JMIR Publications

ABSTRACT

Background:

Alcohol misuse is the fourth leading cause of death in the US and is a significant problem in the US Military, both in terms of its impact on military functioning/readiness and its effect on the health and careers of service members. Brief alcohol interventions are effective at reducing negative alcohol outcomes in both the civilian and military populations, but additional scalable interventions are needed to continue to reduce binge and heavy drinking in this population. Automated short text message service (SMS) interventions could address this need but to date, there have been no programs developed for a military population.

Objective:

The goal of this study was to develop an SMS intervention to address binge and heavy drinking for Airmen in Technical Training in the US Air Force.

Methods:

A two-phase mixed-methods study was implemented to develop the SMS intervention. In Phase 1, N=149 respondents provided feedback on the persuasiveness of 49 messages developed by experts and provided input on message frequency, as well as preferred timing and days of the week to receive messages. Respondents also provided suggested messages. In Phase 2, N=283 respondents provided feedback on the persuasiveness of 77 new messages including messages developed through refinement of messages from Phase 1. Phase 1 messages were qualitatively coded for theme by experts and Phase 2 messages were coded by Behavior Change Technique Taxonomy (BCTT). For both Phases, mean persuasiveness scores (range: 1-5) were calculated and compared by age (< 21 or 21+ years of age) and gender. Top ranking messages from Phase 2 were considered for inclusion in the final message library.

Results:

In Phase 1, qualitative coding indicated that the ten top rated messages had themes related to warning of adverse outcomes (impaired judgement, financial costs), recommendations to reduce drinking, and invoking values and goals. Qualitative coding of respondent suggested messages included themes related to warning of adverse outcomes, recommendations, prioritizing long-term goals, team and belonging, and invoking values and goals. Most respondents preferred to be sent 1-3 messages per week (90.5%), to be sent messages on Friday, Saturday, and Sunday (45.8%), with messages sent in the early evening (56.4%) or late evening (53.7%). In Phase 2, mean scores for included messages in the final message library ranged from 3.26 to 4.21. Four of the top 5 highest rated messages were categorized in two BCTTs: Valued self-identity and Information about health consequences.

Conclusions:

This study included involvement of members from the target population throughout two formative stages of intervention development to design an SMS intervention to reduce binge and heavy drinking. The intervention is now being tested in an efficacy trial to determine the impact on binge drinking alcohol total consumption in the US Air Force.