Abstract
Screening and brief intervention for hazardous alcohol use in trauma care settings is known to reduce alcohol intake and injury recidivism, but is often not implemented due to resource constraints. Brief interventions delivered by mobile phone could overcome this challenge. This study aimed to evaluate the effect of a mobile phone text message intervention (YourCallTM) on hazardous drinkers admitted for an injury. The parallel two-group, single-blind, randomised controlled trial enrolled 598 injured patients aged 16–69 years identified as medium-risk drinkers at recruitment. The intervention group (n = 299) received 16 text messages incorporating brief intervention principles in the 4 weeks following discharge from hospital. Controls (n = 299) received usual care and one text message acknowledging participation in the trial. The primary outcome was the difference in hazardous alcohol use (assessed using AUDIT-C) between study groups at 3 months, with the maintenance of effect examined at 6 and 12 months’ follow-up. Data were analysed using a mixed-effects model for repeated measures. Both groups had similar baseline features. Compared to controls, hazardous drinking was significantly lower in the intervention group at 3 months and maintained over the 12-month follow-up period (least squares mean difference in AUDIT-C scores: −0.322; 95% CI: −0.636, −0.008; p = 0.04). The intervention effect was similar among Māori (New Zealand’s indigenous population) and non-Māori (interaction p = 0.59), and among younger (16–29 years) and older (30–69 years) patients (p = 0.77). The effectiveness of this intervention reflects the potential of low cost, scalable mobile health technologies to overcome common barriers in implementing alcohol harm reduction strategies following injury.
Highlights
IntroductionPrevention of alcohol-related trauma requires a multi-pronged public health approach including strategies that reduce access to and availability of alcohol, control sponsorship and advertising, drinkdriving countermeasures, and appropriate interventions for hazardous drinkers.[11,12,13]
Hazardous alcohol use is a leading risk factor for injury.[1,2,3] Between 7–14% of all emergency department (ED) presentations,4–6 8–60% of injury ED presentations[7] and 23–50% of trauma centre admissions[8,9,10] are reported to be alcohol-related
The mixed-effects model adjusted for age, sex, hospital, ethnicity and baseline Alcohol Use Disorders Identification Test (AUDIT)-C found the mean AUDIT-C score in the intervention group was on average 0.322 lower than the control group (Table 3)
Summary
Prevention of alcohol-related trauma requires a multi-pronged public health approach including strategies that reduce access to and availability of alcohol, control sponsorship and advertising, drinkdriving countermeasures, and appropriate interventions for hazardous drinkers.[11,12,13]. Screening for hazardous alcohol use and brief interventions (BI) in trauma care settings has been reported to reduce alcohol intake, injury recidivism and other alcohol-related harms.[8,14,15] Despite inclusion in several guidelines,[16,17,18] the implementation of BIs in busy clinical settings is challenged by time and resource constraints.[9,19,20,21] Mobile phone (mHealth) text message approaches could contribute to reducing these barriers. Mobile phones have been referred to as 'the most accessible form of mediated communication in world history' and text messaging has become 'one of the most frequently used forms of mobile communication'.22
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