J. Med. Internet Res. - Effects of a Web-based tailored intervention to reduce alcohol consumption in adults: randomized controlled trial.


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CKGROUND: Web-based tailored interventions provide users with information that is adapted to their individual characteristics and needs. Randomized controlled trials assessing the effects of tailored alcohol self-help programs among adults are scarce. Furthermore, it is a challenge to develop programs that can hold respondents' attention in online interventions.OBJECTIVE: To assess whether a 3-session, Web-based tailored intervention is effective in reducing alcohol intake in high-risk adult drinkers and to compare 2 computer-tailoring feedback strategies (alternating vs summative) on behavioral change, dropout, and appreciation of the program.METHODS: A single-blind randomized controlled trial was conducted with an experimental group and a control group (N=448) in Germany in 2010-2011. Follow-up took place after 6 months. Drinking behavior, health status, motivational determinants, and demographics were assessed among participants recruited via an online access panel. The experimental group was divided into 2 subgroups. In the alternating condition (n=132), the tailored feedback was split into a series of messages discussing individual topics offered while the respondent was filling out the program. Participants in the summative condition (n=181) received all advice at once after having answered all questions. The actual texts were identical for both conditions. The control group (n=135) only filled in 3 questionnaires. To identify intervention effects, logistic and linear regression analyses were conducted among complete cases (n=197) and after using multiple imputation.RESULTS: Among the complete cases (response rate: 197/448, 44.0%) who did not comply with the German national guideline for low-risk drinking at baseline, 21.1% of respondents in the experimental group complied after 6 months compared with 5.8% in the control group (effect size=0.42; OR 2.65, 95% CI 1.14-6.16, P=.02). The experimental group decreased by 3.9 drinks per week compared to 0.4 drinks per week in the control group, but this did not reach statistical significance (effect size=0.26; beta=-0.12, 95% CI -7.96 to 0.03, P=.05). Intention-to-treat analyses also indicated no statistically significant effect. Separate analyses of the 2 experimental subgroups showed no differences in intervention effects. The dropout rate during the first visit to the intervention website was significantly lower in the alternating condition than in the summative condition (OR 0.23, 95% CI 0.08-0.60, P=.003). Program appreciation was comparable for the 2 experimental groups.CONCLUSIONS: Complete case analyses revealed that Web-based tailored feedback can be an effective way to reduce alcohol intake among adults. However, this effect was not confirmed when applying multiple imputations. There was no indication that one of the tailoring strategies was more effective in lowering alcohol intake. Nevertheless, the lower attrition rates we found during the first visit suggest that the version of the intervention with alternating questions and advice may be preferred.TRIAL REGISTRATION: International Standard Randomized Controlled Trial Number (ISRCTN): 91623132; http://www.controlled-trials.com/ISRCTN91623132 (Archived by WebCite at http://www.webcitation.org/6J4QdhXeG).

Resumo Limpo

ckground webbas tailor intervent provid user inform adapt individu characterist need random control trial assess effect tailor alcohol selfhelp program among adult scarc furthermor challeng develop program can hold respond attent onlin interventionsobject assess whether session webbas tailor intervent effect reduc alcohol intak highrisk adult drinker compar computertailor feedback strategi altern vs summat behavior chang dropout appreci programmethod singleblind random control trial conduct experiment group control group n germani followup took place month drink behavior health status motiv determin demograph assess among particip recruit via onlin access panel experiment group divid subgroup altern condit n tailor feedback split seri messag discuss individu topic offer respond fill program particip summat condit n receiv advic answer question actual text ident condit control group n fill questionnair identifi intervent effect logist linear regress analys conduct among complet case n use multipl imputationresult among complet case respons rate compli german nation guidelin lowrisk drink baselin respond experiment group compli month compar control group effect size ci p experiment group decreas drink per week compar drink per week control group reach statist signific effect size beta ci p intentiontotreat analys also indic statist signific effect separ analys experiment subgroup show differ intervent effect dropout rate first visit intervent websit signific lower altern condit summat condit ci p program appreci compar experiment groupsconclus complet case analys reveal webbas tailor feedback can effect way reduc alcohol intak among adult howev effect confirm appli multipl imput indic one tailor strategi effect lower alcohol intak nevertheless lower attrit rate found first visit suggest version intervent altern question advic may preferredtri registr intern standard random control trial number isrctn httpwwwcontrolledtrialscomisrctn archiv webcit httpwwwwebcitationorgjqdhxeg

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