Refining the content and design of an alcohol reduction app, Drink Less, to improve its usability and effectiveness: a mixed methods approach

Abstract

Background: Digital interventions have the potential to reduce alcohol consumption, although evidence on the effectiveness of apps is lacking. Drink Less is a popular, evidence-informed app with good usability, putting it in a strong position to be improved upon prior to conducting a confirmatory evaluation. This paper describes the process of refining Drink Less to improve its usability and likely effectiveness. Methods: The refinement consisted of three phases and involved qualitative and quantitative (mixed) methods: i) identifying changes to app content, based on findings from an initial evaluation of Drink Less, an updated review of digital alcohol interventions and a content analysis of user feedback; ii) designing new app modules with public input and a consultation with app developers and researchers; and iii) improving the app’s usability through user testing. Results: As a result of the updated review of digital alcohol interventions and user feedback analysis in Phase 1, three new modules: ‘Behaviour Substitution’, ‘Information about Antecedents’ and ‘Insights’, were added to the app. One existing module – ‘Identity Change’ – was removed based on the initial evaluation of Drink Less. Phases 2 and 3 resulted in changes to existing features, such as improving the navigational structure and onboarding process, and clarifying how to edit drinks and goals. Conclusions: A mixed methods approach was used to refine the content and design of Drink Less, providing insights into how to improve its usability and likely effectiveness. Drink Less is now ready for a confirmatory evaluation.

Do engagement and behavioural mechanisms underpin the effectiveness of the Drink Less app?

“…1 ). The development, refinement, and content of the original Drink Less version is reported in full elsewhere 11 , 12 .…”

“…To this end, process evaluations can help test hypothesised causal pathways using quantitative data 9 . In the current study, the overarching theoretical framework underpinning the Drink Less app is the COM-B model of behaviour 10 , and the proposed mechanisms of action were engagement with the interventional components of the Drink Less app (see ‘Methods’ section) 11 , 12 , which, in turn, influences participants’ behavioural characteristics, including urges to drink, motivation to drink less and self-regulatory behaviour (see Fig. 1 for the logic model).…”

Evaluating the Acceptability of the Drink Less App and the National Health Service Alcohol Advice Web Page: Qualitative Interview Process Evaluation

“…The Drink Less app The development of Drink Less was informed by research findings and behavioural theories such as the COM-B (Capability Opportunity Motivation -Behaviour) model of behaviour change [20]. Drink Less consists of evidence-based modules to help users change their drinking behaviour: Goal Setting (setting weekly 'drinking reduction' goals); Self-Monitoring and Feedback (monitoring alcohol consumption and seeing progress on goals); Action Planning (creating plans for dealing with difficult drinking situations); Normative Feedback (providing personalised feedback on how an individual's drinking behaviour compares with the norm); Cognitive Bias Re-Training (a game for retraining users' automatic biases for alcoholic drinks); Insights (providing users with a running total of their drinking and weekly/monthly feedback); Behavioural Substitution (planning to substitute drinking with a neutral behaviour); and Information about Antecedents (providing users with information about situations and events, emotions and cognitions that predict their drinking [21]).…”

The Effect of the First UK COVID-19 Lockdown on Users of the Drink Less App: Interrupted Time Series Analysis of Sociodemographic Characteristics, Engagement, and Alcohol Reduction

“…Drink Less is a free app containing multiple intervention components informed by behavior change theory and evidence, including a drinking diary and goal setting, that aims to support users in reducing their alcohol consumption [20,21] and has over 70,000 unique users, with a 4.5 star rating in the App Store [8]. The full process of developing and refining Drink Less, along with the intervention content, is reported elsewhere [20,22].…”