Design, implementation and evaluation of a web-based computer-tailored intervention to prevent binge drinking in adolescents: study protocol

Marta Lima-Serrano, José Manuel Martínez-Montilla, Joaquín S Lima-Rodríguez, Liesbeth Mercken, Hein de Vries, Marta Lima-Serrano, José Manuel Martínez-Montilla, Joaquín S Lima-Rodríguez, Liesbeth Mercken, Hein de Vries

Abstract

Background: Binge-drinking in adolescents is a highly prevalent healthcare problem that associates physical and mental health complications with community implications. This paper describes the design, implementation and evaluation of the first web-based computer tailored intervention aimed at the prevention of binge drinking in Spanish adolescents.

Methods: The Alerta Alcohol program is based on the I-Change Model. First, feedback from focus and Delphi groups are used for cultural adaptation and to obtain further information on the items to be included on the program. A pilot study is then conducted to assess feasibility and to identify strengths and weaknesses. Second, a Cluster Randomized Controlled Trial is conducted to test the effectiveness of Alerta Alcohol in students aged 16 to 18 years. The study is performed in 16 high schools from Andalusia (southern Spain), which are randomized either to the experimental or the control condition (EC and CC). The EC receives the Alerta Alcohol intervention, which consists of four sessions at school (baseline questionnaire, two sessions in three scenarios: at home, celebrations, and public places, and a final evaluation). The adolescents are provided with answers related to their views of each scenario; this information is used to provide highly specific feedback regarding their knowledge, risk perception, self-esteem, attitude, social influence, and self-efficacy. In addition, two booster sessions are given at home to reinforce the previous messages. The CC just completes the baseline and the final evaluation questionnaires and then they are allowed to receive the intervention as well (as a waiting list). Evaluation takes place after four months. The primary endpoint is binge drinking within 30 days prior to the evaluation and alcohol use in the previous week. It is expected that Alerta Alcohol reduce the prevalence of binge drinking by 10%. Follow up analyses are carried out to determine the differences in effectiveness according to the compliance of the program (quality of the implementation).

Discussion: The results are expected to be applicable and may incorporate improvements in the practice of the Healthcare and Education Systems. If the program proves to be effective, regional and eventual national implementation should be considered.

Trial registration: Trial registration number (ClinicalTrials.gov): NCT03288896 . This study was retrospectively registered on 19/09/2017.

Keywords: Adolescence; Alcohol drinking; Binge drinking; Computer-tailoring; I-change model; Web-based interventions.

Conflict of interest statement

Ethics approval and consent to participate

The study has the approval of the Bioethical Committee of Andalusia (Spain). Trial registration number (ClinicalTrials.gov): NCT03288896. This study was retrospectively registered on 19/09/2017.

Consent for publication

Not applicable

Competing interests

Hein de Vries is scientific director of Vision2Health, a company that licenses evidence-based innovative computer-tailored health communication tools. No other authors reported any conflicts of interest.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
I-Change model. (Figure obtained from De Vries, Lezwijn, et al., [12])
Fig. 2
Fig. 2
Flowchart of the intervention. * It takes place in the school environment. ** It takes place in the participant’s home
Fig. 3
Fig. 3
ALERTA ALCOHOL: study timeline
Fig. 4
Fig. 4
Description of the intervention routings

References

    1. World Health Organization . Global status report on alcohol and health. Geneva: Editorial WHO; 2011.
    1. Chestnov O. Foreword. En: World Health Organization, editors. Global status report on alcohol and health. Geneva: Editorial World Health Organization; 2014. p. VII-VIII.
    1. Farke W, Anderson P. Binge Drinking in Europe. Adicciones. 2007;19(4):333–340. doi: 10.20882/adicciones.293.
    1. Espada JP, Griffin KW, Pereira JR, Orgilés M, García-Fernández JM. Component analysis of a school-based substance use prevention program in Spain: contributions of problem solving and social skills training content. Prev Sci. 2012;13:86–95. doi: 10.1007/s11121-011-0249-y.
    1. Parada M, Corral M, Caamaño-Isorna F, Mota N, Crego A, Rodríguez S, et al. Definition of adolescent binge drinking. Adicciones. 2011;23(1):53–63. doi: 10.20882/adicciones.167.
    1. Calafat A. El abuso de alcohol de los jóvenes en España. Adicciones. 2007;19(3):217–224. doi: 10.20882/adicciones.302.
    1. . Alcohol Facts and Statistics | National Institute on Alcohol Abuse and Alcoholism (NIAAA). 2015. . Accessed 14 May 2016.
    1. Delegación del gobierno para el Plan Estatal sobre Drogas, Ministerio de Sanidad, Servicios Sociales e Igualdad. Encuesta estatal sobre uso de drogas en enseñanzas secundarias (ESTUDES). Madrid: Ministerio de Sanidad, Servicios Sociales e Igualdad; 2016. . Accessed 25 Feb 2017.
    1. De Vries H, Mudde AN. Predicting stage transitions for smoking cessation applying the attitude-social influence-efficacy model. Psychol Health. 1998;13(2):369–385. doi: 10.1080/08870449808406757.
    1. De Vries H. An integrated approach for understanding health behavior; the I-change model as an example. Psychol Behav Sci Int J. 2017;2(2) 10.19080/PBSIJ.2017.02.555585.
    1. De Vries H, Mesters I, Van de Steeg H, Honing C. The general public’s information needs and perceptions regarding hereditary cancer: an application of the integrated change model. Patient Educ Couns. 2005;56(2):154–165. doi: 10.1016/j.pec.2004.01.002.
    1. De Vries H, Lezwijn J, Hol M, Honing C. Skin cancer prevention: behavior and motives of Dutch adolescents. Eur J Cancer Prev. 2005;14(1):39–50. doi: 10.1097/00008469-200502000-00006.
    1. Jander A, Mercken L, Crutzen R, de Vries H. Determinants of binge drinking in a permissive environment: focus group interviews with Dutch adolescents and parents. BMC Public Health. 2013;13(882) 10.1186/1471-2458-13-882.
    1. Schulz DN, Candel MJ, Kremers SP, Reinwand DA, Jander A y de Vries H. Effects of a web-based tailored intervention to reduce alcohol consumption in adults: randomized controlled trial. J Med Internet Res 2013;15(9): e206. doi: 10.2196/jmir.2568.
    1. Van der Wulp NY, Hoving C, Eijmael K, Candel MJ, van Dalen W, De Vries H. Reducing alcohol use during pregnancy via health counseling by midwives and internet-based computer-tailored feedback: a cluster randomized trial. J Med Internet Res. 2014;16(12):e274. doi: 10.2196/jmir.3493.
    1. Van Lettow B, de Vries H, Burdorf A, Boon B, van Empelen P. Drinker prototype alteration and cue reminders as strategies in a tailored web-based intervention reducing adults’ alcohol consumption: randomized controlled trial. J Med Internet Res. 2015;17(2):e35. doi: 10.2196/jmir.3551.
    1. Drost RM, Paulus AT, Jander AF, Mercken L, de Vries H, Ruwaard D, Evers SM. A web-based computer-tailored alcohol prevention program for adolescents: cost-effectiveness and intersectoral costs and benefits. J Med Internet Res. 2016;18(4):e93. doi: 10.2196/jmir.5223.
    1. de Vries H, Mudde A, Leijs I, Charlton A, Vartiainen E, Buijs G, et al. The European smoking prevention framework approach (ESFA): an example of integral prevention. Health Educ Res. 2003;18(5):611–626. doi: 10.1093/her/cyg031.
    1. Walthouwer MJL, Oenema A, Candel M, Lechner L, de Vries H. Eating in moderation and the essential role of awareness. A Dutch longitudinal study identifying psychosocial predictors. Appetite. 2015;87:152–159. doi: 10.1016/j.appet.2014.12.214.
    1. Richter M, Leppin A, Gabhainn SN. The relationship between parental socio-economic status and episodes of drunkenness among adolescents: findings from a cross-national survey. BMC Public Health. 2006;6(289) 10.1186/1471-2458-6-289.
    1. Donath C, Gräßel E, Baier D, Pfeiffer C, Karagülle D, Bleich S, et al. Alcohol consumption and binge drinking in adolescents: comparison of different migration backgrounds and rural vs. urban residence-a representative study. BMC Public Health. 2011;11(84) 10.1186/1471-2458-11-84.
    1. Cremers HP, Mercken L, Oenema A, de Vries H. A web-based computer-tailored smoking prevention programme for primary school children: intervention design and study protocol. BMC Public Health. 2012;12:277. doi: 10.1186/1471-2458-12-277.
    1. Instituto Nacional sobre el Abuso de Drogas . Una guía con base científica para padres, educadores y líderes de la comunidad. 2. Bethesda, Maryland: NIDA; 2004. Cómo Prevenir el Uso de Drogas en los Niños y los Adolescentes.
    1. Lima-Serrano M, Lima-Rodríguez JS. Impact of school-based health promotion interventions aimed at different behavioral domains: a systematic review. Gac Sanit. 2014;25(5):411–417. doi: 10.1016/j.gaceta.2014.05.003.
    1. Pearson M, Chilton R, Wyatt K, Abraham C, Ford T, Woods HB, et al. Implementing health promotion programmes in schools: a realist systematic review of research and experience in the United Kingdom. Implement Sci. 2015;10:149. doi: 10.1186/s13012-015-0338-6.
    1. De la Villa Moral M, Rodriguez FJ, Ovejero A, Sirvent C. Attitudinal changes and reduction of alcohol use in adolescents following a psychosocial intervention program. Adicciones. 2009;21(3):207–220. doi: 10.20882/adicciones.231.
    1. Jander A, Crutzen R, Mercken L, de Vries H. Web-based computer-tailored game to reduce binge drinking among 16 to 18 year old Dutch adolescents: development and study protocol. BMC Public Health. 2014;14:1054. doi: 10.1186/1471-2458-14-1054.
    1. Jander A, Crutzen R, Mercken L, Candel M, de Vries H. Effects of a web-based computer-tailored game to reduce binge drinking among Dutch adolescents: a cluster randomized controlled trial. J Med Internet Res. 2016;18(2):e29. doi: 10.2196/jmir.4708.
    1. Stanczyk N, Bolman C, Adrichem M v, Candel M, Muris J, Vries H d. Comparison of text and video computer-tailored interventions for smoking cessation: randomized controlled trial. J Med Internet Res. 2014;16(3):e69. doi: 10.2196/jmir.3016.
    1. Krebs P, Prochaska JO, Rossi JS. A meta-analysis of computer-tailored interventions for health behavior change. Prev Med. 2010;51(3–4):214–221. doi: 10.1016/j.ypmed.2010.06.004.
    1. Lustria MLA, Cortese J, Noar SM, Glueckauf RL. Computer-tailored health interventions delivered over the web: review and analysis of key components. Patient Educ Couns. 2009;74:156–173. doi: 10.1016/j.pec.2008.08.023.
    1. De Bourdeaudhuij I, Maes L, De Henauw S, De Vriendt T, HELENA Study Group et al. Evaluation of a computer-tailored physical activity intervention in adolescents in six European countries. J Adolesc Health. 2010;46(5):458–466. doi: 10.1016/j.jadohealth.2009.10.006.
    1. Elfeddali I, Bolman C, Candel MJ, Wiers RW, De Vries H. Preventing smoking relapse via web-based computer tailored feedback in the SQ4U-study: a randomized controlled trial. J Med Internet Res. 2012;14(4):e109. doi: 10.2196/jmir.2057.
    1. Schulz DN, Smit ES, Stanczyk NE, Kremers SP, de Vries H, Evers SM. Economic evaluation of a web-based tailored lifestyle intervention for adults: findings regarding cost-effectiveness and cost-utility from a randomized controlled trial. J Med Internet Res. 2014;16(3):e91. doi: 10.2196/jmir.3159.
    1. Boudreau F, Walthouwer MJL, de Vries H, Dagenais GR, Turbide G, Bourlaud AS, et al. Rationale, design and baseline characteristics of a randomized controlled trial of a webbased computer-tailored physical activity intervention for adults from Quebec City. BMC Public Health. 2015;15:1038. doi: 10.1186/s12889-015-2364-3.
    1. De Josselin de Jong S, Candel M, Segaar D, Cremers HP, de Vries H. Efficacy of a web-based computer-tailored smoking prevention intervention for Dutch adolescents: randomized controlled trial. J Med Internet Res. 2014;16(3):e82. doi: 10.2196/jmir.2469.
    1. Walton MA, Chermack ST, Shope JT, Bingham CR, Zimmerman MA, et al. Effects of a brief intervention for reducing violence and alcohol misuse among adolescents: a randomized controlled trial. JAMA. 2010;304(5):527–535. doi: 10.1001/jama.2010.1066.
    1. Bannink R, Broere S, Joosten-Van Zwanenburg E, Van As E, et al. Effectiveness of a web-based tailored intervention (E-health4Uth) and consultation to promote adolescents’ health. J Med Internet Res. 2014;16(5):e143. doi: 10.2196/jmir.3163.
    1. Moher D, Schulz KF, Altman DG. The CONSORT statement: revised recommendations for improving the quality of reports of parallel group randomized trials. BMC Med Res Methodol. 2001;1(2) 10.1186/1471-2288-1-2.
    1. Cortese J, Lustria MLA. Can tailoring increase elaboration of health messages delivered via an adaptive educational site on adolescent sexual health and decision making? J Am Soc Inf Sci Technol. 2012;63(8):1567–1580. doi: 10.1002/asi.22700.
    1. Bandura A. Social foundations of thought and action: a social cognitive theory. New York: Prentice Hall; 1986.
    1. De Vries H, Brug J. Computer-tailored interventions motivating people to adopt health promoting behaviours: introduction to a new approach. Patient Educ Couns. 1999;36:99–105. doi: 10.1016/S0738-3991(98)00127-X.
    1. Kleinjan M, Strick M, Lemmers L, Engels RC. The effectiveness of a cue-reminder intervention to reduce adolescents’ alcohol use in social contexts. Alcohol Alcohol. 2012;47(4):451–457. doi: 10.1093/alcalc/ags038.
    1. Lima-Serrano M, Vargas-Martínez AM, Gil-García E, Martínez-Montilla JM, Lima-Rodríguez JS, De Vries H. Adaptación y validación al español de cinco escalas para evaluar los determinantes del consumo de alcohol en adolescentes. An Sist Sanit Navar. 2017; IN PRESS
    1. Currie C, Molcho M, Boyce W, Holstein B, Torsheim T, Richter M. Researching health inequalities in adolescent: the development of the health behavior in school-aged children (HBSC) family affluence scale. Soc Sci Med. 2008;66(6):1429–1436. doi: 10.1016/j.socscimed.2007.11.024.
    1. Lima-Serrano M, Martínez-Montilla JM, Guerra-Martín MD, Vargas-Martínez AM, Lima-Rodríguez JS. Quality-of-life-related factors in adolescents. Gac Sanit. 2016; 10.1016/j.gaceta.2016.06.016.
    1. De la Villa M, Rodríguez FJ, Ovejero A. Correlatos psicosociales del consumo de sustancias psicoactivas en adolescentes españoles. Salud Pública Méx. 2010;52(5):406–415. doi: 10.1590/S0036-36342010000500008.
    1. Durlak JA, DuPre EP. Implementation matters: a review of research on the influence of implementation on program outcomes and the factors affecting implementation. Am J Community Psychol. 2008;41:327–350. doi: 10.1007/s10464-008-9165-0.
    1. De Vries H, Logister M, Krekels G, Klaasse F, Servranckx V, Van Osch L. Internet-based computer tailored feedback on sunscreen use. J Med Intern Res. 2012;14(2):e48. 10.2196/jmir.1902.
    1. Jander AF. Alcohol Alert. The development and evaluation of a Web-based computer-tailored game to reduce binge drinking among adolescents. [Tesis]. Maastricht (The Netherlands): Maastricht Univ.; 2016.
    1. Prochaska JO, Redding CA, Evers KE. The Transtheoretical model and stages of change. In: Glan BKRK, Viswanath K, editors. Health behavior and health education: theory, research, and practice. 4ª. San Francisco: Jossey-Bass; 2008. pp. 97–121.
    1. Richardson CG, Kwon JY, Ratner PA. Self-esteem and the initiation of substance use among adolescents. Can J Public Health. 2013;104(1):e60–e63.
    1. Rodríguez C, Caño A. Self-esteem in adolescence: analysis and intervention strategies. IJP&PT. 2012;12(3):389–403.

Source: PubMed

Sponsorer och medarbetare

Medicinska tillstånd

Läkemedelsinterventioner

3
Prenumerera