Formative evaluation and three-month follow-up of an online personalized assessment feedback intervention for problem drinkers
Open accessAbstract
BACKGROUND: In recent years, online services for problem drinkers have been developed. This paper describes ongoing efforts to improve one of these services, the Alcohol Help Center. OBJECTIVE: This report summarizes new modules added to the Check Your Drinking (CYD) screener, a component of the Alcohol Help Center, to make the CYD screener more useful to periodic heavy drinkers, as well as to regular alcohol consumers. Participants' initial reactions to the CYD screener and the changes in their drinking habits at a three-month follow-up are presented. METHODS: The CYD screener provides a free personalized Final Report that compares the user's drinking to that of others in the general population of the same age, gender, and country of origin. Current alcohol consumption and demographic characteristics are collected as part of the CYD screening process. After users were presented with a customized Final Report, they were hot-linked to a volunteer feedback survey. The voluntary feedback survey asked about impressions of the CYD Final Report. Respondents agreeing to participate were sent a follow-up survey after three months. RESULTS: We recruited 388 volunteers (69% female) who were registered users of another free-to-consumer online eHealth service. Of the 343 respondents agreeing to participate in the three-month follow-up, 138 accessed the survey, and 97 provided complete data (participation rate = 40%; completion rate = 70%). Compared to moderate drinkers, current problem drinkers judged the Final Report to be more useful (34% vs. 69%, chi2 (1) = 41.5, P < .001) and accurate (43% vs. 76%, chi2 (1) = 36.0, P < .001). Respondents who participated in the three-month follow-up displayed reductions in drinking compared to baseline (F(4,76) = 12.2, P = .001). CONCLUSIONS: Improvements can still be made to make the CYD screener more relevant to specific populations, particularly periodic heavy drinkers. There is a need to further tailor algorithms that can present questions only relevant to specific populations. There also appears to be a need to further customize the Final Report for respondents who identify themselves as infrequent heavy drinkers. These improvements will be made, and a randomized controlled trial is planned to conduct a rigorous evaluation of the CYD screener as an intervention to help problem drinkers.
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Personalized feedback interventions for the most part do not target a specific clientele, as they include non-consumers with high-risk consumers, with the goal to keep consumption within recommended limits.
“For the most part, these interventions do not target a specific clientele, as they include non-consumers with high-risk consumers (for example, Cunningham et al., 2006; Doumas and Andersen, 2009; Bewick et al., 2010; Labrie et al., 2013), with the goal to keep their consumption within recommended limits.”
From Online and Mobile Interventions for Problem Gambling, Alcohol, and Drugs: A Systematic Review (2017) · cites this paper as Cunningham et al., 2006
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Koski‐Jännes, A., Cunningham, J. A., & Tolonen, K. (2009) · Alcohol and Alcoholism · doi:10.1093/alcalc/agn124 · Cited by 15 · see citing works
“The sample means in this study were rather high compared to previous data from other countries indicating that most of our study participants seemed to be relatively heavy drinkers (see e.g. Cunningham et al., 2006).”
Resultvan Mierlo, T., Li, X., Hyatt, D., & Ching, A. T. (2017) · Journal of Medical Internet Research · doi:10.2196/jmir.6330 · Cited by 14 · see citing works
“The Interventions The 4 interventions in this study [65-68] contained self-guided interactive behavior change treatment programs based on state-of-the-art best practice, and have been examined extensively in the literature [69-83].”
BackgroundUltra-brief intervention for problem drinkers: research protocol
Cunningham, J. A., Neighbors, C., Wild, C. T., & Humphreys, K. N. (2008) · BMC Public Health · doi:10.1186/1471-2458-8-298 · Cited by 10 · see citing works
Newman, M. G., Szkodny, L. E., Llera, S. J., & Przeworski, A. (2011) · Clinical Psychology Review · doi:10.1016/j.cpr.2010.10.002 · Cited by 139 · see citing works
Newton, A. S., Dow, N., Dong, K. A., Fitzpatrick, E. A., Wild, T. C., Johnson, D. W., Ali, S., Colman, I., & Rosychuk, R. J. (2017) · BMJ Open · doi:10.1136/bmjopen-2016-015423 · Cited by 10 · see citing works
“37 We used an iPad to deliver the intervention to facilitate ease of use at the adolescent’s bedside; each iPad used a data plan for Internet access.”
MethodPaulus, D. J., Gallagher, M. W., Neighbors, C., & Zvolensky, M. J. (2020) · Journal of Health Psychology · doi:10.1177/1359105320909858 · Cited by 11 · see citing works
“Participants will view feedback (determined via computer program/algorithm; see Supplemental material) based on their age and gender (Cunningham et al., 2006).”
MethodCunningham, J. A., Godinho, A., Hendershot, C. S., KAY‐LAMBKIN, F. J., Neighbors, C., Griffiths, K. M., & Schell, C. (2021) · Internet Interventions · doi:10.1016/j.invent.2021.100477 · Cited by 10 · see citing works
Vadhan, N. P., Padovano, H. T., Muench, F. J., Levak, S., & Allen, N. (2024) · Alcoholism Clinical and Experimental Research · doi:10.1111/acer.15414 · Cited by 8 · see citing works
Internet Evidence-Based Treatments
Cunningham, J. A. (2009) · Elsevier eBooks · doi:10.1016/b978-0-12-374348-0.00020-3 · Cited by 8 · see citing works
Internetbasierte Vorbereitung auf eine stationäre psychosomatisch-psychotherapeutische Behandlung
Zimmer, B., Dogs, P., & Kordy, H. (2011) · Psychotherapeut · doi:10.1007/s00278-011-0867-7 · Cited by 8 · see citing works
Głowacka, M., Yardley, L., Stone, N., & Graham, C. A. (2018) · JMIR Research Protocols · doi:10.2196/resprot.7937 · Cited by 7 · see citing works
“The results of an exploratory evaluation may support the need for further program development and/or indicate the need for conducting a large scale RCT and provide valuable guidance regarding its optimal design [39,63].”
Innovations in the Utilization of Health Information Technology in Psychiatric Services
Plovnick, R. M. (2009) · Epidemiologia e Psichiatria Sociale · doi:10.1017/s1121189x0000138x · Cited by 7 · see citing works
“Remote Web-based screening and assessment exist for problem drinking (Cunningham et al. , 2006), major depressive disorder, and anxiety disorders (Farvolden et al. , 2003).”
Cunningham, J. A., Hendershot, C. S., & Rehm, J. T. (2015) · BMC Public Health · doi:10.1186/s12889-015-1347-8 · Cited by 4 · see citing works
“The CYD screener consists of an 18 item screener, the responses from which are then used to generate a personalized feedback Final Report containing normative feedback content as well as a summary of the amount and risks associated with the recipient’s drinking [31,32].”
MethodStuder, J., Cunningham, J. A., Schmutz, E., Gaume, J., Adam, A., Daeppen, J., & Bertholet, N. (2025) · Journal of Medical Internet Research · doi:10.2196/55541 · Cited by 3 · see citing works
“Using the same question, the mean risk perception in our sample was approximately half of that reported in a North American sample of older participants reporting unhealthy drinking (mean age 37.9, SD 9.7 years) [71].”
Influentialvan Mierlo, T., Fournier, R., Yeung, S. K., & Lahutina, S. (2025) · JMIR Research Protocols · doi:10.2196/73773 · Cited by 3 · see citing works
Que, W., Hu, X., Wu, T., Zhang, H., Shi, Y., Zhao, J., Xiaoqin, S., Kuai, B.-X., & Guo, Y. (2025) · Archives of Public Health · doi:10.1186/s13690-024-01498-9 · Cited by 2 · see citing works
“…Handbooks [49], Narrative Medicine and Narrative Care Theory [37, 50], Positive Psychology Theory and Feedback Intervention Theory [51, 52] to construct framework for the foundational model and to identify the framework (support elements, support modalities, support processes,…”
Schell, C., Quilty, L. C., & Cunningham, J. A. (2024) · The Canadian Journal of Psychiatry · doi:10.1177/07067437241249412 · Cited by 2 · see citing works
Khadjesari, Z. (2012) · UCL Discovery (University College London) · Cited by 2 · see citing works
Evaluating the efficacy of Internet based motivational interviewing group treatment for weight loss
Webber, K. (2019) · Carolina Digital Repository (University of North Carolina at Chapel Hill) · doi:10.17615/0t4z-8k13
Sinadinovic, K. (2012) · Figshare
Ibanga, A. (2011) · University of Birmingham Institutional Research Archive (University of Birmingham)
Greidanus, E. (2010) · ERA: Education and Research Archive (University of Alberta) · doi:10.7939/r33w61
Terapie internetowe oparte na dowodach naukowych
Cunningham, J. A. (2013) · Wydawnictwa Uniwersytetu Warszawskiego eBooks · doi:10.31338/uw.9788323513759.pp.375-394
Schell, C., Godinho, A., & Cunningham, J. A. (2023) · Substance Use & Misuse · doi:10.1080/10826084.2023.2259453
“As a natural reduction in alcohol use commonly occurs among individuals who indicate they are concerned about their use, a corresponding change in QOL scores would also be expected (Cunningham, 2006).”
BackgroundMethodElectronic Intervention for Patient-Managed Benzodiazepine Tapering
Humphreys, K. N., Hagedorn, H., Han, X., Kemp, L., Poitra, N., & Cucciare, M. A. (2026) · JAMA Network Open · doi:10.1001/jamanetworkopen.2025.51807
- Authors
- Cunningham, J. A., Humphreys, K., Kypri, K., & van Mierlo, T.
- Affiliations
- Centre for Addiction and Mental Health (CA)
- Stanford Medicine (US)
- Corresponding author
- Cunningham, John A
- Venue
- Journal of Medical Internet Research
- Publisher
- JMIR Publications Inc.
- Published
- 2006-04-12
- Volume
- 8
- Issue
- 2
- Pages
- e5
- ISSN
- 1438-8871 (ISSN-L)
- OpenAlex
- W2054457764
- Cited by
- 65
- References
- 35
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 2 · 2023: 1 · 2021: 1 · 2020: 1 · 2019: 2 · 2018: 2 · 2017: 4 · 2016: 1 · 2015: 3 · 2014: 3 · 2013: 3 · 2012: 7
- FWCI
- 3.91
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Journal of Medical Internet Research (publishedVersion, cc-by)
- PubMed (publishedVersion)
- TSpace (University of Toronto) (submittedVersion, cc-by)
- Topics
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Health Sciences › Medicine › Pathology and Forensic Medicine › Alcohol Consumption and Health Effects
- Keywords
- problem drinking, personalized feedback, digital health interventions, drinking behavior change, formative assessment
- MeSH terms
- Adult, Alcoholism, Feedback, Female, Health Services, Health Surveys, Humans, Male, Middle Aged, Self Care, Time Factors, Treatment Outcome, Internet
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