Behavior Change Techniques Used in Digital Behavior Change Interventions to Reduce Excessive Alcohol Consumption: A Meta-regression

Garnett, Claire; Crane, David; Brown, Jamie; Kaner, Eileen; Beyer, Fiona; Muirhead, Colin R.; Hickman, Matthew; Beard, Emma; Redmore, James; Vocht, Frank de; Michie, Susan

doi:10.1093/abm/kax029

Cited by 55 publications

(48 citation statements)

References 96 publications

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“…Some of our findings are consistent with previous work, for example, we found that credibility was a central facet of the acceptability of InDEx; Garnett et al’s meta-regression [25] found that the credibility of sources was associated with a reduction in alcohol consumption. Furthermore, the persuasive system design model proposes that perceived system credibility is required for technologies to be believable and more persuasive [48,49].…”

Section: Discussionsupporting

confidence: 92%

“…One possible way in which monitoring can be maintained is through the use of text messages encouraging adherence [20,21]. Another issue is the extent to which a theory is used to develop alcohol app interventions [22-24]; research has shown that more than half of digital alcohol interventions did not mention the use of theory [14,25] and only 38% used theory to inform intervention development [25]. Therefore, it is difficult to understand if it is effective in changing drinking behavior [14].…”

Section: Introductionmentioning

confidence: 99%

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A Qualitative Evaluation of the Acceptability of a Tailored Smartphone Alcohol Intervention for a Military Population: Information About Drinking for Ex-Serving Personnel (InDEx) App

Puddephatt¹,

Leightley²,

Palmer³

et al. 2019

JMIR Mhealth Uhealth

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Background Alcohol consumption in the UK Armed Forces is higher than in the general population, and this pattern continues after leaving the service. Smartphone apps may be useful to increase ex-serving personnel’s awareness of their alcohol consumption, support self-monitoring, and prompt a change in behavior. Objective The study aimed to explore the acceptability of Information about Drinking in Ex-serving personnel (InDEx), a tailored smartphone app, combined with personalized short message service (SMS) text messaging designed to target ex-serving personnel who meet the criteria for hazardous alcohol use. Methods The InDEx intervention included 4 key modules: (1) assessment and normative feedback, (2) self-monitoring and feedback, (3) goal setting and review, and (4) personalized SMS text messaging. A semistructured telephone interview study was conducted with ex-serving personnel after using the app for a 28-day period. Interviews were used to explore the acceptability of app modules and its functionality and the perceived changes in participant’s drinking. Interview transcripts were analyzed using inductive thematic analysis. Results Overall, 94% (29/31) participants who used InDEx agreed to take part in a telephone interview. Overall, 4 themes were identified: Credibility , Meeting their needs , Simplicity , and Helpful for ex-serving personnel . The importance of credibility, functionality, and meeting the individual needs of ex-serving personnel was emphasized. Acceptability and engagement with specific modules of the app and text messages were influenced by the following: (1) if they felt it provided credible information, (2) whether the content was appropriately personalized to them, (3) the ease of use, and (4) beliefs about their own drinking behaviors. Participants recommended that the app would be most suitable for personnel about to leave the Armed Forces. Conclusions InDEx was an acceptable smartphone app for ex-serving personnel for monitoring alcohol consumption and in providing meaningful feedback to the individual. Pages that met the participant’s interests and provided real time personalized, credible feedback on their drinking and text messages tailored to participant’s interactions with the app were particularly favored.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

A Qualitative Evaluation of the Acceptability of a Tailored Smartphone Alcohol Intervention for a Military Population: Information About Drinking for Ex-Serving Personnel (InDEx) App

Puddephatt¹,

Leightley²,

Palmer³

et al. 2019

JMIR Mhealth Uhealth

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“…We are also much clearer that any definitive trial must be powered to detect small effects and designed to inform a pragmatic decision about whether to invest resources in recommending the app. The optimisation of the Drink Less intervention was based on the findings from this study as well as on user feedback and findings from a meta-analysis of the intervention components in digital alcohol interventions associated with effectiveness 32 . The findings from this study informed the removal of the ‘Identity Change’ module and retention of the remaining four modules.” The stopping rule in frequentist statistics means that additional trial data collected as part of an effectiveness trial for a DBCI would go to waste.…”

Section: Discussionmentioning

confidence: 99%

Updating the evidence on the effectiveness of the alcohol reduction app, Drink Less: using Bayes factors to analyse trial datasets supplemented with extended recruitment

et al. 2019

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Background: A factorial experiment evaluating the Drink Less app found no clear evidence for main effects of enhanced versus minimal versions of five components but some evidence for an interaction effect. Bayes factors (BFs) showed the data to be insensitive. This study examined the use of BFs to update the evidence with further recruitment. Methods: A between-subject factorial experiment evaluated the main and two-way interaction effects of enhanced versus minimal version of five components of Drink Less. Participants were excessive drinkers, aged 18+, and living in the UK. After the required sample size was reached (n=672), additional data were collected for five months. Outcome measures were change in past week alcohol consumption and Alcohol Use Disorders Identification Test (AUDIT) score at one-month follow-up, amongst responders only (those who completed the questionnaire). BFs (with a half-normal distribution) were calculated (BF<0.33 indicate evidence for null hypothesis; 0.33<BF<3 indicate data are insensitive). Results: Of the sample of 2586, 342 (13.2%) responded to follow-up. Data were mainly insensitive but tended to support there being no large main effects of the enhanced version of individual components on consumption (0.22<BF<0.83) or AUDIT score (0.14<BF<0.98). Data no longer supported there being two-way interaction effects (0.31<BF<1.99). In an additional exploratory analysis, participants receiving four of the components averaged a numerically greater reduction in consumption than those not receiving any (21.6 versus 12.1 units), but the data were insensitive (BF=1.42). Conclusions: Data from extended recruitment in a factorial experiment evaluating components of Drink Less remained insensitive but tended towards individual and pairs of components not having a large effect. In an exploratory analysis, there was weak, anecdotal evidence for a synergistic effect of four components. In the event of uncertain results, calculating BFs can be used to update the strength of evidence of a dataset supplemented with extended recruitment.

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“…The two frameworks are complementary and in addition to designing interventions, they have been used as a method for identifying behavioural components in public health interventions and clinical trials 21. The tools have been used in previous systematic reviews to identify behaviour change techniques and functions in health interventions 22–28…”

Section: Methodsmentioning

confidence: 99%

Lifestyle behaviour change for preventing the progression of chronic kidney disease: a systematic review

et al. 2019

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ObjectivesModifying lifestyle can prevent the progression of chronic kidney disease (CKD) but the specific elements which lead to favourable behaviour change are not well understood. We aimed to identify and evaluate behaviour change techniques and functions in lifestyle interventions for preventing the progression of CKD.DesignSystematic review.Data sourcesMEDLINE, EMBASE, CINAHL and PsycINFO.Eligibility criteriaTrials of lifestyle behaviour change interventions (including diet, physical activity, smoking and/or alcohol) published to September 2018 in adults with CKD stages 1–5.Data extraction and synthesisTrial characteristics including population, sample size, study setting, intervention, comparator, outcomes and study duration, were extracted. Study quality was independently assessed by two reviewers using the Cochrane risk of bias tool. The Behaviour Change Technique Taxonomy v1 was used to identify behaviour change techniques (eg, goal setting) and the Health Behaviour Change Wheel was used to identify intervention functions (eg, education). Both were independently assessed by three reviewers.ResultsIn total, 26 studies involving 4263 participants were included. Risk of bias was high or unclear in most studies. Interventions involved diet (11), physical activity (8) or general lifestyle (7). Education was the most frequently used function (21 interventions), followed by enablement (18), training (12), persuasion (4), environmental restructuring (4), modelling (2) and incentivisation (2). The most common behaviour change techniques were behavioural instruction (23 interventions), social support (16), behavioural demonstration (13), feedback on behaviour (12) and behavioural practice/rehearsal (12). Eighteen studies (69%) showed a significant improvement in at least one primary outcome, all of which included education, persuasion, modelling and incentivisation.ConclusionLifestyle behaviour change interventions for CKD patients frequently used education, goal setting, feedback, monitoring and social support. The most promising interventions included education and used a variety of intervention functions (persuasion, modelling and incentivisation).PROSPERO registration numberCRD42019106053.

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Behavior Change Techniques Used in Digital Behavior Change Interventions to Reduce Excessive Alcohol Consumption: A Meta-regression

Abstract: "Behavior substitution," "Problem solving," and "Credible source" were associated with greater alcohol reduction. Many BCTs were used infrequently in DBCIs, including BCTs with evidence of effectiveness in other domains, such as "Self-monitoring" and "Goal setting."

Cited by 55 publications

References 96 publications

A Qualitative Evaluation of the Acceptability of a Tailored Smartphone Alcohol Intervention for a Military Population: Information About Drinking for Ex-Serving Personnel (InDEx) App

A Qualitative Evaluation of the Acceptability of a Tailored Smartphone Alcohol Intervention for a Military Population: Information About Drinking for Ex-Serving Personnel (InDEx) App

Updating the evidence on the effectiveness of the alcohol reduction app, Drink Less: using Bayes factors to analyse trial datasets supplemented with extended recruitment

Lifestyle behaviour change for preventing the progression of chronic kidney disease: a systematic review

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