JMIR Publications

ABSTRACT

Background:

Social equity in the efficacy of behavior change intervention is much needed. While the efficacy of brief alcohol interventions including digital interventions is well established, particularly in health care, social equity of interventions has been sparsely investigated.

Objective:

To investigate whether the efficacy of computer-based versus in-person delivered brief alcohol interventions is moderated by the participants’ socioeconomic status. I.e., to identify whether general hospital patients with low level of school and unemployed patients may benefit more or less from one or the other way of delivery than those with higher levels of school and employed patients.

Methods:

Patients with non-dependent at-risk alcohol use were identified through systematic offline screening conducted on 13 general hospital wards. Patients were approached face-to-face; and asked to respond to an app for self-assessment provided by a mobile device. In total, n=961 (81% of eligibles) were randomized and received their allocated intervention: computer-generated individually tailored feedback letters (CO), in-person counseling by research staff trained in motivational interviewing (PE) or assessment only (AO). CO and PE were delivered on the ward and 1 and 3 months later; were based on the transtheoretical model of intentional behavior change; and required the assessment of intervention data prior to each intervention. In CO, the generation of the computer-based feedback was created automatically; the assessment of data and the sending out of feedback letters were assisted by research staff. Of the CO and PE participants, 89% and 83% received at least two; and 72% and 54% all three doses of intervention, respectively. Outcome was change in grams of pure alcohol per day after 6, 12, 18, and 24 months, with the latter being the primary time-point of interest. Follow-up interviewers were blinded. Using latent growth modelling, study group interactions with school education and employment status were tested as predictors of change in alcohol use.

Results:

The efficacy of CO and PE did not differ by level of school (P = .98). Employment status did not moderate CO efficacy (Ps ≥ .66) but PE efficacy. Up to month 12 and compared to employed participants, unemployed participants reported significantly greater drinking reductions following PE versus AO (incidence rate ratio [IRR]=0.44, 95% confidence interval [CI]: 0.21-0.94, P =.03) and following PE versus CO (IRR=0.48, 95% CI: 0.24–0.96, P = .04). After 24 months, these differences were statistically non-significant (Ps ≥ .31).

Conclusions:

Computer-based and in-person BAI worked equally well independent of the patients’ level of school education. Although findings indicate that in the short-term, unemployed persons may benefit more from brief alcohol intervention when delivered in-person rather than computer-based, the findings suggest that both BAIs have the potential to work well among participants with low socio-economic status. Clinical Trial: ClinicalTrials.gov: NCT01291693