Alcohol brief interventions:

Extending the reach

Professor Iain K Crombie

Alcohol brief interventions

substantial evidence of effectiveness 10-20 minutes of encouragement and goal setting usually delivered by a doctor

tested on middle-aged men usually in healthcare settings reduce weekly consumption

Aim: To reduce harmful drinking across social groups

Non-healthcare settings high risk groups currently not covered

Two stage process funded feasibility study• test study design

full RCT• assess intervention effectiveness

Mortality rates for chronic liver disease

Audit Scotland, 2007

Drinking and disadvantaged men: 25-44 years

hard to reach group seldom attend health care low participation in research

intervention requirements community delivery engage feasible national rollout

Feasibility study

text message intervention low demand on participants computerised delivery

recruitment / retentionlimitations of the intervention delivery

amount of informationopportunities for interaction

monitoring intervention delivery non-contact intervention

2 recruitment strategiesGP registers community outreach

Evidence-based techniques to increase recruitmentfinancial incentivesmultiple attempts at contactpersonalised approaches, assurances of confidentiality

Recruitment target: 60 - Achieved 67

Recruitment strategies

Comparing the recruitment strategiesGP Community

OutreachMarried 75% 36%

Employed 78% 54%

Mean consumption(units previous month)

66 140

Frequent sessions of ≥8 units (>5 per month)

17% 57%

Frequent sessions of ≥16 units(>5 per month)

5% 37%

Forgot what happened(> 1 per month)

6% 54%

Intervention development

Focus groups

Design team

experience of alcohol harms widespread increase salience

mature drinker role recognition of social expectations

• employer, partner, familyutilise discrepancy

• binge drinking and mature drinker role

weekend binge drinking tailor text messages

don’t preach

Focus group findings

Causal model forbehaviour change

What’s the main reason U drink? a.It’s a Habitb.To feel better c.To have fund.To copee.To wash down your chips.

Text me your answer!

Engagement•humour•reflection•interactivity

Andy from Dundee says –“I cut back on drinking because my father-in-law died of it”. What would be a good reason for U to cut back? Text me back!

Motivate change

Can U think of someone who’d be happy if U made a change! What would U hear them say? Please text me your answer! Views of others

Reinforce intention to change

Responses to texts

Reasons for drinking less “I really wanna stay out of trouble and not become the

person I can be after a few too many”

Money saved “£200 a month or more easy. That would be on carry outs

and the pub.”

Buy with money saved “Trek 2.5 road bike - cost £1650.00 RR”

Benefits to others “My dad. Its good ur no phoning me for a lift at 2am!”

Content of the responses

Summary exceeded recruitment target

recruited harmful drinkers 96% retention

outcomes measured theoretically and empirically based text messages

in 160 characters high level of engagement

key components behaviour change strategy

Extended and modified intervention 36 texts 110 texts self-efficacy action planning long term maintenance

Multi-centre trial underway 825 men recruited high level engagement outcome assessment underway

Revisions for the full trial

Young women

binge drinking in social groupshigh risk of harmseffectiveness of individual level intervention

group intervention capitalise on support structure

delivered by lay peers acceptability low cost for roll out

Key feasibility issues

develop intervention recruit and train lay peers recruit drinking groups fidelity of delivery follow-up

Focus groups

established patterns of dinking calculated hedonism

strong motives for drinking fun, socialising

group encouragement to drink marked resistance to change

Intervention: Looking good, feeling great

Three session tailored intervention (HAPA) Organised around fun activities

1. Promoting motivation Mocktail preparation

2. Setting goals Make-up demonstration

3. Action and coping plans Relaxation/ massage

Lay peers

recruitment targeted at peers extended selection process

training techniques from Motivational Interviewing role play: delivery of intervention user friendly manual

findings motivated peers recruited role play extended

Participant recruitment

Marketing campaign local radio, buses, flyers, posters, NHS/university intranets

Outreach strategy community centres, shopping centres, gyms, parks,

university, college Findings

target of 24 groups recruited

Delivering the intervention

variety of venues hotel, cocktail bar, community centres, university

professionals mixologist, beauty therapist, relaxation therapist

findings 92% completed 3 sessions

Assessing fidelity of intervention delivery

Monitoring recorded sessions flipcharts collated feedback with lay trainers

Findingsparticipants enthusiasticdecisional balance

• advantages of less bingeing92% set goals to reduce consumption

• no shots

Follow-up

very challengingparticipants willing, coordination hardmultiple attempts at contactmultiple methods

findings86% completed follow-up

Post-study evaluation

acceptability more fun than expected non-judgemental approach valued group format important

benefits insight into extent of drinking reduced drinking more money, more time goal setting used for other activities

Revisions for the full trial

Multi-centre four cities coordination and support

Over-recruit lay peers replacements

Research assistants to organise sessions facebook

Follow upkeep in regular contact

Risk of death from liver disease for men

Alcohol and Obese Men

HTA feasibility study obese men who drink > 21 units per week motivation of weight loss to reduce drinking sustained behaviour change

Challenges

recruitment obesity is a pejorative term

measure height and weight face to face session

• venues

deliver by lay people recruitment and training

intervention design motivate and maintain

Which men are obese?

Approaches

Literature review self-image and function weight loss groups unpopular

Stakeholder interviews recruitment, venues

Recruitment techniques modified from text message study

Focus groups

Focus groups

benefits of weight loss lose beer belly improved function – football with the kids

weight consequences of alcoholmakes them eat more unaware of calories in alcohol

barriers sociability/ enjoymentexercise is the preferred solution

Intervention strategy

Face to face sessionmotivation

• drinking above guidelines• very overweight• contribution of alcohol to weight

Text messages encourage goal setting/ action planning promote maintenance of reduced drinking

Current status

intervention developed lay people recruited and trained pilot intervention sessions successful recruitment began 02/03/15

Extending the reach

high risk groups tailored recruitment

intervention features strong empirical and theoretical basis

• levers for behaviour change low demand, enjoyable suitable for national roll-out

innovative delivery mechanisms electronic media group interventions trained lay people

Collaborators

Professor Iain Crombie Epidemiologist

Professor Rose Barbour Medical sociologist

Professor Andrew Briggs Health economist

Dr Carol Emslie Sociologist

Dr Josie Evans Epidemiologist

Professor Gerry Humphris Health Psychologist

Dr Linda Irvine Research methodologist

Dr Claire Jones Software Engineer

Dr Ambrose Melson Health Psychologist

Professor John Norrie Statistician and Trialist

Dr Dennis Petrie Health economist

Dr Peter Rice Consultant Psychiatrist

Professor Ian Ricketts Computer Scientist

Dr Peter Slane GP

Dr Falko Sniehotta Health Psychologist

Dr Vivien Swanson Health Psychologist

Professor Brian Williams Medical Sociologist