Improving existing E-health programs: the results of Drinktest.nl Britt van Lettow¹ MSc., MPH. Hein...
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Transcript of Improving existing E-health programs: the results of Drinktest.nl Britt van Lettow¹ MSc., MPH. Hein...
Improving existing E-health programs: the results of Drinktest.nl
Britt van Lettow¹ MSc., MPH.
Hein de Vries² PhD.
Alex Burdorf¹ PhD.
Pepijn van Empelen¹,³ PhD.
¹Erasmus MC, dep. of Public Health, ²Maastricht University, dep. of Health Promotion, ³TNO, Research Group Lifestyle The Netherlands
Presenters disclosure
This research and my visit to the E-Health conference was supported
by a grant of project no. 121020020 from ZonMW, Organization for
Health Research and Development, the Netherlands.
No conflicts of interest
No commercial support
Drinking behavior
All ages: 9.4% (16% among men)
Males (34.1%) > females (9.4%)
Young adults aged 18−25 drink the most: 20% drinks excessively
1 glass = 10 grams alcohol
Excessive drinking norms in NL:
Males: Females
max. 6 glasses p/d max. 4 glass p/d
max. 5 days p/w max. 5 days p/w
max. 21 glasses p/w max. 14 glasses p/w
Short and long term health and other consequences
Diseases: cancer, cardiovascular diseases
Traffic accidents, injuries
Etc.
What is Drinktest.nl?
Meant as online “screening” instrument for people at home
Self-report of own behavior, awareness, etc.
Design:
One moment: questions feedback questions feedback
Tailored feedback regarding their drinking behavior in relation to
Attitude – information on e.g. health to increase awareness
E.g., questions regarding their thoughts on the effect of their
drinking behavior on their brains, liver, etc.
Social norms – own behavior compared to others, drinking norms
Perceived behavioral control – tips and advice on how to
overcome difficulties/barriers
Improving E-health program Drinktest.nl
Addition of
Prototypes
Cue reminders
2 studies first, as basis for the development of modules added
to original drinktest (not discussed today)
Prototypes definition
Prototypes – “Perceptions or cognitions of images of a typical person engaging
in certain risk or health behavior” personal characteristics
Typical drinker
Typical exerciser
Typical smoker
……
Typical person Characteristic Characteristic Characteristic
A scientist is... Smart Boring Nerd
A granny is... Slow Fragile Talkative
A movie star is.… Self-confident Conscientious Social
Why prototypes?
Prototypes have been related to many (un)healthy behaviors
Impact on intention, willingness, and behavior
Changing perception is promising for health interventions
Based on changing desirability and importance of characteristics
The e-health program will provide feedback on which characteristics
are attributed to heavy and moderate drinker prototypes.
Why cue reminders?
Cue reminders help people remember goals, advice, and interventions
Cue unrelated to behavior itself
E.g. power button – recall info on alcohol use
E.g. bracelet – Moroccan women – less sugary meals and snacks
E.g. bracelet – condom use among young adults
E.g. smiley fridge magnet – healthy diet, less snacking
Developing modules added to Drinktest.nl
Aim: reduce alcohol consumption among excessive drinking people
How to best improve drinktest.nl with extra modules?
Inclusion of feedback with prototypes characteristics?
Inclusion of a cue reminder?
Combination of both?
Or nothing?
Design
Online
Baseline (T0): 4 study groups (next slide)
Randomisation by computer
Follow-up & evaluation after 1 month (T1)
Only excessive drinkers
Excessive drinking = exceeding: drinking on a max. of 5 days per
week, a max. of 4 glasses per day and 14 per week for women,
and 6 glasses per day and 21 per week for men
Non-excessive drinkers only receive “original” drinktest.nl and are
excluded from further analyses
Incentive: €50, €100 or €250 (raffle) after completion of 3
measurements
Overview e-health program: 4 study groups
Control group Prototype group Cue reminder group
Combi: Prototype + Cue group
Demography, behavior, intentions, willingness
Demography, behavior, intentions, willingness
Demography, behavior, intentions, willingness
Demography, behavior, intentions, willingness
Drinktest.nl modules (attitude, control, social norms)
Drinktest.nl modules (attitude, control, social norms)
Drinktest.nl modules (attitude, control, social norms)
Drinktest.nl modules (attitude, control, social norms)
- Feedback based on prototype characteristics
- Feedback based on prototype characteristics
- Formulate action plans
Formulate action plans
Formulate action plans
- - Receive bracelet to remind of plans and Drinktest
Receive bracelet to remind of plans and characteristics
E-health program – Control group
Control group = Original drinktest.nl modules:
Tailored feedback regarding their drinking behavior in relation to
Attitude – information on e.g. health to increase awareness
Social norms – own behavior compared to others, drinking norms
Perceived behavioral control – advice on how to overcome
difficulties
Provides info on how much is “responsible” to drink, tailored to gender
and own drinking behavior
E-health program – Prototype group
Original drinktest.nl modules (tailored feedback on attitude, social
norms, pbc)
Tailored feedback based on prototype characteristics:
Which characteristics do you desire for yourself?
feedback which characteristics are related to moderate and heavy
drinking
what would happen if you change your drinking behavior: If you
decrease your consumption, you will more likely acquire your desired
characteristics
Formulate action plans
E-health program – Cue reminder group
Original drinktest.nl modules (tailored feedback on attitude, social
norms, pbc)
Formulate action plans
Receive a silicon bracelet to remind themselves of their plans and/or
information of drinktest.nl
If bracelet is refused, choice of no cue, own jewelry, or other
object
E-health program – Combi of prototype + cue group
Respondent gets all modules
Cue reminder to remind of both plans and (un)desired characteristics
(thus not only of plans as in cue condition)
Overview e-health program: 4 study arms – follow-up after 1 month
Control + Prototype groups
Combi + cue only groups
Drinking behavior, Intentions, Willingness √ √
Awareness of alcohol use and of info from drinktest.nl
√ √
Attempted to reduce alcohol consumption? √ √
Choice of cue reminder, awareness of cure reminder, use of reminder
√ X
Evaluation of intervention √ √
Results – sample
Online only
Total sample: start with 4827 cases
Only excessive drinkers included
Duplicates and outliers excluded
N = 2924 at T0 (drinktest.nl)
N = 784 (26.8% response) who completed drinktest.nl and follow-up of
one month (T1).
48.1% males
M age = 39.7 (SD = 15.4, range 18-77)
75.6% high education
96.2% Western ethnicity
Results – Drinking behavior at follow-up
All regression analyses corrected for their baseline outcomes
Differences between groups were tested
Group Drinking behavior (T1):
Week total – ns
Average nr. of glasses per week day – ns
Average nr. of glasses per weekend day – model: F (3, 783) = 117.6, p = .00, group variable: t = -1.81, p < .007
combi group < control group (p = .054)
Excessive drinking (i.e., type of drinker) –
combi group < cue group: OR = .65, p < .05
Tried to decrease consumption (T1): F(3, 780) = 2.91, p < .05
control < all other groups (p’s < .05)
Results continued
All regression analyses corrected for their baseline outcomes
Differences between groups were tested (LSD)
Group intention to reduce drinking (T1): Model: F(2, 782) = 190.5, p
< .001, group variable: t(784) = 1.84, p =.07:
combi group > control group (p = .07)
Group willingness to drink (T1): Model: F(2, 782) = 217.6, p < .001,
group variable t(784) = -1.77, p = .08
combi group < control group (p = .08)
Group thought of drinktest (T1): F(3, 780) = 6.1, p < .001
control < all other groups (p’s < .05)
No difference in evaluation of intervention between groups
Conclusion and discussion intervention
Combination of feedback on prototypical characteristics and use of a
cue reminder most effective compared to control group (i.e., original
drinktest)
Temptations, intentions, willingness, drinking in weekends
Trying to decrease consumption, thinking of intervention
Thus, drinktest.nl could be enhanced by the additional modules of a
cue reminder and feedback on prototypical characteristics
Preliminary data – still collecting
Conclusion and discussion intervention
The results may help in tailoring and targeting interventions (e-health
programs) aimed at reducing alcohol consumption via prototypes and
cue reminders
Both prototypes and cue reminders can be helpful tools in other
interventions to improve lifestyles
Cues do not need to be related to the behavior
Results may be applicable for other behaviors
CHEERS!
Results – Descriptives
No significant differences between conditions
Control group
Prototype group
Cuegroup
Combi group
Statistics
N 207 233 177 167
M age (SD) 39.8 (15.6) 39.8 (14.5) 39.7 (15.4) 41.1 (16.3) F(3, 780) = .85
% males 46.9 45.5 50.8 50.3 X2 (3) = 1.62
% high education
75.2 77.6 74.6 74.3 X2 (3) = 0.78
% Western 85.7 97 94.9 97 X2 (3) = 1.66
Table 13. Descriptives per study group
Baseline (T0) differences between groups
Intention – ns
Willingness – ns
Drinking behavior
Weektotal – p < .10 (M = 27.1, SD = 17.3)
Average nr. of glasses per weekday (M = 4.2, SD = 3.6) – ns
Average nr. of glasses per weekendday (M = 6.0, SD = 3.7) – ns