Feasibility of a Fully Automated Multiple Session Alcohol Intervention to University Students, Using Different Modes of Electronic Delivery—The TOPHAT 1 Study

Bendtsen Marcus, Bendtsen Preben

Department of Medicine and Health, Link?ping University, Link?ping, Sweden.

DOI: 10.4236/jsea.2013.610A003                

Abstract

Background: In recent years more and more electronic health behaviour interventions have been developed in order to reach individuals with an unhealthy behaviour such as risky drinking. This is especially relevant in university students who are among those who most frequently are risky drinkers. This study explored the acceptability and feasibility, in an unselected group of university students, of a fully automated multiple session alcohol intervention offering different modes of delivery such as email, SMS and Android. Material and Methods: A total of 11,283 students at Link?ping University in Sweden were invited to perform a single session alcohol intervention and among those accepting this (4916 students) a total of 24.7% accepted to further participate in the extended multiple intervention lasting 3 - 6 weeks. The students could choose mode of delivery, total length of the intervention (between 3 - 6 weeks) and number of messages per week (3, 5, or 7 per week). A follow-up questionnaire was applied after the intervention to which 82.7% responded. Results: most students wanted to receive the messages by email with the shortest intervention length (3 weeks) and as few messages as possible per week (3 messages). However, no major difference was seen regarding satisfaction with the length and frequency of the intervention despite chosen length and frequency. Most students also expressed satisfaction with the content of the messages and would recommend the intervention to a fellow student in need of reducing drinking. Discussion and Conclusion: Based upon feedback from the students, a multiple push-based intervention appears to be feasible to offer students interested in additional support after a single session alcohol intervention. In a forthcoming study we will further explore the optimal mode of delivery and length of intervention and number of messages per week.

Keywords

Excessive Alcohol Drinking; University Students; Fully Automated Intervention; Health Behavior Change

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	J. Rehm, C. Mathers, S. Popova, M. Thavorncharoensap, Y. Teerawattananon and J. Patra, “Global Burden of Disease and Injury and Economic Cost Attributable to Alcohol Use and Alcohol-Use Disorders,” The Lancet, Vol. 373, No. 9682, 2009, pp. 2223-2233. http://dx.doi.org/10.1016/S0140-6736(09)60746-7
[2]	P. Bendtsen, J. McCambridge, M. Bendtsen, N. Karlsson and P. Nilsen, “Effectiveness of a Proactive MailBased Alcohol Internet Intervention for University Students: Dismantling the Assessment and Feedback Components in a Randomized Controlled Trial,” Journal of Medical Internet Research, Vol. 14, No. 5, 2012, Article ID: e142. http://dx.doi.org/10.2196/jmir.2062
[3]	D. S. Ekman, A. Andersson, P. Nilsen, H. Stahlbrandt, A. L. Johansson and P. Bendtsen, “Electronic Screening and Brief Intervention for Risky Drinking in Swedish University Students—A Randomized Controlled Trial,” Addictive Behaviours, Vol. 36, No. 6, 2011, pp. 654-659. http://dx.doi.org/10.1016/ j.addbeh.2011.01.015
[4]	S. Bullock, “Alcohol, Drugs and Student Lifestyle! A Study of the Attitudes, Beliefs and Use of Alcohol and Drugs among Swedish University Students,” Stockholm University, SoRAD Research Report No 21, 2004.
[5]	A. Andersson, A.-B. Wiréhn, C. Olvander, D. S. Ekman and P. Bendtsen, “Alcohol Use among University Students in Sweden Measured by an Electronic Screening Instrument,” BMC Public Health, Vol. 9, 2009, p. 229. http://dx.doi.org/10.1186/1471-2458-9-229
[6]	E. F. S. Kaner, F. Beyer, H. O. Dickinson, et al., “Effectiveness of Brief Alcohol Interventions in Primary Care Populations,” Cochrane Database of Systematic Reviews, Vol. 18, No. 2, 2007, Article ID: CD004148.
[7]	P. Nilsen, M. Aalto, P. Bendtsen and K. Seppa, “Effectiveness of Strategies to Implement Brief Alcohol Intervention in Primary Healthcare, A Systematic Review,” Scandinavian Journal of Primary Health Care, Vol. 24, No. 1, 2006, pp. 5-15. http://dx.doi.org/10.1080/02813430500475282
[8]	T. L. Webb, J. Joseph, L. Yardley and S. Michie, “Using the Internet to Promote Health Behavior Change: A Systematic Review and Meta-Analysis of the Impact of Theoretical Basis, Use of Behavior Change Techniques, and Mode of Delivery on Efficacy,” Journal of Medical Internet Research, Vol. 12, No. 1, 2010, Article ID: e4. http://dx.doi.org/10.2196/jmir.1376
[9]	S. Linke, A. Brown and P. Wallace, “Down Your Drink: A Web-Based Intervention for People with Excessive Alcohol Consumption,” Alcohol and Alcoholism, Vol. 39, No. 1, 2004, pp. 29-32. http://dx.doi.org/10.1093/alcalc/agh004
[10]	P. Bendtsen, J. McCambridge, M. Bendtsen, N. Karlsson and P. Nilsen, “Effectiveness of a Proactive Mail-Based Alcohol Internet Intervention for University Students: Dismantling the Assessment and Feedback Components in a Randomized Controlled Trial,” Journal of Medical Internet Research, Vol. 14, No. 5, 2012, Article ID: e142. http://dx.doi.org/10.2196/jmir.2062
[11]	K. Kypri, J. Hallett, P. Howat, A. McManus, B. Maycock, S. Bowe and N. J. Horton, “Randomized Controlled Trial of Proactive Web-Based Alcohol Screening and Brief Intervention for University Students,” Archives of Internal Medicine, Vol. 169, No. 16, 2009, pp. 1508-1514. http://dx.doi.org/10.1001/archinternmed.2009.249
[12]	Z. Khadjesari, E. Murray, C. Hewitt, S. Hartley and C. Godfrey, “Can Stand-Alone Computer-Based Interventions Reduce Alcohol Consumption? A Systematic Review,” Addiction, Vol. 106, No. 2, 2011, pp. 267-282. http://dx.doi.org/10.1111/j.1360-0443.2010.03214.x
[13]	H. Riper, V. Spek, B. Boon, B. Conijn, J. Kramer, K. Martin-Abello and F. Smit, “Effectiveness of E-Self-Help Interventions for Curbing Adult Problem Drinking: A Meta-Analysis,” Journal of Medical Internet Research, Vol. 13, No. 2, 2011, Article ID: e42. http://dx.doi.org/10.2196/jmir.1691
[14]	J. A. Cunningham, T. C. Wild, J. Cordingley, T. van Mierlo and K. Humphreys, “A Randomized Controlled Trial of an Internet-Based Intervention for Alcohol Abusers,” Addiction, Vol. 104, No. 12, 2009, pp. 2023-2032. http://dx.doi.org/10.1111/j.1360-0443.2009.02726.x
[15]	H. Riper, J. Kramer, F. Smit, B. Conijn, G. Schippers and P. Cuijpers, “Web-Based Self-Help for Problem Drinkers: A Pragmatic Randomized Trial,” Addiction, Vol. 103, No. 2, 2008, pp. 218-227. http://dx.doi.org/10.1111/ j.1360-0443.2007.02063.x
[16]	M. T. Moreira, L. A. Smith and D. Foxcroft, “Social Norms Interventions to Reduce Alcohol Misuse in University or College Students,” Cochrane Database of Systematic Reviews, Vol. 3, 2009, Article ID: CD006748.
[17]	C. Free, R. Knight, S. Robertson, et al., “Smoking Cessation Support Delivered via Mobile Phone Text Messaging (txt2stop): A Single-Blind, Randomised Trial,” Lancet, Vol. 378, No. 9785, 2011, pp. 49-55. http://dx.doi.org/10.1016/S0140-6736(11)60701-0
[18]	G. Block, B. Sternfeld, B. Torin, et al., “Development of Alive! [A Lifestyle Intervention via Email], and Its Effect on Health-Related Quality of Life, Presenteeism, and Other Behavioral Outcomes: Randomized Controlled Trial,” Journal of Medical Internet Research, Vol. 10, No. 4, 2008, Article ID: e43. http://dx.doi.org/10.2196/jmir.1112
[19]	K. Patrick, F. Raab, M. A. Adams, et al., “A Text MesSage-Based Intervention for Weight Loss: Randomized Controlled Trial,” Journal of Medical Internet Research Vol. 11, No. 1, 2009, Article ID: e1. http://dx.doi.org/10.2196/jmir.1100
[20]	S. Krishna, S. A. Boren and A. Balas, “Healthcare via Cell Phones. A Systematic Review,” Telemedicine Journal and E-Health, Vol. 15, No. 3, 2009, pp. 231-240. http://dx.doi.org/10.1089/tmj.2008.0099
[21]	I. Back and K. Makela, “Mobile Phone Messaging in Health Care—Where Are We Now?” Journal of Information Technology & Software Engineering, Vol. 2, No. 1, 2012. http://dx.doi.org/10.4172/2165-7866
[22]	H. Cole-Lewis and T. Kerslaw, “Text Messaging as a Tool for Behaviour Change in Disease Prevention and Management,” Epidemiologic Reviews, Vol. 32, No. 1, 2010, pp. 56-69. http://dx.doi.org/10.1093/epirev/mxq004
[23]	C. Free, G. Phillips, L. Watson, L. Galli, L. Felix, P. Edwards, V. Patel and A. Haines, “The Effectiveness of Mobile-Health Technologies to Improve Health Care Service Delivery Processes: A Systematic Review and Meta-Analysis,” PLOS Medicine, Vol. 10, No. 12013, Article ID: e1001363. http://dx.doi.org/ 10.1371/journal. pmed.1001363
[24]	E. Kuntsche and B. Robert, “Short Message Service [SMS] Technology in Alcohol Research—A Feasibility Study,” Alcohol and Alcoholism, Vol. 44, No. 4, 2009, pp. 394-399. http://dx.doi.org/10.1093/alcalc/agp033
[25]	B. Suffoletto, C. Callaway, J. Kristan, K. Kraemer and D. B. Clark, “Text-Message-Based Drinking Assessments and Brief Interventions for Young Adults Discharged from the Emergency Department,” Alcoholism: Clinical and Experimental Research, Vol. 36, No. 3, 2012, pp. 552-560. http://dx.doi.org/ 10.1111/j.1530-0277. 2011.01646.x
[26]	J. McCambridge, P. Bendtsen, M. Bendtsen and P. Nilsen, “Alcohol Email Assessment and Feedback Study Dismantling Effectiveness for University Students [AMADEUS-1]: Study Protocol for a Randomized Controlled Trial,” Trials, Vol. 13, No. 1, 2012, p. 49. http://dx.doi.org/10.1186/1745-6215-13-49