Pragmatic randomized controlled trial of a web-based intervention for alcohol use among Brazilian college students: Motivation as a moderating effect

TY - JOUR

T1 - Pragmatic randomized controlled trial of a web-based intervention for alcohol use among Brazilian college students

T2 - Motivation as a moderating effect

AU - Bedendo, André

AU - Ferri, Cleusa Pinheiro

AU - de Souza, Altay Alves Lino

AU - Andrade, André Luiz Monezi

AU - Noto, Ana Regina

N1 - Copyright © 2019 Elsevier B.V. All rights reserved.

PY - 2019/6/1

Y1 - 2019/6/1

N2 - BACKGROUND: Web-based personalized normative feedback (PNF) interventions are less effective than their laboratory versions. Participant motivation may account for this reduced effect, but there is only a limited amount of research into the influence of motivation on PNF effectiveness. We evaluated the effectiveness of a web-based PNF in reducing alcohol use and consequences among college students with different motivation levels.METHODS: Pragmatic randomized controlled trial among Brazilian college drinkers aged 18-30 years (N = 4460). Participants were randomized to a Control or PNF group and followed-up after one (T1), three (T2) and six (T3) months. Outcomes were: AUDIT score (primary outcome), the number of consequences, and the typical number of drinks. Motivation for receiving the intervention was assessed with a visual analog scale (range: 0-10). Generalized mixed models assessed intervention effects via two paradigms: observed cases and attrition models.RESULTS: PNF reduced the number of typical drinks at T1 (OR = 0.71, p = 0.002), T2 (OR = 0.60, p < 0.001) and T3 (OR = 0.68, p = 0.016), compared to the control. Motivated students (score ≥3) receiving PNF also reduced the number of typical drinks at T1 (OR = 0.60, p < 0.001), T2 (OR = 0.55, p < 0.001) and T3 (OR = 0.56, p = 0.001), compared to the control. However, the attrition models were more robust at T1 and T2. In contrast, low-motivated students receiving the PNF increased AUDIT score at T3 (b = 1.49, p < 0.001).CONCLUSIONS: The intervention reduced alcohol use, and motivation for receiving the intervention moderated the intervention effects. Motivated students reduced their typical alcohol use, whereas low-motivated students increased their AUDIT score.

AB - BACKGROUND: Web-based personalized normative feedback (PNF) interventions are less effective than their laboratory versions. Participant motivation may account for this reduced effect, but there is only a limited amount of research into the influence of motivation on PNF effectiveness. We evaluated the effectiveness of a web-based PNF in reducing alcohol use and consequences among college students with different motivation levels.METHODS: Pragmatic randomized controlled trial among Brazilian college drinkers aged 18-30 years (N = 4460). Participants were randomized to a Control or PNF group and followed-up after one (T1), three (T2) and six (T3) months. Outcomes were: AUDIT score (primary outcome), the number of consequences, and the typical number of drinks. Motivation for receiving the intervention was assessed with a visual analog scale (range: 0-10). Generalized mixed models assessed intervention effects via two paradigms: observed cases and attrition models.RESULTS: PNF reduced the number of typical drinks at T1 (OR = 0.71, p = 0.002), T2 (OR = 0.60, p < 0.001) and T3 (OR = 0.68, p = 0.016), compared to the control. Motivated students (score ≥3) receiving PNF also reduced the number of typical drinks at T1 (OR = 0.60, p < 0.001), T2 (OR = 0.55, p < 0.001) and T3 (OR = 0.56, p = 0.001), compared to the control. However, the attrition models were more robust at T1 and T2. In contrast, low-motivated students receiving the PNF increased AUDIT score at T3 (b = 1.49, p < 0.001).CONCLUSIONS: The intervention reduced alcohol use, and motivation for receiving the intervention moderated the intervention effects. Motivated students reduced their typical alcohol use, whereas low-motivated students increased their AUDIT score.

KW - Adolescent

KW - Adult

KW - Alcohol Drinking in College/psychology

KW - Brazil/epidemiology

KW - Early Medical Intervention/methods

KW - Feedback, Psychological/physiology

KW - Female

KW - Humans

KW - Internet/trends

KW - Male

KW - Motivation/physiology

KW - Students/psychology

KW - Universities/trends

KW - Young Adult

U2 - 10.1016/j.drugalcdep.2019.02.021

DO - 10.1016/j.drugalcdep.2019.02.021

M3 - Article

C2 - 31029880

SN - 0376-8716

VL - 199

SP - 92

EP - 100

JO - Drug and alcohol dependence

JF - Drug and alcohol dependence

ER -