Identification of Behavior Change Techniques and Engagement Strategies to Design a Smartphone App to Reduce Alcohol Consumption Using a Formal Consensus Method

Background: Digital interventions to reduce excessive alcohol consumption have the potential to have a broader reach and be more cost-effective than traditional brief interventions. However, there is not yet strong evidence for their ability to engage users or their effectiveness. Objective: This study aimed to identify the behavior change techniques (BCTs) and engagement strategies most worthy of further study by inclusion in a smartphone app to reduce alcohol consumption, using formal expert consensus methods. Methods: The first phase of the study consisted of a Delphi exercise with three rounds. It was conducted with 7 international experts in the field of alcohol and/or behavior change. In the first round, experts identified BCTs most likely to be effective at reducing alcohol consumption and strategies most likely to engage users with an app; these were rated in the second round; and those rated as effective by at least four out of seven participants were ranked in the third round. The rankings were analyzed using Kendall's W coefficient of concordance, which indicates consensus between participants. The second phase consisted of a new, independent group of experts (n=43) ranking the BCTs that were identified in the first phase. The correlation between the rankings of the two groups was assessed using Spearman's rank correlation coefficient. Results: Twelve BCTs were identified as likely to be effective. There was moderate agreement among the experts over their ranking (W=.465, chi(2)(11)=35.8, P<.001) and the BCTs receiving the highest mean rankings were self-monitoring, goal-setting, action planning, and feedback in relation to goals. There was a significant correlation between the ranking of the BCTs by the group of experts who identified them and a second independent group of experts (Spearman's rho=.690, P=.01). Seventeen responses were generated for strategies likely to engage users. There was moderate agreement among experts on the ranking of these engagement strategies (W=.563, chi(2)(15)=59.2, P<.001) and those with the highest mean rankings were ease of use, design aesthetic, feedback, function, design-ability to change design to suit own preferences, tailored information, and unique smartphone features. Conclusions: The BCTs with greatest potential to include in a smartphone app to reduce alcohol consumption were judged by experts to be self-monitoring, goal-setting, action planning, and feedback in relation to goals. The strategies most likely to engage users were ease of use, design, tailoring of design and information, and unique smartphone features.