Can Simply Answering Research Questions Change Behaviour? Systematic Review and Meta Analyses of Brief Alcohol Intervention Trials

Abstract

BackgroundParticipant reports of their own behaviour are critical for the provision and evaluation of behavioural interventions. Recent developments in brief alcohol intervention trials provide an opportunity to evaluate longstanding concerns that answering questions on behaviour as part of research assessments may inadvertently influence it and produce bias. The study objective was to evaluate the size and nature of effects observed in randomized manipulations of the effects of answering questions on drinking behaviour in brief intervention trials.Methodology/Principal FindingsMultiple methods were used to identify primary studies. Between-group differences in total weekly alcohol consumption, quantity per drinking day and AUDIT scores were evaluated in random effects meta-analyses.Ten trials were included in this review, of which two did not provide findings for quantitative study, in which three outcomes were evaluated. Between-group differences were of the magnitude of 13.7 (−0.17 to 27.6) grams of alcohol per week (approximately 1.5 U.K. units or 1 standard U.S. drink) and 1 point (0.1 to 1.9) in AUDIT score. There was no difference in quantity per drinking day.Conclusions/SignificanceAnswering questions on drinking in brief intervention trials appears to alter subsequent self-reported behaviour. This potentially generates bias by exposing non-intervention control groups to an integral component of the intervention. The effects of brief alcohol interventions may thus have been consistently under-estimated. These findings are relevant to evaluations of any interventions to alter behaviours which involve participant self-report.

The question–behavior effect: Genuine effect or spurious phenomenon? A systematic review of randomized controlled trials with meta-analyses.

“…For example, baseline questions about alcohol consumption may increase awareness and subsequently reduce instances of binge drinking because participants may realize that their alcohol intake is excessive through their interaction with a questionnaire. Therefore, in trials where an intervention designed to reduce drinking behavior is tested against a control condition, baseline assessment may mask or reduce observed intervention effects (McCambridge & Kypri, 2011). Moreover, in some trials, individuals allocated to an intervention group could receive different forms of measurement in order to tailor intervention components to participants.…”

Factors Influencing the Implementation of Screening and Brief Interventions for Alcohol Use in Primary Care Practices: A Systematic Review Protocol

“…12,13 Most trials use self-reported alcohol consumption as their primary outcome measure rather than alcohol-related morbidity or mortality problems, and such self-reported outcomes may be subject to social desirability bias or other research participation effects. 14,15 Furthermore, the active ingredients of SBI have yet to be determined. 16,17 Notwithstanding these discussions, it is clear that alcohol increases the risk of and/ or exacerbates many conditions that present in primary care.…”

Telling your patients to cut down on alcohol: does it work?

“…[13][14][15][16] Brief interventions can vary in their degree of complexity and duration, ranging from the provision of simple advice through to several sessions of motivational interviewing, and delivered by either the person who administered the screening test, a specialist nurse or via SMS, web or email. 17,18 There is some evidence to suggest that simply asking questions about consumption can change behaviour, 19 and that accepting an appointment with an alcohol health worker is as effective as actually attending one. 20 Recent reviews of the evidence suggest that male AUD patients benefit more from brief interventions than females in both primary care and emergency department settings.…”