Design and development of a complex narrative intervention delivered by text messages to reduce binge drinking among socially disadvantaged men

Abstract

BackgroundSocially disadvantaged men are at high risk of suffering from alcohol-related harm. Disadvantaged groups are less likely to engage with health promotion. There is a need for interventions that reach large numbers at low cost and which promote high levels of engagement with the behaviour change process. The aim of this study was to design a theoretically and empirically based text message intervention to reduce binge drinking by socially disadvantaged men.ResultsFollowing MRC guidance, the intervention was developed in four stages. Stage 1 developed a detailed behaviour change strategy based on existing literature and theory from several areas. These included the psychological theory that would underpin the intervention, alcohol brief interventions, text message interventions, effective behaviour change techniques, narratives in behaviour change interventions and communication theory. In addition, formative research was carried out. A logic model was developed to depict the pathways between intervention inputs, processes and outcomes for behaviour change. Stage 2 created a narrative which illustrated and modelled key steps in the strategy. Stage 3 rendered the intervention into a series of text messages and ensured that appropriate behavioural change techniques were incorporated. Stage 4 revised the messages to ensure comprehensive coverage of the behaviour change strategy and coherence of the narrative. It also piloted the intervention and made final revisions to it.ConclusionsThe structured, systematic approach to design created a narrative intervention which had a strong theoretical and empirical basis. The use of a narrative helped make the intervention realistic and allowed key behaviour change techniques to be modelled by characters. The narrative was intended to promote engagement with the intervention. The intervention was rendered into a series of short text messages, and subsequent piloting showed they were acceptable in the target group. Delivery of an intervention by text message offers a low-cost, low-demand method that can reach large numbers of people. This approach provides a framework for the design of behaviour change interventions which could be used for interventions to tackle other health behaviours.Electronic supplementary materialThe online version of this article (10.1186/s40814-018-0298-0) contains supplementary material, which is available to authorized users.

Text messaging and financial incentives to encourage weight loss in men with obesity: the Game of Stones feasibility RCT

“…This medium may provide an engaging vehicle through which to deliver theory-and evidence-based behaviour change techniques (BCTs). 21 The content, embedded in imaginable real-world scenarios and enabled by characters that are similar to participants, draws on established principles of engagement from the film and games industries. 22 For details of the specific approach used to develop the narrative SMS in the current study and how it used theory and evidence-based BCTs and storytelling elements, see Chapter 3.…”

“…The overall narrative was first designed with enough interlinked stories to engage participants over 12 months, taking into account the number and frequency of texts used in previous studies that showed strong levels of engagement. 13,15,21,57 The number of interwoven stories was therefore increased to create an engaging narrative using no more than five texts per day over the 12 months.…”

“…All SMS replies were forwarded to the research team by e-mail. The SMS system used in this study automatically screened incoming SMS words such as 'suicide', 'die' and 'death' based on participant safety assessments in previous SMS intervention trials 13,15,21 for alcohol reduction, and e-mail alerts to researchers from these messages were highlighted with a red flag. Researchers then followed the ethics approved protocol for following up participants.…”

“…The FFIT study 7 used community recruitment activities, and 35% of the participants randomised were from disadvantaged backgrounds. Irvine et al 21 recruited 44% of participants from SIMD category 1 or 2 areas to a SMS intervention, including a face-to-face component, using similar recruitment strategies to those in Game of Stones. Two large English weight management studies delivered in primary care 96,97 included a minority of men and recruited participants who were more affluent, on average, than the English population.…”

Test@Work Texts: Mobile Phone Messaging to Increase Awareness of HIV and HIV Testing in UK Construction Employees During the COVID-19 Pandemic

“…This was to identify any additional HIV -related messages that had not arisen from the literature and to ensure the language of messaging both communicated the intended health message and was appropriate for working-age adults. Following a fidelity testing process previously used for text messaging content development [17,64] participants were asked to answer five questions with additional opportunity for providing free text responses: a) What do you think are the advantages of getting a regular HIV test? ; b) What do you think are the barriers that prevent people from getting regular HIV tests?…”