Journal
ANNALS OF BEHAVIORAL MEDICINE
Volume 52, Issue 6, Pages 530-543Publisher
OXFORD UNIV PRESS INC
DOI: 10.1093/abm/kax029
Keywords
Behavior change techniques; Alcohol; Drinking; Digital interventions; Meta-regression; Systematic review
Categories
Funding
- NIHR School for Public Health Research (SPHR)
- National Institute for Health Research's School for Public Health Research
- CRUK [C1417/A22962, C1417/A14135]
- UK Centre for Tobacco and Alcohol Studies
- UKCRC Public Health Research Centre of Excellence
- Medical Research Council
- British Heart Foundation
- Cancer Research UK
- Economic and Social Research Council
- National Institute for Health Research under the UK Clinical Research Collaboration
- Society for the Study of Addiction
- Cancer Research UK [22962] Funding Source: researchfish
- Medical Research Council [MR/K023233/1, MR/L022206/1, G0802736, MR/K023195/1, G0800612, MR/K02325X/1] Funding Source: researchfish
- National Institute for Health Research [NF-SI-0515-10023, NF-SI-0617-10014] Funding Source: researchfish
- MRC [G0802736, MR/K023233/1, G0800612, MR/L022206/1] Funding Source: UKRI
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Background Digital behavior change interventions (DBCIs) appear to reduce alcohol consumption, but greater understanding is needed of their mechanisms of action. Purpose To describe the behavior change techniques (BCTs) used in DBCIs and examine whether individual BCTs, the inclusion of more BCTs or more Control Theory congruent BCTs is associated with increased effectiveness. Methods Forty-one randomized control trials were extracted from a Cochrane review of alcohol reduction DBCIs and coded for up to 93 BCTs using an established and reliable method. Random effects unadjusted and adjusted meta-regression models were performed to assess associations between BCTs and intervention effectiveness. Results Interventions used a mean of 9.1 BCTs (range 1-22), 23 different BCTs were used in four or more trials. Trials that used Behavior substitution (-95.112 grams per week [gpw], 95% CI: -162.90, -27.34), Problem solving (-45.92 gpw, 95% CI: -90.97, -0.87) and Credible source (-32.09 gpw, 95% CI: -60.64, -3.55) were significantly associated with greater alcohol reduction than trials without these BCTs. The Behavior substitution result should be treated as preliminary because it was reported in only four trials, three of which were conducted by the same research group. Feedback was used in 98% of trials (n = 41); other Control Theory congruent BCTs were used less frequently: for example, Goal setting 43% (n = 18) and Self-monitoring 29%, (n = 12). Conclusions Behavior substitution, Problem solving, and Credible source were associated with greater alcohol reduction. Many BCTs were used infrequently in DBCIs, including BCTs with evidence of effectiveness in other domains, such as Self-monitoring and Goal setting.
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