Despite growing evidence of the efficacy of electronic screening and brief interventions for reducing unhealthy alcohol use, there is no published work describing the development of such interventions. We describe the process of developing and implementing an electronic screening and brief intervention in a large university population.
Thematic analysis of seven focus groups, involving a total of 69 students, informed the content and design of THRIVE (Tertiary Health Research Intervention Via Email). Pilot testing was conducted through usability analysis with a further 16 students. A random sample of 13,000 undergraduates was invited to complete screening and hazardous drinkers were randomised to receive Web-based assessment and feedback or screening alone. Participants' use of THRIVE was examined through server log analysis and responses to questions on instrument design/usability during follow-up assessment 6 months later.
A total of 7237 students (56% of those invited) completed screening; 2435 (34%) screened positive for unhealthy drinking; 1251 were randomly assigned to receive the intervention; and 1184 served as controls. In total, 99% of participants found THRIVE easy to complete, 76% said it provided personally relevant information and 55% said they would recommend it to a friend with a drinking problem. Thirty per cent sought additional information on support services through the site.
Key design elements include ease of access (e.g. via an emailed hyperlink), length (<10 min), clear, non-judgmental language, personalised normative feedback and links to appropriate services. The study demonstrates the potential reach of a carefully implemented intervention in a high-risk, non-treatment-seeking population group.
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"There is some potential for distress with the subject of alcohol being raised for some participants, as may occur outside the research context. Extensive and detailed pilot work has been done in a range of earlier studies to refine the methods used, being vigilant for adverse reactions (Hallett et al. 2009). We have focused on the ethical concerns involved in infringing rights rather than causing harm to participants, partly due to the lack of obvious potential to engender significant harm and the absence of such data in feedback. "
[Show abstract][Hide abstract] ABSTRACT: Some public health behavioral intervention research studies involve deception. A methodological imperative to minimize bias can be in conflict with the ethical principle of informed consent. As a case study, we examine the specific forms of deception used in three online randomized controlled trials evaluating brief alcohol interventions. We elaborate our own decision making about the use of deception in these trials, and present our ongoing findings and uncertainties. We discuss the value of the approach of pragmatism for examining these kinds of ethical issues that can arise in research on public health interventions.
Preview · Article · Nov 2013 · The American Journal of Bioethics
"In addition to the electronic personalized feedback, three pages offering facts about alcohol (for example, the health consequences of unhealthy alcohol consumption), tips for reducing the risk of alcohol-related harm and sources of support for drinking problems (for example, contact details for services available in the local health district) will be included. The time to complete the intervention and read the electronic personalized feedback is expected to be less than 10 minutes . A copy of the electronic personalized feedback will be emailed or posted to participants who agree to this information being sent to them. "
[Show abstract][Hide abstract] ABSTRACT: Electronic screening and brief intervention (e-SBI) is a promising alternative to screening and brief intervention by health-care providers, but its efficacy in the hospital outpatient setting, which serves a large proportion of the population, has not been established. The aim of this study is to estimate the effect of e-SBI in hospital outpatients with hazardous or harmful drinking.Methods/design: This randomized controlled trial will be conducted in the outpatient department of a large tertiary referral hospital in Newcastle (population 540,000), Australia. Some 772 adults with appointments at a broad range of medical and surgical outpatient clinics who score 5--9 inclusive on the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) subscale will be randomly assigned in a 1:1 ratio to electronic alcohol screening alone (control) or to e-SBI. As randomization will be effected by computer, researchers and participants (who will be invited to participate in a study of alcohol use over time) will be blinded to group assignment. The primary analysis will be based on the intention-to-treat principle and compare weekly volume (grams of alcohol) and the full AUDIT score with a six-month reference period between the groups six months post randomization. Secondary outcomes, assessed six and 12 months after randomization, will include drinking frequency, typical occasion quantity, proportion who report binge drinking, proportion who report heavy drinking, and health-care utilization.
If e-SBI is efficacious in outpatient settings, it offers the prospect of systematically and sustainably reaching a large number of hazardous and harmful drinkers, many of whom do not otherwise seek or receive help.Trial registration: Australian New Zealand Clinical Trials Registry ACTRN12612000905864.
"Template analysis is a qualitative technique that lies between grounded theory and content analysis and begins with an inventory of a priori domains expected to be strongly relevant. For this study, a priori domains reflected the anonymity and individual features of DrinkCheck [33,41]. Emergent domains were those that emerged from the data as coding proceeded (e.g., those not identified a priori) and were extensively and iteratively reviewed with investigators. "
[Show abstract][Hide abstract] ABSTRACT: Veterans of Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) are at increased risk for alcohol misuse, and innovative methods are needed to improve their access to alcohol screening and brief interventions (SBI). This study adapted an electronic SBI (e-SBI) website shown to be efficacious in college students for OEF/OIF veterans and reported findings from interviews with OEF/OIF veterans about their impressions of the e-SBI.
Outpatient veterans of OEF/OIF who drank ≥3 days in the past week were recruited from a US Department of Veterans Affairs (VA) Deployment Health Clinic waiting room. Veterans privately pretested the anonymous e-SBI then completed individual semistructured audio-recorded interviews. Their responses were analyzed using template analysis to explore domains identified a priori as well as emergent domains.
During interviews, all nine OEF/OIF veterans (1 woman and 8 men) indicated they had received feedback for risky alcohol consumption. Participants generally liked the standard-drinks image, alcohol-related caloric and monetary feedback, and the website's brevity and anonymity (a priori domains). They also experienced challenges with portions of the e-SBI assessment and viewed feedback regarding alcohol risk and normative drinking as problematic, but described potential benefits derived from the e-SBI (emergent domains). The most appealing e-SBIs would ensure anonymity and provide personalized transparent feedback about alcohol-related risk, consideration of the context for drinking, strategies to reduce drinking, and additional resources for veterans with more severe alcohol misuse.
Results of this qualitative exploratory study suggest e-SBI may be an acceptable strategy for increasing OEF/OIF veteran access to evidenced-based alcohol SBI.
Full-text · Article · Aug 2012 · Addiction science & clinical practice