Gabrielle Humphreys, a PhD student at the University of Liverpool, discusses findings from her recent publication, which examines behaviour change techniques used in existing online addiction interventions, and considers possible changes in practice. This paper looked at alcohol use, as well as binge eating and gambling – grouped due to their compulsive nature, social aspect, and typical acceptance in society – with results informing the development of future transdiagnostic interventions.
Background
Alcohol misuse, similarly to binge eating and gambling, is increasing in prevalence in the UK [1-3]. Due to their legality, often these behaviours are undertaken socially and are widely accessible. This leads to these addictive behaviours being normalised, and sometimes encouraged, by society. Recent data reported that 29% of adults’ alcohol consumption in the United Kingdom is hazardous [4], categorized as typically drinking over 14 units of alcohol a week. This remains to be a global problem, with 39.5% of drinkers worldwide reporting heavy episodic drinking [5].
Many individuals actively avoid seeking a formal diagnosis of their alcohol misuse, binge eating, or gambling due to negative self and social stigma [6-8]. This is despite many individuals recognizing the negative impact of these addictions on their quality of life (including their physical health, mental distress, and financial burden [9,10]). Furthermore, individuals may not seek traditional face-to-face treatments due to geographical restrictions, availability, or time constraints [11]. This has resulted in a considerable treatment gap [12], with many people in need not seeking or receiving help for their behaviour.
Online interventions have the potential to reduce this treatment gap by providing any-time accessibility. Despite promising findings, many web-based intervention assessments lack vigorous testing methods, such as randomized controlled trials (RCTs) to determine their behaviour change effectiveness [13]. Alternatively, if the effectiveness of the web-based intervention is tested, the reasons for this effectiveness, such as the behaviour change techniques (BCTs) used, may not be explored [14].
The BCT taxonomy provides an overview of methods for behaviour change and their hierarchical structure [15]. By looking at the underpinning mechanisms behind a behaviour, an appropriate BCT, or more likely, a combination of BCTs can be identified to target a behaviour effectively. Using this theory-based procedure to design an intervention means that optimum results are achieved for both the intervention users and business owners due to increased user satisfaction.
Research summary
This systematic reviewed aimed to identify existing online interventions which aim to reduce alcohol consumption, binge eating or gambling. Full searches were conducted on PsycINFO, PubMed and Scopus and a study protocol was uploaded to Open Science Framework [16]. From searches, 5,252 papers were identified. The eligibility of papers was assessed by two researchers. Studies were included if they were Randomised Control Trials or Case Control Trials which examined the behaviour change from an alcohol, binge eating or gambling intervention. Other inclusion criteria were as follows: measurements reported at baseline and immediately postintervention for the relevant behaviour change, either sufficient detail of the intervention content in the paper or a direct link to the study protocol to allow for BCTs to be coded, and research published in the past 20 years with a human-only sample. Exclusion criteria included interventions that were not entirely delivered on the web, meaning that any intervention with a face-to-face element was not eligible.
From the 45 papers which were eligible, data on participant characteristics, intervention characteristics, intervention effectiveness, and BCTs used in the intervention were extracted. BCTs were coded independently by two authors, trained using the BCT taxonomy version 1 [15]. Study quality was determined using the Office of Health Assessment and Translation (OHAT) Risk of Bias Rating Tool [17] – selected due to its use in health-related studies and RCTs. The effectiveness of an intervention was determined by a statistically significant effect (P<.05) on behaviour change in drinking, gambling, or eating. If a paper reported mixed findings regarding behaviour change effectiveness, we used the most relevant variable as an indicator of effectiveness.
Five frequency counts were performed to identify popular BCTs – all papers identified as eligible; effective only papers; high quality papers only (with the advised score of over 70% on OHAT); papers that meet a higher threshold score of over 80% on OHAT; and over 70% and OHAT and effective. These frequency counts revealed seven BCTs which can be recommend for future addiction interventions. These were problem solving, feedback on behaviour, self-monitoring of behaviour, self-monitoring of outcomes of behaviour, instruction on how to perform the behaviour, information about social and environmental consequences, and social comparison.
Four BCTs were present in all frequency counts: feedback on behaviour, self-monitoring of behaviour, instruction on how to perform a behaviour, and social comparison. Self-monitoring of outcomes of behaviour was found in three of the five frequency counts, problem solving was found in two, and information about social and health consequences was found in one frequency count.
Implications
These seven BCTs can inform the future development of online, transdiagnostic addiction interventions. It can be presumed that these BCTs were included because of their relevance to addictive behaviour change, rather than purely from theoretical findings, as many interventions do not prioritise theory or follow a scientific procedure when designing programs [18]. This means these recommendations can be adopted into practice with ease.
This paper also highlights the importance of using evidence-based theory while developing behaviour change interventions, which many treatments lack. Theory-based interventions are not only more likely to result in effective behaviour change [19], but also allow a richer evaluation of interventions, enabling one to identify the active components of behaviour change [18]. Ultimately, the consideration of behaviour change theory and the testing of BCT effectiveness during the early stages of design means that addiction-based interventions will result in greater, long-lasting behaviour change [20]. Future research should adopt the experimental medicine approach [21,22] to examine whether these BCTs are present in interventions, as well as identifying which are the active mechanism of behaviour change.
By Gabby Humphreys (@GabbyHumphreys)
This systematic review, ‘Identification of Behaviour Change Techniques from Successful Web-based Interventions Targeting Alcohol Consumption, Binge Eating, and Gambling: Systematic Review” has been published in the Journal of Medical Internet Research.
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