Feasibility and User Perception of a Fully Automated Push-Based Multiple-Session Alcohol Intervention for University Students: Randomized Controlled Trial

Abstract

BackgroundIn recent years, many electronic health behavior interventions have been developed in order to reach individuals with unhealthy behaviors, such as risky drinking. This is especially relevant for university students, many of whom are risky drinkers.ObjectiveThis study explored the acceptability and feasibility in a nontreatment-seeking group of university students (including both risk and nonrisk drinkers), of a fully automated, push-based, multiple-session, alcohol intervention, comparing two modes of delivery by randomizing participants to receive the intervention either by SMS text messaging (short message service, SMS) or by email.MethodsA total of 5499 students at Luleå University in northern Sweden were invited to participate in a single-session alcohol assessment and feedback intervention; 28.04% (1542/5499) students completed this part of the study. In total, 29.44% (454/1542) of those participating in the single-session intervention accepted to participate further in the extended multiple-session intervention lasting for 4 weeks. The students were randomized to receive the intervention messages via SMS or email. A follow-up questionnaire was sent immediately after the intervention and 52.9% (240/454) responded.ResultsNo difference was seen regarding satisfaction with the length and frequency of the intervention, regardless of the mode of delivery. Approximately 15% in both the SMS (19/136) and email groups (15/104) would have preferred the other mode of delivery. On the other hand, more students in the SMS group (46/229, 20.1%) stopped participating in the intervention during the 4-week period compared with the email group (10/193, 5.2%). Most students in both groups expressed satisfaction with the content of the messages and would recommend the intervention to a fellow student in need of reducing drinking. A striking difference was seen regarding when a message was read; 88.2% (120/136) of the SMS group read the messages within 1 hour in contrast to 45.2% (47/104) in the email group. In addition, 83.1% (113/136) in the SMS group stated that they read all or almost all the messages, compared with only 63.5% (66/104) in the email group.ConclusionsBased on the feedback from the students, an extended, multiple-session, push-based intervention seems to be a feasible option for students interested in additional support after a single-session alcohol intervention. SMS as a mode of delivery seems to have some advantages over email regarding when a message is read and the proportion of messages read. However, more students in the SMS group stopped the intervention than in the email group. Based on these promising findings, further studies comparing the effectiveness of single-session interventions with extended multiple-session interventions delivered separately or in combination are warranted.

A Text Message�Based Intervention Targeting Alcohol Consumption Among University Students: User Satisfaction and Acceptability Study (Preprint)

“…Previous research shows that, despite the promising potential of text messaging-based interventions, it is difficult to tell how effectiveness can be optimized through the content and structure chosen [11,16]. The present study sheds light on some of these questions because the results show that the overall structure and content of the text-based intervention was well received by most participants, regardless of whether they reduced their drinking or not.…”

“…For instance, text messages have been shown to be highly accessible to the user in the sense that the messages are likely to be read within minutes of being received, and interventions have shown to be user friendly in that reading text messages requires limited time and effort by the user [9][10][11]. Thus, text-based interventions can enable continuous, real-time, brief support in a real-world setting [9,12,13].…”

Realising the technological promise of smartphones in addiction research and treatment: An ethical review

“…BinDhim et al, 2014;Borland et al, 2013;Bricker et al, 2014;Buller et al, 2014;Haug et al, 2014;Hertzberg et al, 2013;Kirchner et al, 2013;Meredith et al, 2014;V. Patel, Nowostawski, Thomson, Wilson, & Medlin, 2013;Ploderer et al, 2014;Reitzel et al, 2014; Whittaker, 2011) Alcohol 12 (34.3%) (Bendtsen & Bendtsen, 2014;Dulin et al, 2014;Gajecki et al, 2014;Gamito et al, 2014;Haug et al, 2014;Kauer, Reid, Sanci, & Patton, 2009;Matsumura, Yamakoshi, & Ida, 2009;McTavish et al, 2012;Renner, 2012;Yu et al, 2012) Heroin 2 (5.7%) Epstein et al, 2009) Cocaine 1 (2.9%) (Freedman, Lester, McNamara, Milby, & Schumacher, 2006) General 3 (8.6%) (Campling, 2011;Ingersoll et al, 2014; Bendtsen & Bendtsen, 2014;BinDhim et al, 2014;Borland et al, 2013;Bricker et al, 2014;Buller et al, 2014;Dulin et al, 2014;Hasin et al, 2014;Haug et al, 2014;Ingersoll et al, 2014;Ploderer et al, 2014;Renner, 2012;Whittaker, 2011;Yu et al, 2012) Relapse prevention 3 (8.6...…”

“…User anonymity 13 (38.2% a ) BinDhim et al, 2014;Borland et al, 2013;Freedman et al, 2006;Gajecki et al, 2014;Haug et al, 2014;Matsumura et al, 2009;Renner, 2012;) Data encryption 11 (32.3% b ) BinDhim et al, 2014;Boyer et al, 2012;Gajecki et al, 2014;Gamito et al, 2014;Haug et al, 2014;Meredith et al, 2014;Renner, 2012;) Password protection 7 (24.1% c ) Hasin et al, 2014;Haug et al, 2014;Hertzberg et al, 2013;Renner, 2012;) User control 20 (69.0% d ) (Bendtsen & Bendtsen, 2014;BinDhim et al, 2014;Bricker et al, 2014;Campling, 2011;Gajecki et al, 2014;Haug et al, 2014;Hertzberg et al, 2013;Ingersoll et al, 2014;Kauer et al, 2009;Ploderer et al, 2014;Reitzel et al, 2014;Renner, 2012;Whittaker, 2011;Yu et al, 2012 Dulin et al, 2014;Epstein et al, 2009;Freedman et al, 2006;Gamito et al, 2014;Hasin et al, 2014;Ingersoll et al, 2014;Johnson et al, 2009;Kauer et al, 2009;…”

Effectiveness of a Text Messaging�Based Intervention Targeting Alcohol Consumption Among University Students: Randomized Controlled Trial (Preprint)

“…Furthermore, text-based interventions have several advantages compared to other digital interventions (e.g. web portals requiring users to log in multiple times), as they allow for high accessibility in that messages are likely to be read within minutes of being received, that receiving and reading messages require limited time and effort by the user [8][9][10], and that they can enable continuous, real-time, brief support in a real-world setting [11]. A common challenge in technology based interventions is participant retention, however in a review by Head et al [4] the retention in text-based interventions were around 70%.…”