can stand-alone computer-based interventions reduce alcohol consumption? zarnie khadjesari (phd...
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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
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)
Why conduct this review?
•All designs of computer-based intervention
•All computer-based (on- and off-line)
•All adult populations
•Meta-analysis
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)
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
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
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
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
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
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
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
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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