Predictors of Booster Engagement Following a Web-Based Brief Intervention for Alcohol Misuse Among National Guard Members: Secondary Analysis of a Randomized Controlled Trial

Abstract

Background Alcohol misuse is a major health concern among military members. Reserve component members face unique barriers as they live off base with limited access to behavioral health services. Web and app-based brief interventions are a promising means to improve access to treatment for those who misuse alcohol, with the use of booster sessions to enhance effectiveness, solidify gains, and reinforce changes. However, little is known about who will engage in booster sessions. Objective This study aims to evaluate booster engagement across booster delivery modalities (Web and Peer) and identify participant-specific factors associated with booster session engagement. Methods Following a brief web-based alcohol misuse intervention in National Guard members (N=739), we examined engagement in a series of three booster sessions. Using unadjusted and adjusted models, demographic and clinical characteristics that may serve as predictors of booster session engagement were examined across the 2 arms of the trial with different types of booster sessions: peer-delivered (N=245) and web-delivered (N=246). Results Booster session completion was greater for Peer than Web Booster sessions, with 142 (58%) service members in the Peer Booster arm completing all three boosters compared with only 108 (44%) of participants in the Web Booster arm (χ23=10.3; P=.006). In a model in which the 2 groups were combined, socioeconomic factors predicted booster engagement. In separate models, the demographic and clinical predictors of booster engagement varied between the 2 delivery modalities. Conclusions The use of peer-delivered boosters, especially among subsets of reserve members at risk of lack of engagement, may foster greater uptake and improve treatment outcomes. Trial Registration ClinicalTrials.gov NCT02181283; https://clinicaltrials.gov/ct2/show/NCT02181283

Peer‐ and web‐based interventions for risky drinking among US National Guard members: Mission Strong randomized controlled trial

“…The peer‐based booster seemed to be more effective than the web‐based booster for a broader range of hazardous and harmful alcohol use measures, although the study was not designed to have sufficient power to allow direct comparisons between the two booster options. In a recently published comprehensive examination of the factors related to engagement in booster sessions, we demonstrated that the peer booster approach led to significantly greater engagement in booster sessions than the web booster format, controlling for multiple other factors that were also significantly related to engagement in boosters including educational level, rank and income [56]. These findings point to the benefit of social support, as well as the potentially greater personalization of booster content, given that the peers were former military service people.…”

Examining engagement effects in an adaptive preventive intervention for college student drinking.

“…If the level of engagement corresponds to decreases in alcohol use or consequences, then interventions can be improved to enhance the likelihood of engagement following principles of implementation science (Bauer & Kirchner, 2020;Becker et al, 2022). Previous studies have found that increased engagement predicts positive health-related behavior changes, including reductions in drinking (Carrà et al, 2017;Paz Castro et al, 2017;Donkin et al, 2011;Linke et al, 2007;Norman et al, 2019) and higher likelihood of follow-up responses (Coughlin et al, 2021;Eysenbach, 2005). However, no work has examined the impact of engagement on outcomes of an intervention for college student alcohol use in a methodological and empirical way.…”