Stuart Linke

On-line Randomized Controlled Trial of an Internet Based Psychologically Enhanced Intervention for People with Hazardous Alcohol Consumption

Background Interventions delivered via the Internet have the potential to address the problem of hazardous alcohol consumption at minimal incremental cost, with potentially major public health implications. It was hypothesised that providing access to a psychologically enhanced website would result in greater reductions in drinking and related problems than giving access to a typical alcohol website simply providing information on potential harms of alcohol. DYD-RCT Trial registration: ISRCTN 31070347. Methodology/Principal Findings A two-arm randomised controlled trial was conducted entirely on-line through the Down Your Drink (DYD) website. A total of 7935 individuals who screened positive for hazardous alcohol consumption were recruited and randomized. At entry to the trial, the geometric mean reported past week alcohol consumption was 46.0 (SD 31.2) units. Consumption levels reduced substantially in both groups at the principal 3 month assessment point to an average of 26.0 (SD 22.3) units. Similar changes were reported at 1 month and 12 months. There were no significant differences between the groups for either alcohol consumption at 3 months (intervention: control ratio of geometric means 1.03, 95% CI 0.97 to 1.10) or for this outcome and the main secondary outcomes at any of the assessments. The results were not materially changed following imputation of missing values, nor was there any evidence that the impact of the intervention varied with baseline measures or level of exposure to the intervention. Conclusions/Significance Findings did not provide support for the hypothesis that access to a psychologically enhanced website confers additional benefit over standard practice and indicate the need for further research to optimise the effectiveness of Internet-based behavioural interventions. The trial demonstrates a widespread and potentially sustainable demand for Internet based interventions for people with hazardous alcohol consumption, which could be delivered internationally. Trial Registration Controlled-Trials.com ISRCTN31070347

Development of a psychologically enhanced interactive online intervention for hazardous drinking

Aims: The content of novel interventions is often not well specified. We provide a detailed account of the rationale for and redevelopment of an Internet resource for hazardous drinkers—Down Your Drink (DYD) (www.downyourdrink.org.uk). Development Work: An iterative process blended literature reviews of Internet interventions for health conditions and brief treatments for alcohol problems, feedback from users of the original site and from users panels, and completion of a series of developmental tasks. Intervention: The detailed structure and content of the new version of the website is presented. This permits an appreciation of the intended interaction between the user and the intervention, and emphasizes both the freedom of choice available to the user to access diverse material for personal benefit and the value of a clear organizational structure. Conclusions: Presentation of detailed information on the theoretical underpinning, content and structure of an intervention makes it easier to interpret the results of any evaluation and is likely to be of use to those developing other online interventions for alcohol or other health behaviours.

The DYD-RCT protocol: an on-line randomised controlled trial of an interactive computer-based intervention compared with a standard information website to reduce alcohol consumption among hazardous drinkers.

BackgroundExcessive alcohol consumption is a significant public health problem throughout the world. Although there are a range of effective interventions to help heavy drinkers reduce their alcohol consumption, these have little proven population-level impact. Researchers internationally are looking at the potential of Internet interventions in this area.Methods/DesignIn a two-arm randomised controlled trial, an on-line psychologically enhanced interactive computer-based intervention is compared with a flat, text-based information web-site. Recruitment, consent, randomisation and data collection are all on-line. The primary outcome is total past-week alcohol consumption; secondary outcomes include hazardous or harmful drinking, dependence, harm caused by alcohol, and mental health. A health economic analysis is included.DiscussionThis trial will provide information on the effectiveness and cost-effectiveness of an on-line intervention to help heavy drinkers drink less.Trial registrationInternational Standard Randomised Controlled Trial Number Register ISRCTN31070347

Impact of Length or Relevance of Questionnaires on Attrition in Online Trials: Randomized Controlled Trial

Background There has been limited study of factors influencing response rates and attrition in online research. Online experiments were nested within the pilot (study 1, n = 3780) and main trial (study 2, n = 2667) phases of an evaluation of a Web-based intervention for hazardous drinkers: the Down Your Drink randomized controlled trial (DYD-RCT). Objectives The objective was to determine whether differences in the length and relevance of questionnaires can impact upon loss to follow-up in online trials. Methods A randomized controlled trial design was used. All participants who consented to enter DYD-RCT and completed the primary outcome questionnaires were randomized to complete one of four secondary outcome questionnaires at baseline and at follow-up. These questionnaires varied in length (additional 23 or 34 versus 10 items) and relevance (alcohol problems versus mental health). The outcome measure was the proportion of participants who completed follow-up at each of two follow-up intervals: study 1 after 1 and 3 months and study 2 after 3 and 12 months. Results At all four follow-up intervals there were no significant effects of additional questionnaire length on follow-up. Randomization to the less relevant questionnaire resulted in significantly lower rates of follow-up in two of the four assessments made (absolute difference of 4%, 95% confidence interval [CI] 0%-8%, in both study 1 after 1 month and in study 2 after 12 months). A post hoc pooled analysis across all four follow-up intervals found this effect of marginal statistical significance (unadjusted difference, 3%, range 1%-5%, P = .01; difference adjusted for prespecified covariates, 3%, range 0%-5%, P = .05). Conclusions Apparently minor differences in study design decisions may have a measurable impact on attrition in trials. Further investigation is warranted of the impact of the relevance of outcome measures on follow-up rates and, more broadly, of the consequences of what we ask participants to do when we invite them to take part in research studies. Trial registration ISRCTN Register 31070347; http://www.controlled-trials.com/ISRCTN31070347/31070347 Archived by WebCite at (http://www.webcitation.org/62cpeyYaY)

A randomized controlled trial of an interactive Web-based intervention for reducing alcohol consumption.

In an uncontrolled pilot study of an interactive, Web-based treatment programme for people with alcohol problems, the mean number of units consumed decreased from 33 per week to 23. A two-arm online randomized controlled trial will be conducted to determine the effectiveness of an interactive Web-based intervention for reducing alcohol consumption. Participants will be randomized to intervention (access to an interactive Web-based intervention plus information) or control (access to an information Website only) groups, and followed up for six months. The primary outcome measure will be reduction in units of alcohol consumed in the previous seven days; secondary outcome measures will determine effects on alcohol dependence, alcohol-related harm and social disruption and quality of life. Recruitment, consent, randomization, intervention and follow-up will all be delivered online.

Widening Access to Treatment for Alcohol Misuse: Description and Formative Evaluation of an Innovative Web-Based Service in One Primary Care Trust

AIMS To describe the development and evaluation of an innovative web-based service for hazardous or harmful drinkers. METHODS Patients were identified in General Practice and referred to the new service. Mixed methods were used for evaluation. RESULTS The service was feasible and acceptable to patients, primary care professionals and commissioners. Users appeared to reduce their alcohol consumption. CONCLUSION This model may be of interest to other primary care commissioners looking to increase access to alcohol treatments at low cost.

How big is the elephant in the room? Estimated and actual IT costs in an online behaviour change trial

BackgroundThe practical and methodological challenges inherent in online behaviour change studies are both novel and complex. We relate our experiences of estimating and managing information technology (IT) research and intervention costs in an ongoing internet trial in the hope that others will find this information useful.FindingsActual IT costs were approximately twice those that had been originally estimated by external contractors. These original estimates for IT costs allowed little scope for the identification of new needs, which was intrinsic to the iterative nature of the research enterprise.ConclusionsMaking greater provision for the uncertain nature of these costs in future studies is a key practical lesson for the planning of future online behaviour change studies.

Calling the shots: Young professional women's relationship with alcohol

Alcohol consumption by young professional women is increasing. Whilst the media and public health campaigns have condemned this increase, societal attitudes and advertising discourses frame it as a display of “power femininity”. This qualitative study explored young professional womens “relationship with alcohol”: why they drank and how they felt about it. Twelve young professional women who reported drinking over official limits and had not sought professional help were recruited via UK public houses (drinking establishments, usually called pubs) and later interviewed. Transcripts were analysed thematically. Participants used alcohol to gain power; they saw drinking as a masculine ability demonstrating stamina, valued professionally and socially. However, women were also ashamed of their drinking; they felt criticised by health professionals and the media. Rather than perpetuating a blaming and shaming discourse, it may be important to counteract social norms associating alcohol use with power and sobriety with weakness.