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Delivering Personalized Protective Behavioral Drinking Strategies via a Smartphone Intervention: a Pilot Study

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Abstract

Background

Smartphone-based interventions are a potentially effective way to minimize alcohol-related harm in young adult, non-dependent drinkers. This pilot study is the first to evaluate the benefits and feasibility of a personalized alcohol harm-minimization intervention delivered via smartphones.

Methods

Within a single-blind, randomized controlled design, 45 young adults were randomly assigned to either the intervention app (n = 25; 18 females; Mage = 21.36 years, SDage = 4.15 years) or the control app (n = 20; 18 females; Mage = 22.75; SDage = 4.41). The two primary outcomes were frequency of risky drinking and drinking-related harms, and the secondary outcome was frequency of protective behavioral strategies (PBS) use. All outcomes were measured at baseline and immediately post-intervention. Using the Enlight framework [1], usability was evaluated via structured one-on-one phone interviews with a subgroup of six participants from the intervention group (3 females; Mage = 19.5 years, SDage = 1.64).

Results

There was no significant reduction in the primary outcomes from baseline to post-intervention across the groups. For the secondary outcome, the application of PBS within drinking contexts increased at follow-up for those in the intervention group but not for control participants. End-users rated the app as highly usable but had some concerns with repetition of the app-recommended strategies.

Conclusions

This intervention, designed to reduce risky drinking behaviors among young adults, was rated as highly usable and was shown to increase the application of harm minimization strategies within drinking contexts. While the intervention and its delivery show promise, it did not appear to mitigate risky drinking behaviors. Implications of this research and future directions are discussed.

Trial Registration

This trial is registered at the Australian New Zealand Clinical Trials Registry: BLINDED.

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References

  1. Baumel A, Faber K, Mathur N, Kane JM, Muench F. Enlight: a comprehensive quality and therapeutic potential evaluation tool for mobile and web-based eHealth interventions. J Med Internet Res. 2017;19(3):e82.

    PubMed Central  PubMed  Google Scholar 

  2. Carey KB, Scott-Sheldon LA, Carey MP, DeMartini KS. Individual-level interventions to reduce college student drinking: a meta-analytic review. Addict Behav. 2007;32(11):2469–94.

    PubMed Central  PubMed  Google Scholar 

  3. Dvorak RD, Pearson MR, Day AM. Ecological momentary assessment of acute alcohol use disorder symptoms: associations with mood, motives, and use on planned drinking days. Exp Clin Psychopharmacol. 2014;22(4):285–97.

    PubMed Central  PubMed  Google Scholar 

  4. Kuntsche E, Otten R, Labhart F. Identifying risky drinking patterns over the course of Saturday evenings: an event-level study. Psychol Addict Behav. 2015;29(3):744–52.

    PubMed  Google Scholar 

  5. Hunt J, Eisenberg D. Mental health problems and help-seeking behavior among college students. J Adolesc Health. 2010;46(1):3–10.

    PubMed  Google Scholar 

  6. Wu LT, Pilowsky DJ, Schlenger WE, Hasin D. Alcohol use disorders and the use of treatment services among college-age young adults. Psychiatr Serv. 2007;58(2):192–200.

    PubMed Central  PubMed  Google Scholar 

  7. National Health and Medical Research Council. Australian code for the care and use of animals for scientific purposes. 8th ed. Canberra: National Health and Medical Research Council; 2013.

    Google Scholar 

  8. Martens MP, Ferrier AG, Sheehy MJ, Corbett K, Anderson DA, Simmons A. Development of the protective behavioral strategies survey. J Stud Alcohol. 2005;66(5):698–705.

    PubMed  Google Scholar 

  9. Martens MP, Pederson ER, LaBrie JW, Ferrier AG, Cimini MD. Measuring alcohol-related protective behavioral strategies among college students: further examination of the Protective Behavioral Strategies Scale. Psychol Addict Behav. 2007;21(3):307–15.

    PubMed  Google Scholar 

  10. Sugarman DE, Carey KB. The relationship between drinking control strategies and college student alcohol use. Psychol Addict Behav. 2007;21(3):338–45.

    PubMed Central  PubMed  Google Scholar 

  11. Barnett NP, Murphy JG, Colby SM, Monti PM. Efficacy of counselor vs. computer-delivered intervention with mandated college students. Addict Behav. 2007;32(11):2529–48.

    PubMed Central  PubMed  Google Scholar 

  12. Dimeff LA, editor. Brief alcohol screening and intervention for college students (BASICS): a harm reduction approach. New York City: Guilford Press; 1999.

    Google Scholar 

  13. Martens MP, Taylor KK, Damann KM, Page JC, Mowry ES, Cimini MD. Protective behavioral strategies when drinking alcohol and their relationship to negative alcohol-related consequences in college students. Psychol Addict Behav. 2004;18(4):390–3.

    PubMed  Google Scholar 

  14. LaBrie JW, Napper LE, Grimaldi EM, Kenney SR, Lac A. The efficacy of a standalone protective behavioral strategies intervention for students accessing mental health services. Prev Sci. 2015;16(5):663–73.

    PubMed Central  PubMed  Google Scholar 

  15. Martens MP, Smith AE, Murphy JG. The efficacy of single-component brief motivational interventions among at-risk college drinkers. J Consult Clin Psychol. 2013;81(4):691–701.

    PubMed Central  PubMed  Google Scholar 

  16. Gardner B. Habit as automaticity, not frequency. Eur Health Psychol. 2012;14(2):32–6.

    Google Scholar 

  17. Wood W, Neal DT. A new look at habits and the habit-goal interface. Psychol Rev. 2007;114(4):843–63.

    PubMed  Google Scholar 

  18. Adamson SJ, Heather N, Morton V, Raistrick D. Initial preference for drinking goal in the treatment of alcohol problems: II. Treatment outcomes. Alcohol & Alcoholism. 2010;45(2):136–42.

    Google Scholar 

  19. Moos RH. Theory-based active ingredients of effective treatments for substance use disorders. Drug Alcohol Depend. 2007;88(2–3):109–21.

    PubMed  Google Scholar 

  20. Heron KE, Smyth JM. Ecological momentary interventions: incorporating mobile technology into psychosocial and health behaviour treatments. Br J Health Psychol. 2010;15(1):1–39.

    PubMed  Google Scholar 

  21. Nahum-Shani I, Smith SN, Tewari A, Witkiewitz K, Collins LM, Spring B, Murphy S. Just in time adaptive interventions (jitais): an organizing framework for ongoing health behavior support. Methodology Center technical report; 2014. pp. 14–126.

  22. Cerrada CJ, Dzubur E, Blackman KC, Mays V, Shoptaw S, Huh J. Development of a just-in-time adaptive intervention for smoking cessation among Korean American emerging adults. Int J Behav Med. 2017;24(5):665–72.

    PubMed Central  PubMed  Google Scholar 

  23. Johnson M, Jackson R, Guillaume L, Meier P, Goyder E. Barriers and facilitators to implementing screening and brief intervention for alcohol misuse: a systematic review of qualitative evidence. J Public Health. 2010;33(3):412–21.

    Google Scholar 

  24. Sawares AS, Shen N, Xue Y, Abi-Jaoude A, Wiljer D. The impact of mobile apps on alcohol use disorder: a systematic review protocol. JMIR Res Protoc. 2017;6(4):e49.

    PubMed Central  PubMed  Google Scholar 

  25. Hoeppner BB, Schick MR, Kelly LM, Hoeppner SS, Bergman B, Kelly JF. There is an app for that–or is there? A content analysis of publicly available smartphone apps for managing alcohol use. J Subst Abus Treat. 2017;82:67–73.

    Google Scholar 

  26. Garnett C, Crane D, West R, Brown J, Michie S. The development of drink less: an alcohol reduction smartphone app for excessive drinkers. Transl Behav Med. 2018;9(2):296–307.

  27. Gustafson DH, McTavish FM, Chih MY, Atwood AK, Johnson RA, Boyle MG, et al. A smartphone application to support recovery from alcoholism: a randomized clinical trial. JAMA Psychiatry. 2014;71(5):566–72.

    PubMed Central  PubMed  Google Scholar 

  28. 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. Sci Rep. 2018;8(1):4384.

    PubMed Central  PubMed  Google Scholar 

  29. Witkiewitz K, Desai SA, Bowen S, Leigh BC, Kirouac M, Larimer ME. Development and evaluation of a mobile intervention for heavy drinking and smoking among college students. Psychol Addict Behav. 2014;28(3):639–50.

    PubMed Central  PubMed  Google Scholar 

  30. Gajecki M, Andersson C, Rosendahl I, Sinadinovic K, Fredriksson M, Berman AH. Skills training via smartphone app for university students with excessive alcohol consumption: a randomized controlled trial. Int J Behav Med. 2017;24(5):778–88.

    PubMed Central  PubMed  Google Scholar 

  31. Richardson B. Instant Survey (iOS Version 2.0; Android Version 2.0) [Mobile application software]; 2015. Retrieved from https://itunes.apple.com/us/app/instantsurvey/id955226674?mt=8. Accessed 05 May 2016.

  32. Saunders JB, Aasland OG, Babor TF, De la Fuente JR, Grant M. Development of the alcohol use disorders identification test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption-II. Addiction. 1993;88(6):791–804.

    CAS  PubMed  Google Scholar 

  33. Donovan DM, Kivlahan DR, Doyle SR, Longabaugh R, Greenfield SF. Concurrent validity of the Alcohol Use Disorders Identification Test (AUDIT) and AUDIT zones in defining levels of severity among out-patients with alcohol dependence in the COMBINE study. Addiction. 2006;101(12):1696–704.

    PubMed  Google Scholar 

  34. Muthén LK, Muthén BO. Mplus user’s guide. 6th ed. Los Angeles: Muthén & Muthén; 1998-2011.

    Google Scholar 

  35. Singer JD, Willett JB. Applied longitudinal data analysis: modeling change and event occurrence. New York: Oxford University Press; 2003. https://doi.org/10.1093/acprof:oso/9780195152968.001.0001.

    Book  Google Scholar 

  36. Arnaud N, Diestelkamp S, Wartberg L, Sack PM, Daubmann A, Thomasius R. Short-to midterm effectiveness of a brief motivational intervention to reduce alcohol use and related problems for alcohol intoxicated children and adolescents in pediatric emergency departments: a randomized controlled trial. Acad Emerg Med. 2017;24(2):186–200.

    PubMed  Google Scholar 

  37. Haug S, Paz Castro R, Kowatsch T, Filler A, Dey M, Schaub MP. Efficacy of a web-and text messaging-based intervention to reduce problem drinking in adolescents: results of a cluster-randomized controlled trial. J Consult Clin Psychol. 2017;85(2):147–59.

    PubMed  Google Scholar 

  38. Napper LE, Kenney SR, Lac A, Lewis LJ, LaBrie JW. A cross-lagged panel model examining protective behavioral strategies: are types of strategies differentially related to alcohol use and consequences? Addict Behav. 2014;39(2):480–6.

    PubMed  Google Scholar 

  39. Wiers RW, Van De Luitgaarden J, Van Den Wildenberg E, Smulders FT. Challenging implicit and explicit alcohol-related cognitions in young heavy drinkers. Addiction. 2005;100(6):806–19.

    PubMed  Google Scholar 

  40. Lewis JR. Sample sizes for usability studies: additional considerations. Hum Factors. 1994;36(2):368–78.

    CAS  PubMed  Google Scholar 

  41. Virzi RA. Refining the test phase of usability evaluation: how many subjects is enough? Hum Factors. 1992;34(4):457–68.

    Google Scholar 

  42. Brooke J. SUS-A quick and dirty usability scale. Usability evaluation in industry. 1996;189(194):4–7.

  43. McLellan S, Muddimer A, Peres SC. The effect of experience on system usability scale ratings. J Usability Stud. 2012;7(2):56–67.

    Google Scholar 

  44. Lewis JR, Sauro J. The factor structure of the system usability scale. In International conference on human centered design. Berlin: Springer; 2009. p. 94–103.

    Google Scholar 

  45. Kortum PT, Bangor A. Usability ratings for everyday products measured with the System Usability Scale. Int J Hum Comput Interact. 2013;29(2):67–76.

    Google Scholar 

  46. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101.

    Google Scholar 

  47. Larimer ME, Lee CM, Kilmer JR, Fabiano PM, Stark CB, Geisner IM, et al. Personalized mailed feedback for college drinking prevention: a randomized clinical trial. J Consult Clin Psychol. 2007;75(2):285–93.

    PubMed Central  PubMed  Google Scholar 

  48. Schinke SP, Cole KC, Fang L. Gender-specific intervention to reduce underage drinking among early adolescent girls: a test of a computer-mediated, mother-daughter program. J Stud Alcohol Drugs. 2009;70(1):70–7.

    PubMed Central  PubMed  Google Scholar 

  49. Witkiewitz K, Donovan DM, Hartzler B. Drink refusal training as part of a combined behavioral intervention: effectiveness and mechanisms of change. J Consult Clin Psychol. 2012;80(3):440–9.

    PubMed Central  PubMed  Google Scholar 

  50. Oei TP, Hasking P, Phillips L. A comparison of general self-efficacy and drinking refusal self-efficacy in predicting drinking behavior. Am J Drug Alcohol Abuse. 2007;33(6):833–41.

    PubMed  Google Scholar 

  51. Pearson MR, Kite BA, Henson JM. The assessment of protective behavioral strategies: comparing prediction and factor structures across measures. Psychol Addict Behav. 2012;26(3):573–84.

    PubMed  Google Scholar 

  52. Dulin PL, Gonzalez VM, Campbell K. Results of a pilot test of a self-administered smartphone-based treatment system for alcohol use disorders: usability and early outcomes. Subst Abus. 2014;35(2):168–75.

    PubMed Central  PubMed  Google Scholar 

  53. Gonzalez VM, Dulin PL. Comparison of a smartphone app for alcohol use disorders with an internet-based intervention plus bibliotherapy: a pilot study. J Consult Clin Psychol. 2015;83(2):335–45.

    PubMed Central  PubMed  Google Scholar 

  54. Neighbors C, Lee CM, Atkins DC, Lewis MA, Kaysen D, Mittmann A, et al. A randomized controlled trial of event-specific prevention strategies for reducing problematic drinking associated with 21st birthday celebrations. J Consult Clin Psychol. 2012;80(5):850–62.

    PubMed Central  PubMed  Google Scholar 

  55. Wright C, Dietze PM, Agius PA, Kuntsche E, Livingston M, Black OC, et al. Mobile phone-based ecological momentary intervention to reduce young adults’ alcohol use in the event: a three-armed randomized controlled trial. JMIR mHealth uHealth. 2018;6(7):e149.

    PubMed Central  PubMed  Google Scholar 

  56. Jacobs RJ, Lou JQ, Ownby RL, Caballero J. A systematic review of eHealth interventions to improve health literacy. Health Informatics J. 2016;22(2):81–98.

    PubMed  Google Scholar 

  57. Yardley L, Morrison L, Bradbury K, Muller I. The person-based approach to intervention development: application to digital health-related behavior change interventions. J Med Internet Res. 2015;17(1):e30.

    PubMed Central  PubMed  Google Scholar 

  58. Freedman MJ, Lester KM, McNamara C, Milby JB, Schumacher JE. Cell phones for ecological momentary assessment with cocaine-addicted homeless patients in treatment. J Subst Abus Treat. 2006;30(2):105–11.

    Google Scholar 

  59. Scott CK, Dennis ML, Gustafson DH. Using smartphones to decrease substance use via self-monitoring and recovery support: study protocol for a randomized control trial. Trials. 2017;18(1):374.

    PubMed Central  PubMed  Google Scholar 

  60. Michie S, Whittington C, Hamoudi Z, Zarnani F, Tober G, West R. Identification of behaviour change techniques to reduce excessive alcohol consumption. Addiction. 2012;107(8):1431–40.

    PubMed  Google Scholar 

  61. Fry ML, Drennan J, Previte J, White A, Tjondronegoro D. The role of desire in understanding intentions to drink responsibly: an application of the model of goal-directed behaviour. J Mark Manag. 2014;30(5–6):551–70.

    Google Scholar 

  62. Ryan RM, Patrick H, Deci EL, Williams GC. Facilitating health behaviour change and its maintenance: interventions based on self-determination theory. European Health Psychologist. 2008;10(1):2–5.

    Google Scholar 

  63. Gollwitzer PM, Sheeran P. Implementation intentions and goal achievement: a meta-analysis of effects and processes. Adv Exp Soc Psychol. 2006;38:69–119.

    Google Scholar 

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Authors and Affiliations

  1. Faculty of Health, School of Psychology, Deakin University, 221 Burwood Highway, Burwood, Victoria, 3125, Australia

    Renee O’Donnell, Matthew Fuller-Tyszkiewicz & Petra K. Staiger

  2. The Cairnmillar Institute, Melbourne, Australia

    Ben Richardson

  3. Centre of Drug Use, Addictive and Anti-social Behaviours Research (CEDAAR), Deakin University, Victoria, Australia

    Petra K. Staiger

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  1. Renee O’Donnell
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  2. Ben Richardson
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  4. Petra K. Staiger
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Correspondence to Petra K. Staiger.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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O’Donnell, R., Richardson, B., Fuller-Tyszkiewicz, M. et al. Delivering Personalized Protective Behavioral Drinking Strategies via a Smartphone Intervention: a Pilot Study. Int.J. Behav. Med. 26, 401–414 (2019). https://doi.org/10.1007/s12529-019-09789-0

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