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