Alcohol brief interventions :

1. Alcohol brief interventions: Extending the reach Professor Iain K Crombie

2. 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

3. 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

4. Mortality rates for chronic liver disease Audit Scotland, 2007

5. 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

6. Feasibility study • text message intervention • low demand on participants • computerised delivery • recruitment / retention • limitations of the intervention delivery • amount of information • opportunities for interaction • monitoring intervention delivery • non-contact intervention

7. Recruitment strategies • 2 recruitment strategies • GP registers • community outreach • Evidence-based techniques to increase recruitment • financial incentives • multiple attempts at contact • personalised approaches, assurances of confidentiality Recruitment target: 60 - Achieved 67

8. Comparing the recruitment strategies

9. Intervention development Focus groups Design team

10. Focus group findings • experience of alcohol harms widespread • increase salience • mature drinker role • recognition of social expectations • employer, partner, family • utilise discrepancy • binge drinking and mature drinker role • weekend binge drinking • tailor text messages • don’t preach

11. Causal model forbehaviour change Engage participants Increase salience of harms Address drinking discrepancy Identify benefits of reduced consumption Emphasise views of others Set goals

12. What’s the main reason U drink? It’s a Habit To feel better To have fun To cope To wash down your chips. Text me your answer! • Engagement • humour • reflection • interactivity

13. 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

14. 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

15. Responses to texts

16. Content of the responses • 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!”

17. 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

18. Revisions for the full trial • 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

19. Young women • binge drinking in social groups • high risk of harms • effectiveness of individual level intervention • group intervention • capitalise on support structure • delivered by lay peers • acceptability • low cost for roll out

20. Key feasibility issues • develop intervention • recruit and train lay peers • recruit drinking groups • fidelity of delivery • follow-up

21. Focus groups • established patterns of dinking • calculated hedonism • strong motives for drinking • fun, socialising • group encouragement to drink • marked resistance to change

22. Intervention: Looking good, feeling great • Three session tailored intervention (HAPA) • Organised around fun activities • Promoting motivation • Mocktailpreparation • Setting goals • Make-up demonstration • Action and coping plans • Relaxation/ massage

23. 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

24. 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

25. Delivering the intervention • variety of venues • hotel, cocktail bar, community centres, university • professionals • mixologist, beauty therapist, relaxation therapist • findings • 92% completed 3 sessions

26. Assessing fidelity of intervention delivery • Monitoring • recorded sessions • flipcharts collated • feedback with lay trainers • Findings • participants enthusiastic • decisional balance • advantages of less bingeing • 92% set goals to reduce consumption • no shots

27. Follow-up • very challenging • participants willing, coordination hard • multiple attempts at contact • multiple methods • findings • 86% completed follow-up

28. 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

29. Revisions for the full trial • Multi-centre • four cities • coordination and support • Over-recruit lay peers • replacements • Research assistants to organise sessions • facebook • Follow up • keep in regular contact

30. Risk of death from liver disease for men

31. 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

32. 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

33. Which men are obese?

34. Approaches • Literature review • self-image and function • weight loss groups unpopular • Stakeholder interviews • recruitment, venues • Recruitment techniques • modified from text message study • Focus groups

35. Focus groups • benefits of weight loss • lose beer belly • improved function – football with the kids • weight consequences of alcohol • makes them eat more • unaware of calories in alcohol • barriers • sociability/ enjoyment • exercise is the preferred solution

36. Intervention strategy • Face to face session • motivation • drinking above guidelines • very overweight • contribution of alcohol to weight • Text messages • encourage goal setting/ action planning • promote maintenance of reduced drinking

37. Current status • intervention developed • lay people recruited and trained • pilot intervention sessions successful • recruitment began 02/03/15

38. 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

39. Collaborators