JMIR Publications

ABSTRACT

Background:

Mobile apps have shown considerable promise for reducing alcohol consumption amongst problem drinkers but like many mHealth apps, they frequently report low utilization, which is an important limitation as research suggests effectiveness is related to higher utilization. Interactive chatbots have the ability to provide a conversational interface with users and may be more engaging and result in higher utilization and effectiveness, but there is limited research into this possibility, a limitation addressed in this study.

Objective:

The purpose of this study was first to develop a chatbot alcohol intervention that is based on an empirically supported app (Step Away) for reducing drinking and second, to conduct a pilot trial of the two interventions in a sample of participants who met criteria for hazardous drinking and were interested in reducing alcohol consumption, assessing for utilization patterns and alcohol outcomes across the two technology conditions and a waitlist control group.

Methods:

Participants were recruited through Facebook advertisements. Participants who met criteria for hazardous consumption and expressed an interest in changing their drinking were randomly assigned to three conditions; the Step Away app, the Step Away chatbot, and a waitlist control condition. Participants were assessed online with the USAUDIT, the RTCQ, the SIP-R, and the Timeline Followback (TLFB) at baseline and at 12-weeks follow up.

Results:

A total of 150 participants who completed baseline and follow-ups were included in the final analysis. ANOVA results indicated that participants in the 3 conditions changed their drinking from baseline to follow-up with large effect sizes noted (i.e., η2=.31 for change in drinks per day across conditions). However, the differences between groups were not significant across the alcohol outcome variables. The only significant difference between conditions was in the readiness to change variable with the bot group evidencing the most improvement in readiness (F2,147=5.6, P=.004, η2=.07). Results suggested that the app group used the app for a longer duration (mean 50.7 days) than the bot group (mean 27.2 days; P=.02). Utilization of the interventions was shown to predict reduced drinking in a multiple regression analysis (β=.29, 95%, P=.049).

Conclusions:

Results indicated that all groups in the study reduced their drinking considerably from baseline to 12-week follow-up but no differences were found on the alcohol outcome variables between groups, possibly due to a combination of small sample size and methodological issues. The app group also reported greater utilization and slightly higher usability scores over the bot group but the bot group evidenced improved readiness to change scores over the app group. The strengths and limitations of the app and bot interventions as well as directions for future research are discussed. Clinical Trial: ClinicalTrials.gov NCT04447794