New technologies for reducing excessive alcohol use – the development and evaluation of a theory-based smartphone application
Research Team: Dr David Crane, Dr Claire Garnett, Professor Susan Michie, Dr Jamie Brown & Professor Robert West
Who's involved: University College London
The Alcohol Toolkit Study (ATS)
A detailed monthly national survey was needed to understand population-wide influences on alcohol use, and to inform and evaluate policies aimed at reducing alcohol-related harm.
March 2014 - ongoing
Alcohol consumption is responsible for approximately 3.3 million deaths worldwide each year. Over 10 million people in the UK regularly drink in excess of Government guidelines. Tackling excessive alcohol consumption is a public health priority. Web interventions to help people reduce their consumption appear to be effective, but there is little evidence about apps and a lack of understanding about what behaviour change techniques an app should contain to make it effective.
SPHR researchers examined the literature for behaviour change theory and techniques that may inform interventions to help people to reduce their alcohol consumption. Alcohol and behaviour change experts were consulted for their views about which techniques an app should contain. This led to a scientifically-informed app which was professionally designed and subsequently improved in response to user feedback. The main feature of the app was that it allowed each user to set their own goal to which they would like to reduce their alcohol consumption. There were five additional features that were based on behaviour change techniques to help participants reduce their drinking. These features were called normative feedback, cognitive bias re-training, identity change, self-monitoring, and action planning.
Almost 700 drinkers took part in a study to evaluate the effectiveness of the app. Groups of users were randomly given ‘intensive’ or ‘minimal’ versions of different techniques and the effectiveness of each was measured by comparing levels of drinking before and after using the app. On average, people logged-in 12 times during a one-month period and drank four fewer units of alcohol at the end of using the app compared with the start. People who received a more intensive version of a technique did not reduce their alcohol consumption significantly more than people who got a less intensive version of the same technique.
The combinations of normative feedback and cognitive bias re-training, and of self-monitoring and action-planning led to significantly improved alcohol consumption outcomes. These findings suggest that these techniques may assist with reducing drinking and are worth keeping in future version of the app for further development and evaluation.
Final report
SPHR final report: Theory-based smartphone app for alcohol use
Publications
Crane, D., Garnett, C., Brown, J., West, R., & Michie, S. (2015). Behavior change techniques in popular alcohol reduction apps: content analysis. Journal of medical Internet research, 17(5).
Garnett, C., Crane, D., West, R., Brown, J., & Michie, S. (2015). Identification of behavior change techniques and engagement strategies to design a smartphone app to reduce alcohol consumption using a formal consensus method. JMIR mHealth and uHealth, 3(2).
Garnett, C., Crane, D., West, R., Michie, S., Brown, J., & Winstock, A. (2015). Normative misperceptions about alcohol use in the general population of drinkers: A cross-sectional survey. Addictive behaviors, 42, 203-206.
Kaner EF, Beyer FR, Brown J, Crane D, Garnett C, Hickman M, Muirhead C, Redmore J, Michie S, de Vocht F. (2015) Personalised digital interventions for reducing hazardous and harmful alcohol consumption in community-dwelling populations (Protocol). Cochrane Database of Systematic Reviews.
Crane D, Garnett C, Brown J, West R, Michie S. (2016). Evaluating the effectiveness of a smartphone app to reduce excessive alcohol consumption: Protocol for a randomised control trial. BMC Public Health, 16(1),536.
Crane D, Garnett C, Brown J, West R, Michie S. (2017) Factors influencing usability of a smartphone app to reduce excessive alcohol consumption: think-aloud and interview studies. Frontiers in Public Health, 5 (39).
Garnett C, Crane D, Brown J, Kaner E, Beyer F, Muirhead C, Hickman M, Beard E, Redmore J, De Vocht F, Michie S. Behaviour change techniques used in digital behaviour change interventions to reduce excessive alcohol consumption: A meta-regression. Annals of Behavioural Medicine.
Garnett C, Crane D, Brown J, Kaner, E.; Beyer F, Muirhead C, Hickman M, Redmore J, de Vocht F, Beard E, Michie S. Reported theory use by digital alcohol interventions and association with effectiveness: meta-regression. JMIR.
Crane D, Garnett C, Michie S, West R, Brown J. A smartphone app to reduce excessive alcohol consumption: Identifying the effectiveness of intervention components in a factorial randomised control trial. Scientific Reports.
Garnett C, Crane D, Brown J, West R, Michie S. The development of Drink Less: an alcohol reduction smartphone app for excessive drinkers. Translational Behavioural Medicine.
Resources
SPHR Public Health Evidence Briefing: Alcohol reduction app
SPHR Public Health Evidence Briefing: Technologies to reduce alcohol use
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