Reported Theory Use by Digital Interventions for Hazardous and Harmful Alcohol Consumption, and Association With Effectiveness: Meta-Regression

Abstract

BackgroundApplying theory to the design and evaluation of interventions is likely to increase effectiveness and improve the evidence base from which future interventions are developed, though few interventions report this.ObjectiveThe aim of this paper was to assess how digital interventions to reduce hazardous and harmful alcohol consumption report the use of theory in their development and evaluation, and whether reporting of theory use is associated with intervention effectiveness.MethodsRandomized controlled trials were extracted from a Cochrane review on digital interventions for reducing hazardous and harmful alcohol consumption. Reporting of theory use within these digital interventions was investigated using the theory coding scheme (TCS). Reported theory use was analyzed by frequency counts and descriptive statistics. Associations were analyzed with meta-regression models.ResultsOf 41 trials involving 42 comparisons, half did not mention theory (50% [21/42]), and only 38% (16/42) used theory to select or develop the intervention techniques. Significant heterogeneity existed between studies in the effect of interventions on alcohol reduction (I2=77.6%, P<.001). No significant associations were detected between reporting of theory use and intervention effectiveness in unadjusted models, though the meta-regression was underpowered to detect modest associations.ConclusionsDigital interventions offer a unique opportunity to refine and develop new dynamic, temporally sensitive theories, yet none of the studies reported refining or developing theory. Clearer selection, application, and reporting of theory use is needed to accurately assess how useful theory is in this field and to advance the field of behavior change theories.

Mobile Health Interventions for Self-Control of Unhealthy Alcohol Use: Systematic Review

“…Psychological theory of motivation is used to develop motivational strategies to control UAU against psychological craving for alcohol [81]. Although mHealth interventions based on theory can improve instructional design and the effect of self-control of UAU [76], no significant difference in health outcomes was found in this review for the studies based on theory and those otherwise, which is in accordance with the finding of Garnett et al [82]. There might be two reasons to explain this phenomenon.…”

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

“…However, in the main Cochrane review, the trials were classified based on their longest follow-up and the change per month of follow-up in the difference in alcohol consumption between experimental and control arms was not statistically significant [52]. Other potential moderators of intervention effectiveness, such as age and gender, have been analyzed and reported in the main Cochrane review [52] and whether reported use of theory in the intervention can account for any of the heterogeneity in intervention effectiveness is analyzed in a separate paper [101]. These moderator analyses were not part of the pre-specified analysis plan and would likely over parametrize the models in the current study, whose main focus was explanatory.…”

Development of a formal system for representing behaviour-change theories

“…Reviews of behaviour change theories have noted that they are often not clearly specified nor capable of generating clear and accurate predictions [9][10][11][12][13] . Moreover, the informal ways in which they tend to be presented limit direct comparison and integration 14,15 .…”