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Can stand-alone computer-based interventions reduce alcohol consumption?
Zarnie Khadjesari (PhD student)Elizabeth Murray (Director e-Health Unit)
e-Health Unit, University College London
Christine Godfrey (Head of Department)Catherine Hewitt (Research Fellow)
Dept. Health Sciences, University of York
Suzanne Hartley (Senior Trial Coordinator)CTRU, University of Leeds
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Background
•Alcohol misuse is a major public health concern
•Gap between need and access •Internet interventions
– Convenient, confidential, and comparatively low cost– Scalability and personalised approach
•Recent reviews– Elliot 2008 (computer-based interventions for college drinkers)– Bewick 2008 (Internet interventions)– Riper 2009 (personalised feedback interventions – any modality)
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Why conduct this review?
•All designs of computer-based intervention
•All computer-based (on- and off-line)
•All adult populations
•Meta-analysis
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Aim
• To determine the effectiveness of computer-based interventions aimed at reducing alcohol consumption
• Computer-based interventions compared with either:
i. Minimally active comparator (e.g. assessment-only, information-only website)
ii. Active comparator (e.g. face-to-face motivational interview)
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Inclusion criteria
• Study design: RCT• Population: Adults (excl. dependent drinkers)• Intervention:
– Computer-based interventions aimed at reducing alcohol intake– Definition: behavioural interventions, adapted for computer– Stand-alone: no expert facilitation
• Outcome: Alcohol consumption– Grams per week– Frequency of binges / week
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Search results
Databases searched from inception – end 2008
MedlineEmbaseWeb of ScienceCochrane LibraryPsycINFOCinahlERICISI ProceedingsIBSSIndex to Theses
10 databases searched 8,084 references
Excluded7,930
Full paper ordered
154
Excluded119
Included publications
36
Individual studies
23
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Characteristics of included studies (1)
Year published
1997 = 1; 2004 = 4; 2005 = 3; 2006 = 3; 2007 = 7; 2008 = 5.
Country US = 17; NZ = 3; Netherlands = 1; Germany = 1; UK = 1.
Population •Students = 17 •Problem drinkers from general population = 3•Workplace employees = 2•Emergency department attendees = 1
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Characteristics of included studies (2)
Screening •At-risk drinkers = 10•Any drinkers = 6•No-screen = 7
Intervention approach
•Personalised feedback•Harm-prevention / skills training•Expectancy challenge•Self-control / CBT / motivational enhancement
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Characteristics of included studies (3)
Comparator Minimally active comparator = 21 Active comparator = 3
Outcome Grams per week = 18Frequency of binges (days or occasions / week) = 8
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Results
Comparison: minimally active comparator (n=2,425)Outcome: g/wk
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Sub-group analysis - population
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Results
Comparison: minimally active comparator (n=848)Outcome: binge frequency / wk
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Results
Comparison: active comparator (n=457)Outcome: g/wk
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Further analyses
• Skewed data
• Baseline risk
• Loss to follow-up
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Summary of findings
• Computer-based interventions appear:– more effective than minimally active comparator– as effective as alternative treatment approaches
• Findings support continued development and evaluation of computer-based interventions for reducing alcohol intake
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Limitations of this review
• Restricted to stand-alone interventions
• Different types of computer-based interventions
• Two measures of alcohol consumption
• Mediators of drinking outcomes, s/a motivation, normative perceptions.
• Dose response
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Gaps in the literature
• Few comparisons with conventional approaches
• Few studies in non-student adult populations
• Few studies outside the US
• Few studies measuring long-term effectiveness
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Thank you for listeningQuestions, comments, suggestions?