change theory, participant feedback, and focus groups. Participants were recruited between May 2017 and June 2017 from an existing United Kingdom longitudinal military health and well-being cohort study, prescreened for eligibility, and directed to download either Android or iOS versions of the ”Information about Drinking for Ex-serving personnel” (InDEx) app. Through the app, participants were asked to record alcohol consumption, complete a range of self-report measures, and set goals using implementation intentions (if-then plans). Alongside the app, participants received daily automated personalized text messages (SMS) corresponding to specific behavior change techniques with content informed by the health action process approach with the intended purpose of promoting the use of the drinks diary, suggesting alternative behaviors, and providing feedback on goals setting.ResultsInvitations to take part in the study were sent to ex-serving personnel, 22.6% (31/137) of whom accepted and downloaded the app. Participants opened the InDEx app a median of 15.0 (interquartile range [IQR] 8.5-19.0) times during the 4 week period (28 days), received an average of 36.1 (SD 3.2) text messages (SMS), consumed alcohol on a median of 13.0 (IQR 11.0-15.0) days, and consumed a median of 5.6 (IQR 3.3-11.8) units per drinking day in the first week, which decreased to 4.7 (IQR 2.0-6.9) units by the last week and remained active for 4.0 (IQR 3.0-4.0) weeks.ConclusionsPersonnel engaged and used the app regularly as demonstrated by the number of initializations, interactions, and time spent using InDEx. Future research is needed to evaluate the engagement with and efficacy of InDEx for the reduction of alcohol consumption and binge drinking in an armed forces population.

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

“…The Drinks :Ration app, formerly called InDEx [ 49 - 51 ], has been developed following the Medical Research Council Complex Intervention Guidelines and using co-design methodology. It has been developed by the King’s Centre for Military Health Research (at King’s College London) and the University of Liverpool, supported by experts in smartphone app development, epidemiology, addiction psychiatry, and military mental health.…”

“…The app is designed to enhance participants’ motivation and self-efficacy in modifying their alcohol consumption by means of BCT in the content displayed ( Multimedia Appendix 1 ) and the messaging sent to participants. The iterative development process, theoretical framework, and feasibility trial have already been reported [ 49 - 51 ]. Briefly, Drinks :Ration has been developed and tested with the following 5 core modules:…”

“…In addition to the Drinks :Ration app, participants will receive personalized push notifications and SMS text messaging that provide prompts to use the drinks diary, complete questionnaires, suggest alternative behaviors, provide feedback on goals, and promote a healthy lifestyle. A bank of personalized messages (both for SMS text messages and push notifications) informed by 180 tailored messages developed previously (which are informed by the Health Action Process Approach framework and targeted toward specific BCTs) [ 49 ] will be used.…”

Identifying Veterans Using Electronic Health Records in the United Kingdom: A Feasibility Study

“…Recent research suggests that 93% of veterans who reported having a mental health difficulty seek some form of help for their problems, with 86% endorsing informal support through family and friends and 46% endorsing formal non-medical (or welfare) support [8]. To support help-seeking, a range of interventions are currently being developed [9][10][11]. However, it is worth noting that treatment seeking rates vary across studies in the UK.…”

Effectiveness of PUSH notifications from a mobile app for improving the body composition of overweight or obese women: a protocol of a three-armed randomized controlled trial

“…SMSs have demonstrated that they are an excellent resource for delivering electronic reminders in practice and a very feasible platform, being useful in increasing adherence to treatment [18], preventing complications in non-communicable diseases [19], facilitating interprofessional communication [20], and helping in disease self-management [21]. PUSH notifications (defined as an event-based mechanism where remote servers "push"/ CONVEY events to Smartphone client apps) [22] has recently appeared in mhealth, showing its potential for improving pervasive functionalities in mobile health apps, allowing the delivery of timely updates and customized reminders to users or patients. One of the essential functionalities is to offer alerts to inform the user about a received message and invite him/her to act, even without needing to be the app being used [23].…”