Personalised digital interventions for reducing hazardous and harmful alcohol consumption in community-dwelling populations
Open accessAbstract
BACKGROUND: Excessive alcohol use contributes significantly to physical and psychological illness, injury and death, and a wide array of social harm in all age groups. A proven strategy for reducing excessive alcohol consumption levels is to offer a brief conversation-based intervention in primary care settings, but more recent technological innovations have enabled people to interact directly via computer, mobile device or smartphone with digital interventions designed to address problem alcohol consumption. OBJECTIVES: To assess the effectiveness and cost-effectiveness of digital interventions for reducing hazardous and harmful alcohol consumption, alcohol-related problems, or both, in people living in the community, specifically: (i) Are digital interventions more effective and cost-effective than no intervention (or minimal input) controls? (ii) Are digital interventions at least equally effective as face-to-face brief alcohol interventions? (iii) What are the effective component behaviour change techniques (BCTs) of such interventions and their mechanisms of action? (iv) What theories or models have been used in the development and/or evaluation of the intervention? Secondary objectives were (i) to assess whether outcomes differ between trials where the digital intervention targets participants attending health, social care, education or other community-based settings and those where it is offered remotely via the internet or mobile phone platforms; (ii) to specify interventions according to their mode of delivery (e.g. functionality features) and assess the impact of mode of delivery on outcomes. SEARCH METHODS: We searched CENTRAL, MEDLINE, PsycINFO, CINAHL, ERIC, HTA and Web of Knowledge databases; ClinicalTrials.com and WHO ICTRP trials registers and relevant websites to April 2017. We also checked the reference lists of included trials and relevant systematic reviews. SELECTION CRITERIA: We included randomised controlled trials (RCTs) that evaluated the effectiveness of digital interventions compared with no intervention or with face-to-face interventions for reducing hazardous or harmful alcohol consumption in people living in the community and reported a measure of alcohol consumption. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by The Cochrane Collaboration. MAIN RESULTS: We included 57 studies which randomised a total of 34,390 participants. The main sources of bias were from attrition and participant blinding (36% and 21% of studies respectively, high risk of bias). Forty one studies (42 comparisons, 19,241 participants) provided data for the primary meta-analysis, which demonstrated that participants using a digital intervention drank approximately 23 g alcohol weekly (95% CI 15 to 30) (about 3 UK units) less than participants who received no or minimal interventions at end of follow up (moderate-quality evidence).Fifteen studies (16 comparisons, 10,862 participants) demonstrated that participants who engaged with digital interventions had less than one drinking day per month fewer than no intervention controls (moderate-quality evidence), 15 studies (3587 participants) showed about one binge drinking session less per month in the intervention group compared to no intervention controls (moderate-quality evidence), and in 15 studies (9791 participants) intervention participants drank one unit per occasion less than no intervention control participants (moderate-quality evidence).Only five small studies (390 participants) compared digital and face-to-face interventions. There was no difference in alcohol consumption at end of follow up (MD 0.52 g/week, 95% CI -24.59 to 25.63; low-quality evidence). Thus, digital alcohol interventions produced broadly similar outcomes in these studies. No studies reported whether any adverse effects resulted from the interventions.A median of nine BCTs were used in experimental arms (range = 1 to 22). 'B' is an estimate of effect (MD in quantity of drinking, expressed in g/week) per unit increase in the BCT, and is a way to report whether individual BCTs are linked to the effect of the intervention. The BCTs of goal setting (B -43.94, 95% CI -78.59 to -9.30), problem solving (B -48.03, 95% CI -77.79 to -18.27), information about antecedents (B -74.20, 95% CI -117.72 to -30.68), behaviour substitution (B -123.71, 95% CI -184.63 to -62.80) and credible source (B -39.89, 95% CI -72.66 to -7.11) were significantly associated with reduced alcohol consumption in unadjusted models. In a multivariable model that included BCTs with B > 23 in the unadjusted model, the BCTs of behaviour substitution (B -95.12, 95% CI -162.90 to -27.34), problem solving (B -45.92, 95% CI -90.97 to -0.87), and credible source (B -32.09, 95% CI -60.64 to -3.55) were associated with reduced alcohol consumption.The most frequently mentioned theories or models in the included studies were Motivational Interviewing Theory (7/20), Transtheoretical Model (6/20
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- [19]19. 3. Avoidance/reducing exposure to cues for the behaviour 7.1% (3) 1.5. Review behaviour goal(s) 4.8% (2) 5.4. Monitoring of emotional consequences 4.8% (2) 10.3. Non-specific reward 4.8% (2) 10.9. Self-reward 4.8% (2)
- [20]20. 7. Review outcome goal(s) 2.4% (1) 1.8. Behavioural contract 2.4% (1) 3.3. Social support (emotional) 2.4% (1)
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- Authors
- Kaner, E. F., Beyer, F. R., Garnett, C., Crane, D., Brown, J., Muirhead, C., Redmore, J., O'Donnell, A., Newham, J. J., de Vocht, F., Hickman, M., Brown, H., Maniatopoulos, G., & Michie, S.
- Affiliations
- Newcastle University (GB)
- University College London (GB)
- University of Bristol (GB)
- King's College London (GB)
- University of Bristol; School of Social and Community Medicine; 39 Whatley Road Bristol UK BS8 2PS
- ORCID
- Venue
- Cochrane Database of Systematic Reviews
- Publisher
- Wiley
- Published
- 2017-09-25
- Volume
- 2017
- Issue
- 9
- Pages
- CD011479-CD011479
- ISSN
- 1361-6137 (ISSN-L)
- 1465-1858
- PMC
- PMC6483779
- OpenAlex
- W1899156315
- Semantic Scholar
- dbe46ba341fb69f0ffd0694317cb47309cdd9f68
- Cited by
- 308
- References
- 245
- Citations by year
- 2026: 13 · 2025: 28 · 2024: 41 · 2023: 41 · 2022: 35 · 2021: 41 · 2020: 39 · 2019: 31 · 2018: 28 · 2017: 8 · 2016: 2 · 2015: 1
- FWCI
- 3.84
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Cochrane Database of Systematic Reviews (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Research Explorer (The University of Manchester) (publishedVersion, other-oa)
- Bristol Research (University of Bristol) (publishedVersion, other-oa)
- Northumbria Research Link (Northumbria University) (acceptedVersion)
- Explore Bristol Research (submittedVersion, other-oa)
- UCL Discovery (University College London) (submittedVersion)
- Research Portal (King's College London) (submittedVersion, other-oa)
- Newcastle University ePrints (Newcastle Univesity)
- Funders
- Wellcome Trust (WT086516MA)
- Cancer Research UK (22962)
- National Institute for Health and Care Research (SPCR-092)
- Alcohol Advisory Council of New Zealand
- ZonMw
- Forskningsrådet för Arbetsliv och Socialvetenskap (2010-0024)
- Medical Research Council (MR/K02325X/1, MR/K023195/1, U1052 60558)
- Health Research Council of New Zealand
- National Institute on Alcohol Abuse and Alcoholism (R21AA019993, RC1AA019248)
- Topics
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Keywords
- digital interventions, hazardous drinking, brief alcohol intervention, behaviour change techniques, cost-effectiveness, mode of delivery, mobile health, online intervention, community-dwelling adults, alcohol-related problems, primary care, social care, health education, theory-based intervention, mechanism of action, attrition bias, alcohol consumption reduction, alcohol harm prevention
- MeSH terms
- Alcohol Drinking, Behavior Therapy, Cost-Benefit Analysis, Humans, Minicomputers, Therapy, Computer-Assisted, Randomized Controlled Trials as Topic, Alcohol-Related Disorders, Computers, Handheld, Cell Phone, Motivational Interviewing, Binge Drinking
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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