Background
Methods
Study design
Overview of the Drinkaware app
App Feature | Behaviour Change Technique [21] |
---|---|
Recording the number of alcoholic drinks consumed per day | Self-monitoring of behaviour |
Feedback of the number of alcoholic drinks consumed and associated risk level | Feedback on behaviour |
Information about health consequences | |
Feedback of the cost and calorie equivalent of alcoholic drinks consumed | Feedback on outcomes of behaviour |
Setting goals to reduce alcohol consumption (e.g. no drink day, drink within guidelines, drink one less) | Goal setting (behaviour) |
Action Planning | |
Identification of drinking “weak spots” based on geolocation | Avoidance/ reducing exposure to cues for behaviour |
Reductions in alcohol consumption are awarded via notifications | Social reward |
Quantitative phase
Data collection
Data analysis
Higher risk: consumption of more than twice the upper limit of the lower risk daily guidelines (6 units for women, 8 units for men), on four or more occasions within 1 week. Alternatively, consumption of more than 50 units within 1 week for a man, or more than 35 units within 1 week for a woman, regardless of the regularity of drinking |
Increasing risk: consumption of more than the upper limit of the lower risk daily guidelines (3 units for women, 4 units for men), on four or more occasions during the week. Alternatively, consumption of more than 21 units within 1 week for a man, or more than 14 units within 1 week for a woman, regardless of the regularity of drinking. |
Lower risk: consumption of more than the upper limit of the lower risk daily guidelines (3 units for women, 4 units for men), on no more than three occasions during the week. Alternatively, consumption of no more than 21 units within 1 week for a man, or no more than 14 within 1 week units for a woman, regardless of the regularity of drinking. |
Qualitative phase
Recruitment
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Aged between 18 to 65 years
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Resident in the UK
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Able to consent to and complete a telephone interview in English.
Materials
Analysis
Results
Quantitative findings
User demographic characteristics, motivations to download the app and baseline drinking data
Pattern of app use
Drinking behaviour over time
Exploring determinants of drinking behaviour over 4 weeks in engaged users
Qualitative findings
Participant characteristics
Interviewee Identifier | Gender | Age bracket (years) | Risk profile | Motivation for downloading the app |
---|---|---|---|---|
A1 | Female | 25–44 | Low risk | To reduce drinking |
A2 | Female | 45–60 | High risk | No information |
B1 | Male | 45–60 | High risk | To reduce drinking |
B2 | Female | 25–44 | Low risk | To be healthier |
C1 | Male | 61–64 | Low risk | To reduce drinking |
C2 | Female | 45–60 | High risk | To lose weight |
C3 | Female | 25–44 | High risk | To be healthier |
C4 | Female | 45–60 | Low risk | Just curious |
C5 | Female | 25–44 | Low risk | To be healthier |
C6 | Female | 45–60 | High risk | To reduce drinking |
C7 | Female | 45–60 | High risk | Just curious |
C8 | Female | 25–44 | Low risk | To be healthier |
C9 | Male | 25–44 | Low risk | To reduce drinking |
C10 | Female | 17–24 | High risk | To reduce drinking |
C11 | Male | 25–44 | High risk | To reduce drinking |
C12 | Male | 45–60 | High risk | Just curious |
C13 | Male | 25–44 | High risk | To reduce drinking |
C14 | Female | 45–60 | High risk | Just curious |
C15 | Male | 25–44 | High risk | No information |
C16 | Male | 25–44 | Low risk | Just curious |
C17 | Male | 17–24 | High risk | To reduce drinking |
Getting started with the app
The on-boarding process
“But initially, I thought, this is quite a strange thing to do. And I was thinking back to my week, and thinking, oh God, I can’t remember. I was just throwing some random figures and drinks in there, that I thought were roughly accurate, but I wasn’t completely sure.” (C10)
Motivations for downloading the app
“It was health reasons, there wasn’t really any one, just one thing, it was a series of things….it’s says it’s no good for your health and then if you don’t have good health then it affects your appearance” (C9)
“I’m not sure if this is sort of a usual thing to download it for, but as well as sort of improving just my physical wellbeing, it was also an experiment for me, to see if it affected my mental wellbeing as well. So the whole reason I actually downloaded it, is because I thought, I wondered if certain difficulties I was experiencing at the time, were linked to excessive drinking. So it was actually more for the mental wellbeing, than the physical wellbeing” (C10)
Patterns of app usage
Self-monitoring alcohol consumption
“I do it daily most of the time. If I haven’t done it for a few days then I will go back and add it in retrospectively. I’m not in a particular routine with it I would say. I don’t know 80 per cent of the time I do it daily but then I might forget for a few days and just go back and do it”. (C8)
“I’d use it in the evening after…like bedtime sort of time”. (B2)
“Because, I’ve got a couple of other little apps that I look at on a daily, not all apps, but a little regime of four or five, you know, I check the weather and I look at my drink app, and various things like that, a little routine, so pretty much daily” (B1)
“When I say every day, I tend to fill them in the next day. If I’m out having a drink in the pub, I don’t sit there and each time put it into the app. Either when I come home, depending on the time like. If it was after say, midnight, then you’d have to go back a day so I would leave it ‘til the following morning” (C12)
“But often on the heavier nights, I have to guess because I don’t always do it when I’m out. So when I go to the pub or sometimes when I’m not having very many, I can easily remember so I’ll either do it at the time or after. But to be honest, when I’ve had more, I’m guessing roughly at how much I’ve had”. (C17)
“And I think…..even when I stopped all together, there was something still really…something to be said for still logging that, even though I was looking at a whole month and it would just be all green, and it would be like nothing, nothing, nothing, nothing, it was still quite satisfying to log that somewhere, if that makes sense….And then you’ve got somewhere to actually log that and you’ve got something that shows you the progress that you’ve made. And so that’s really, really helpful, and it’s sort of a little motivator for yourself (C10)
App feature usage
Goal setting feature experience
“To an extent I was already doing it, because…I don’t know why, I just was, I thought, right, okay, you can’t drink on a school night, obviously” (C2)
“… if I happened to have had no drinks on a day that I didn’t set as a no drink day and then it kind of racks up that way, I swear it [the app] gets confused sometimes. My goal is to not drink Monday to Thursday, but say I didn’t drink Sunday to Wednesday I think sometimes it goes, oh yes, congratulations, you’ve met your goal and I’m a bit unclear whether I have or not.” (C8)
“I felt that I probably couldn’t really pick a day when I’d drunk one less or I thought that would be really easy to do because I don’t drink a set amount on a certain day. I don’t like go to the pub on a certain day and think, right, I’ll have three pints today so this time I’ll just have two instead.” (C17)
“I only set one goal because I was very keen to kind of remain focused on one thing. I didn’t want to come and get lost in the app using it like a game. You know, I wanted to use it for one very specific thing.....I think I set it to drink probably within guidelines.” (C13)
“No, it didn’t appeal - probably because I thought if I put some goals in I’m probably not going to stick to it, which probably makes me sound a bit naughty.” (C7)
“Weak spot” feature experience
“It doesn’t really work for me…There’s not really any one place where I would go to consume alcohol. (C8)
“I think the weak spot is more not a physical place, the weak spot is because you suddenly think, oh god, I’ll go and have a drink.....Yes, your general circumstances are much more accurate, or much more relevant.” (B1)
“Yes. I did. I set up a few. I’m just wondering if it was meant to give me a notification, but I don’t recall ever getting one.” (C10)
Feedback and notifications from the Drinkaware app
“I like the numbers. I like to track stuff and have some figures behind it rather than just like, oh, I’ll go for a run today. I’ll be like, well, I’ll go for a run today but what’s my time from last time and how can I beat it? And I think that’s why this kind of app appeals to me. If I just put the drinks in and it just said you’re drinking too much but didn’t give any numbers behind it, I’d probably delete it within a few days”. (C17)
“I guess because you were filling out a diary it’s a bit more passive and the fact is that when you enter your figures on the Drinkaware app that first notification and ongoing notifications made you more aware of what you were doing and you are more inclined to do something about it”. (C13)
Type of feedback received
“The most surprising thing actually was the amount of calories……the calories was something I hadn’t expected, so I think when I’ve looked back on it, that’s probably been quite useful to see.... You know, if you think about having a massive pizza that might be a 1,000 calories, I’d think twice about eating a really big pizza. But having ten pints in any night, I would link it to be unhealthy and costly and feeling a bit bad the next day, but I wouldn’t have thought before that it was also calorific. (C17)
“…it just feels a bit too generic. Whereas with the MyFitnessPal it’s very much, you know, one can of Carling you know you’re going to consume, you know, 210 calories and that’s it for Carling. If you drink Carlsberg it could be 220 or, you know”. (C5)
“I think putting things in terms of money. So when it works out how much you’ve saved. I think that means a lot to people and that could really hit home as well.” (C9)
“The cost for me personally isn’t so much of a driver; it’s much more just about bringing down the level of drinking and about my health as opposed to what I’m spending”. (C11)
“I probably had it switched off, I tend to switch notifications off.” (B1)
“I think because they were just pinging… and I was just thinking, I don’t really want to read this right now. Obviously, and I don’t know whether they do but I guess most people check their phone when something pings in and you can be with your friends and actually maybe you wouldn’t want to be saying to your friends, I’ve just got a notification from Drinkaware”. (C14)
Perceived effectiveness of the Drinkaware app
“Because, just like the name of it, Drinkaware, it made me aware of my alcohol intake….rather than sat there with a calculator, which is really boring, nobody wants to do it, all you have to do is write, large glass of wine, boom boom, you’ve got all your statistics there”. (C9)
“Well, I guess like all these things, I was hoping that it would change my behaviour. I think in reality it just made me more thoughtful about how much I’m drinking, which is probably a good thing”. (C17)
“So what I’ve learnt about my drinking habits is that probably I can do 5 days a week and not drink but on a Friday or a Saturday or a Saturday and a Sunday then I’ll drink more, so I might have half a bottle of wine on a Saturday and half a bottle of wine on a Sunday, but that almost puts me into, well it puts me into a red; it puts me in towards binge drinking”. (C14)
“I attribute a lot of it [reduction in drinking] to the app I guess because it’s a tool isn’t it? I mean obviously I wouldn’t have achieved it without the wish to do something as well personally, the drive to cut down my drinking, but I think that app is a great tool to help you achieve that”. (C11)
“It’s very, very easy to just slip back into how you were before or to just, yeah, go on, I’ll just have a another, and things like that. And so it’s nice to have something completely external from that, that sort of just keeps you on track. (C10)
“No, no [app has not changed drinking]….having found that I am not drinking to excess or to a bad problematic level, it’s been quite reassuring to know the amount I’m drinking is you might say fine, so I haven’t had to change anything”. (C16)
“To be honest, in a way, I think it’s probably made things worse, because while I might have been interested in pursuing a programme, like, you know, following that and trying to do something about it, it’s just forced me to go off the app, delete it, and forget all about the idea. Do you know what I mean? So, I might even be worse off after the app, rather than better off”. (B1)
Recommendations for improvements to the Drinkaware app
“Maybe a graph of the whole 28 days, might be a really good overview.....so you can see if it’s gone down, if it’s gone up across the month, where maybe at what point in the month it goes up and down, and then, yeah, that might be quite helpful”. (C10)
“It might give you a real big overview, say if you’ve been doing it for a year, it might give you a whole overview of how you’ve done in that year and how much you’ve saved, and how much…things like that. That might be quite helpful, to really look at it quite broadly.” (C10)
“Because it’s almost like you expect it to be kind of saved on a…because I’ve got the same email address and the same everything…I just literally swapped the device. So I was quite surprised to sort of lose all that. When you’ve done well that was quite gutting.” (C3)
“Yeah, not just generically saying you shouldn’t drink because in the long-term it’s bad for you. It’s like, well, tell me something I don’t know. But if it was personalised and said, this is the long-term effect. I mean, I would even go as far as… I know some people wouldn’t like it but I’d even go as far as saying, if you drink this amount, the risk to your health is like minus 3 years off your life.” (C17)
“…but the education side, how do you try and get out of the yellow [indicating ‘increasing risk’]. Like what ways can you actually…how can you change your behaviour rather than just see that you’re in the yellow.” (C5)