Text message intervention to reduce frequency of binge drinking among disadvantaged men: the TRAM RCT

Abstract

Background Socially disadvantaged men are more likely to binge drink frequently and to experience high levels of alcohol-related harm. Objectives To test the effectiveness and cost-effectiveness of a text message intervention in reducing the frequency of binge drinking among disadvantaged men. Study design A four-centre, parallel-group, pragmatic, individually randomised controlled trial was conducted. Randomisation was carried out using a secure remote web-based system. It was stratified by participating centre and recruitment method and restricted using block sizes of randomly varying lengths. Setting The study was conducted in the community. Members of the public helped to develop the study methods. Participants Participants were men aged 25–44 years who had ≥ 2 episodes of binge drinking (> 8 units of alcohol in a single session) in the preceding 28 days. Men were recruited from areas of high deprivation. Interventions An empirically and theoretically based text message intervention was delivered by 112 interactive text messages over a 12-week period. The control group received an attentional control comprising 89 text messages on general health. Primary outcome measure The primary outcome measure was the proportion of men consuming > 8 units of alcohol on ≥ 3 occasions (in the previous 28 days) at 12 months post intervention. Results The recruitment target of 798 was exceeded and 825 men were randomised. Retention was high and similar in the intervention (84.9%) and control (86.5%) groups. Most men in the intervention group engaged enthusiastically with the text messages: almost all (92%) replied to text messages and over two-thirds (67%) replied more than 10 times. The intervention was estimated to have had a modest, statistically non-significant effect on the primary outcome at the 12-month follow-up [odds ratio 0.79, 95% confidence interval (CI) 0.57 to 1.08]. This corresponds to a net reduction of 5.7% in regular binge drinking. Five secondary outcomes showed small non-significant and inconsistent effects on alcohol consumption, with one suggesting a positive effect and four suggesting an adverse effect. Both the short- and the long-term cost per quality-adjusted life-year (QALY) analysis suggested that the brief intervention was dominated by a ‘do-nothing’ option. The intervention’s impacts on patterns of alcohol consumption, QALYs and downstream costs were inconsistent and uncertain. Limitations The study used an active control that, combined with the recruitment procedures and baseline assessments, could have biased the treatment effect towards the null. The measurement of alcohol consumption relied on self-reported drinking. Conclusions The trial has demonstrated that it is possible to recruit and retain large numbers of socially disadvantaged men in a research study. The text messages delivered a complex theoretically and empirically based intervention that fostered enthusiastic engagement with the key components of the behaviour change sequence. The intervention produced a modest, statistically non-significant effect on the primary outcome, with wide CIs. Further research is needed to reduce uncertainty about the treatment effect. The methods developed for this study provide a platform for the design and testing of interventions to reduce inequalities in health. Future work A future trial could reduce the uncertainty around the treatment effect of the intervention. Trial registration Current Controlled Trials ISRCTN07695192. Funding This study was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 6, No. 6. See NIHR Journals Library website for further information.

Participation with online recovery specific groups - findings from the UK Life in Recovery survey 2015

“…These findings are consistent with the analyses in this emerging field of enquiry (Cohn, Hunter-Reel, Hagman & Mitchell, 2011;Marsch, 2012;Savic et al, 2013). Although previous research has found that some mobile-based interventions are ineffective in reducing heavy drinking (e.g., Crombie et al, 2018), assessing ORMs use by recovery stage in this paper provides us with new insights. In this regard, this research uncovered a small but significant association between recovery stage and the use of recovery apps, with more people in stable recovery and fewer in early recovery than expected engaged with recovery apps.…”

Text messaging interventions for reducing alcohol consumption among risky drinkers: systematic review and meta‐analysis

“…The text messages were designed to support behaviour change, typically including: self‐assessment and feedback on alcohol consumption, information addressing drinking culture in the target population, facts about alcohol, strategies to limit alcohol consumption, motivational content including benefits and consequences, normative feedback and linking out to additional support. Six of the interventions included a broad set of components [20, 23–25, 27, 28], one focused primarily on normative feedback [26] and one intervention (included in three reports) focused on assessment and feedback [19, 21, 22].…”

“…The prevalence of risky drinking, a planned secondary outcome, was not studied consistently with our protocol to enable meta‐analysis to be undertaken; only two trials (Sharpe [27] and Crombie [25]) measured prevalence of risky drinking following criteria specified by authors in the reports (Sharpe [27] used AUDIT‐C ≥ 3 for females and ≥ 4 for males, and Crombie [25] used ≥ 3 episodes of heavy drinking per month).…”

Recruitment, consent and retention of participants in randomised controlled trials: a review of trials published in the National Institute for Health Research (NIHR) Journals Library (1997–2020)

“…27 The 80th and 90th percentiles were found to be 3.70 and 9.47 participants recruited per centre per month, respectively. From the 22 single centre trials with sufficient information, the median recruitment rate was found to be 14.12 (IQR: However, there are only six trials from the PHR journal included in this review and three of these trials [30][31][32] have a recruitment rate of 10 participants per centre per month or greater. Figure 2 shows the distribution of recruitment rates by clinical area.…”

“…The published International Standardised Randomised Controlled Trial Number (ISRCTN) was used where available to check the ISRCTN register of clinical trials for additional information (https://www.isrctn.com/). The titles and abstracts of all reports published in the five NIHR journals from 1 January 1997 to 31 December 2020 were checked for relevance.…”