Leeds Institute of Health Sciences Academic Unit of Psychiatry and Behavioural Sciences, School of Medicine

Transcription

1 How do individuals process the information we provide? Verbal protocols to explore the user experience of brief personalised e-interventions for alcohol use Dr Bridgette M Bewick Associate Professor Danish Society of Psychosocial Medicine Copenhagen June 2016

2 Acknowledgements Unitcheck: Michael Barkham; Andrew J Hill; Brendan Mulhern; Karen Trusler; Robert West ChangeDrinking: Duncan Raistrick; Gillian Tober; Kat Rumball; Jakki Birtwistle Doctorate of Clinical Psychology students Rebecca Yule, Cheryl Barrass, Sarah Marley (co-supervisors Dr Louise Bryant, Dr Carol Martin, and Dr Hilary Bekker). The above is a list of key individuals who contributed to material subsequently included in this presentation. Acknowledgement is given that unfortunately it is not possible to list everyone who has had any input in to the projects therefore thanks to all that contributed in some shape or form. Thanks to participants, student union executive members, university staff; Leeds Addiction Unit staff, and National Health Service (NHS) staff who gave their time to be involved in the projects. Conflicts of interest: In the past Bewick has received funding from the European Research Advisory Board, and has received reimbursement from Anheuser-Busch and the International Centre for Alcohol Polices.

3 Leeds Institute f Health Sciences Thanks to support from...

4 Where?

5 Who?

6 Unitcheck Personalized feedback via the web University students Effectiveness Process

7 Screening and brief intervention (personalised feedback) that included information informed by the social norms approach

8 Personalised feedback Alcohol consumption Units consumed per week Number of alcohol free days Binge drinking behaviour Social norms The percentage of students who drink less than them Perceived negative effects of alcohol perceived by other students who consume a similar amount of alcohol. Information on support services

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11 Academic Unit of Psychiatry and Behavioural Sciences

12 Academic Unit of Psychiatry and Behavioural Sciences

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17 The effectiveness of a web-based personalized feedback and social norms alcohol intervention in UK university students: A randomized controlled trial. Bewick, B.M., West, R.M., Barkham, M., Mulhern, B., Marlow, R., Traviss, G., and Hill, A.J.... Findings: The regression model predicted a monitoring effect, with participants who completed assessments reducing alcohol consumption over the last week. Further reductions were predicted for those allocated to receive the intervention, and additional reductions were predicted as the number of visits to the intervention website increased. Conclusions: Unitcheck can reduce the amount of alcohol consumed and the reduction can be sustained in the medium-term (i.e. 19 weeks after intervention was withdrawn). The findings suggest self-monitoring is an active ingredient to web-based personalized feedback. (Bewick et al., 2013)

18 (Bewick et al., 2010)

19 How do students process the information? Sarah Marley Doctoral Student (Dclin) Marely et al. (2016) Bridgette Bewick and Hilary Bekker Supervisory team

20 Design: Qualitative study with an experimental design (2 conditions) Procedure: Think-aloud and semi structured interview Analysis: Framework analysis Thinking my thoughts aloud, thinking my thoughts aloud, thinking my thoughts aloud

21 Participants: 21 first year University of Leeds students Female n=14; Male n= 7 Mean age 19 years (range 18-21) Reported units consumed in previous week (at interview): Sex-specific labelling median 36.5 units No sex-specific labelling median 28.0 units

22 Results: Five meta-themes were identified Active thinking about alcohol use Comparison with others Beliefs and knowledge about alcohol consumption Inter-relationship between personal codes and context Engagement with Unitcheck

23 Active thinking about current drinking Utterances about their current drinking and its implications. Includes active evaluation of own alcohol use.

24 This evaluative process started early on in the Unitcheck programme. 17 out of 21 participants negatively evaluated some aspect of their drinking behaviour before receiving any feedback. Um, so that would be 100ml um, 200ml er, lets call it actually and then I had a couple of shots when I got to the club as well. God <pauses> that's really bad! (P16; Male; condition: no sexspecific labelling)

25 ...that's your life that's like life recommendations to you and it's saying that I'm it's putting it that I weekly, yeh have arguments with my girlfriend, I break the law, but you know that's and they are because of drinking yeh, arguments with the Mrs are definitely because of drinking she said on our one year anniversary she said that I had a drinking problem, I was like well and I think that's literally that's just hit me now.. which is s***, yeh, its literally just hit me. (P7; Male; condition: sex-specific labelling)

26 Comparison with others Encapsulates the cognitive and emotional reaction of participants when comparing their own drinking behaviour with that of a specific reference group. This process begins with participant estimates of where their drinking rates in comparison to other student groups (people on their course, at the University of Leeds, at University in the UK). Continues with their initial cognitive and emotional appraisal of the normative feedback they receive and concludes with their evaluation of the feedback and the specific normative reference group used.

27 19 of the 21 participants estimated that they were average in terms of student drinking 13 of the 21 participants described being shocked or surprised by the actual normative feedback Yeh, I just think like...i am just shocked...i guess I thought I drank pretty much the same as the majority of people and according to the results they've got on there I don't at all, I drink more than the majority. (P5; Female; condition: sexspecific labelling) 7 out of 21 participants stated that they did not believe the normative feedback specifically comparing their own drinking with that of other students At least 75%... they drink less than me are you sure?! Only 20% of female university students drink... Really? I don't know if I believe it. Um, a female I really don't believe it actually (P3; Female; condition: sex-specific labelling)

28 8 participants specifically commented on the use of normative comparative data as interesting and worthy of further consideration um, I guess it's more useful to be told in comparison to other students because I know what I'm drinking (aware of what I'm drinking) and I already know what I do when I get drunk like so it's just knowing what other people do. 'Cause I guess this is an assumption that everyone else just does the same things (P10; Female; condition: no sex-specific labelling)

29 Normative feedback was separated out as a focus of interest and consideration. The process of comparison was an uncomfortable experience that displaced participants from the security of the average into the territory of the minority. Because it makes me seem like I'm like abnormal, um it makes it seem like after reading the information about the other students it makes me feel like I'm not average anymore. (P21; Female; condition: no sex-specific labelling)

30 There was evidence of changes in opinion, with participations moving between disbelief, consideration, and acceptance. it's hard to believe but at the same time you do have a niggling feeling that it could be... it probably is true. It's just difficult to believe well, yo... yo... you either feeling that it's hard to believe, it sort of instantly quashed by the reason in your mind and why it sort of says it's probably right. 'You probably do drink too much and you know it. Stop being a pratt' (P12; Male; condition: sex-specific labelling)

31 Beliefs and knowledge about drinking behaviour Utterances about beliefs and knowledge of drinking behaviour expressed when working through Unitcheck. Participants actively questioned the accuracy and personal relevance of the normative data.

32 Participants viewed normative feedback in light of their own experience and observations. They drew on comparisons with friends, or their wider beliefs about student drinking, to challenge the normative feedback. <pauses> cause I wonder where all those people are hiding, cause that seems like a hell of a lot of people <pauses> cause you see how rammed all the clubs are on a night are in Leeds (on every day of the week) and it just makes it does give you the media attention that students get at the moment anyway, just generally makes you believe that stu that is student, lifestyle, you know. You you go out; have a great time; you binge drink; you come into lectures hung-over; you do your best and you look a bit of a state. And, I dunno. It is really its endemic in our culture at the moment. So I m surprised that 75% of people have completed alluded that stereotype (P8; Male; condition: no sex-specific labelling)

33 Participants compared their drinking with referent groups of varying proximity ranging from close friends and housemates to unknown others observed on nights out. Because, erm, everybody that I've met at Leeds University erm always goes on nights out like erm I've never met somebody that doesn't drink and I've never met somebody that doesn't get drunk, so even though there are people that maybe don't get drunk as many days as I get drunk... so it's just like where are these people that are in the, are in the under category of me you know where have they been found. (P5; Female; condition: sexspecific labelling)

34 Some participants began to tentatively question their own perceptions of student drinking. it made me think about like the students of Leeds University, like, who they are, cos who, it makes me feel like maybe, well I know I've only met like a really small percentage of people here but it just makes me feel like I've got like the wrong impression of everyone entirely or something... (P21; Female; condition: no sex-specific labelling)

35 Inter-relationship of personal code and context Participants felt that certain behaviour was the accepted student norm, particularly when considering the consequences of drinking.

36 Behaving in an embarrassing way, having a hangover and missing class were dismissed by seven participants, as being a normal, expected part of University life. Um... er... I've not gone to work or missed class because of drinking: yes, I have. I think everyone at Uni has done that once. And if they haven't, they probably shouldn't be at university (P12; Male; condition: sex-specific labelling)

37 Interaction with the programme Includes fractured vocalisations that allow some insight into how participants approached the think aloud task. For example, participants frequently read aloud questions and feedback from the programme interspersed with ambiguous vocalisations, or brief asides. These vocalisations, although difficult to code for meaning, suggest that participants were engaged in the task and responding to the information presented.

38 Conclusions Students drinking over recommended weekly limits can engage with web based interventions, actively processing information and applying it to their own lives. The evaluative process starts before any feedback has been given. Students consistently processed feedback by drawing comparisons to their personal experience, perceptions and knowledge. Comparisons are consistent with the assertion that to be effective normative feedback must be salient and perceived as relevant to the individual. Immediate reaction to feedback was malleable and tended to fluctuate throughout the interview.

39 How do students process the information?

40 The shift observed in some participants makes visible how single session personalised feedback can facilitate change within an individual. The findings support the continued use of personalised normative information in web based student alcohol interventions.

41 Thanks for listening Faculty of Medicine and Health, School of Medicine, Charles Thackrah Building 101 Clarendon Road, Leeds, United Kingdom. LS2 9LJ (0)

42 Unitcheck Bewick, B.M., Trusler, K., Barkham, M., Hill, A.J., Cahill, J. and Mulhern, B. (2008). The effectiveness of web-based interventions designed to decrease alcohol consumption a systematic review. Preventive Medicine, Doi: /j.ypmed Bewick, B.M, Mulhern, B., Barkham, M., Trusler, K., Hill, A.J. and Stiles, W.B. (2008). Changes in undergraduate student alcohol consumption as they progress through university. BMC Public Health, 8, 163, Doi: / Bewick, B.M., West, R.M., Gill, J., O May, F., Mulhern, B., Barkham, M. and Hill, A.J. (2010). Providing web-based feedback and social norms information to reduce student alcohol intake: a multi-site investigation. Journal of Medical Internet Research. Bewick, B.M., West, R.M., Barkham, M., Mulhern, B., Marlow, R., Traviss, G. and Hill, A.J. (2013). The effectiveness of a webbased personalised feedback and social norms alcohol intervention in UK university students: A randomised controlled trial. Journal of Medical Internet Research.,15(7), e137 Bewick, B.M. Trusler, K., Mulhern, B., Barkham, M. and Hill, A.J. (2008). Feasibility and effectiveness of a web-based personalized feedback and social norms alcohol intervention in UK university students: a randomized control trial. Addictive Behaviors, Doi: /j.addbeh Marley, S., Bekker, H.L., Bewick, B.M. (2016). Responding to personalized social norms feedback from a web-based alcohol reduction intervention or students: Analysis of think-aloud verbal protocols. Psychology and Health, DOI: / Marley, S.L. (2012). Understanding the role of social norms in a web-based personalised, feedback intervention for alcohol use. Doctoral of Clinical Psychology, University of Leeds.

43 Student alcohol consumption Barrass, C.J. (2012). Drinking experiences of first year female students: Using narratives to explore the transition to university life. Doctoral of Clinical Psychology, University of Leeds. Bewick, B.M, Mulhern, B., Barkham, M., Trusler, K., Hill, A.J. and Stiles, W.B. (2008). Changes in undergraduate student alcohol consumption as they progress through university. BMC Public Health, 8, 163, Doi: / Craigs, C.L., Bewick, B.M., Gill, J., O May, F. and Radley, D. (2011). UK student alcohol consumption: A cluster analysis of drinking behaviour typologies. Health Education Journal, Doi: /00i

44 ChangeDrinking Bewick, B.M., Rumball, K., Birtwistle, J.C., Shaw, J.R., Johnson, O., Raistrick, D. and Tober, G. (2014). Developing a webbased intervention to increase motivation to change and encourage uptake of specialist face-to-face treatment by hospital inpatients: ChangeDrinking. Drug and Alcohol Review. Other resources Haines, M.P., Perkins, H.W., Rice, R.M. and Barker, G. (2005). A guide to marketing social norms for health promotion in schools and communities. National Social Norms Resource Center. ( McAlaney, J., Bewick, B.M. and Bauerle, J. (2010). Social Norms Guidebook: A guide to implementing the social norms approach in the UK. University of Bradford, University of Leeds, Department of Health: West Yorkshire, UK. (electronic copy available: McAlaney, J., Bewick, B.M., Hughes, C. (2010). The international development of the Social Norms approach to drug education and prevention. Drugs: Education, Prevention and Policy.