Computer-based Intervention Research Articles

Generic preparation for upcoming explanations: intra- and inter-domain effects of a digital training intervention

Learning from instructional explanations is one of the most established, prevalent, and obvious ways of learning—but it carries the risk of shallow processing. Unlike previous research that focused on providing digital just-in-time support measures for learning with explanations, we strived to prepare learners on how to make the most of upcoming explanations. We thus developed a short-term computer-based training intervention on the focused processing of instructional explanations. In two experiments (N1 = 47, N2 = 42), we tested its effects on learning processes and outcomes of a subsequent learning phase. Our results revealed that the training intervention fostered domain-general knowledge about explanations. Furthermore, it enabled learners to benefit from future instructional explanations in other domains (inter-domain transfer for university students, Experiment 1) or at least on other topics (intra-domain transfer for primary school fourth graders, Experiment 2). The digital training intervention did not trigger more cognitive load in the subsequent learning phase. All in all, we describe an initial promising step toward a generic training effect that has the potential advantage of enhancing learning from explanations without altering the actual learning material.

Counting strategies of students struggling in mathematics in a computer-based learning environment

Children with mathematics difficulties often show challenges in additive reasoning and problem solving and may experience challenges with more advanced mathematics. To address these challenges, we implemented a computer-based intervention to promote children’s conceptual understanding of numbers, counting, and additive strategies. The purpose of this exploratory case study was to provide an in-depth analysis of the progression of counting and composite unit development as well as strategies for solving addition and subtraction problems by two third-graders with mathematics difficulties in a computer-based learning environment. We analyzed video-recorded sessions, field notes, and pre- and post-assessments. Our findings show that participating students negotiated solving addition and subtraction problems through inventing more advanced and efficient additive double-counting strategies. In addition, it seems that the growth of their counting through the computer-based intervention was generalized to solving additive problems on a paper-and-pencil test.

The Role of Sex and Age in Moderating the Outcome of In-Person and Computer-Based Brief Alcohol Interventions at General Hospitals: Reanalysis of a Brief Intervention Study

Introduction: The aim of this study was to test whether brief alcohol interventions at general hospitals work equally well for males and females and across age-groups. Methods: The current study includes a reanalysis of data reported in the PECO study (testing delivery channels of individualized motivationally tailored alcohol interventions among general hospital patients: in PErson vs. COmputer-based) and is therefore of exploratory nature. At-risk drinking general hospital patients aged 18–64 years (N = 961) were randomized to in-person counseling, computer-generated individualized feedback letters, or assessment only. Both interventions were delivered on the ward and 1 and 3 months later. Follow-ups were conducted at months 6, 12, 18, and 24. The outcome was grams of alcohol/day. Study group × sex and study group × age interactions were tested as predictors of change in grams of alcohol/day over 24 months in latent growth models. If rescaled likelihood ratio tests indicated improved model fit due to the inclusion of interactions, moderator level-specific net changes were calculated. Results: Model fit was not significantly improved due to the inclusion of interaction terms between study group and sex (χ²[6] = 5.9, p = 0.439) or age (χ²[6] = 5.5, p = 0.485). Discussion: Both in-person counseling and computer-generated feedback letters may work equally well among males and females as well as among different age-groups. Therefore, widespread delivery of brief alcohol interventions at general hospitals may be unlikely to widen sex and age inequalities in alcohol-related harm.

Computer-Based Intervention Closes Learning Gap in Maths Accumulated in Remote Learning.

Remote learning has reduced the mathematical performance of students. Mathematical reasoning is the critical skill that enables students to make use of all other mathematical skills. The aim of the present study was (1) to develop the mathematical reasoning skills of underachieving students and (2) to explore the application options, benefits and limitations of an online game-based intervention programme among third- and fourth-grade pupils (aged 9–11, N = 810). The content of the programme was designed to strengthen their basic maths skills in line with the curriculum. Beyond assigning the tasks, the digital intervention programme also performed the motivational, differentiation- and feedback-related tasks of the teacher. The reliability indices for pre-, post and follow-up test results proved to be high (Cronbach’s alpha = .90, .91 and .92, respectively). The effect size of the programme proved to be significant in both grades (d = .22 and .38, respectively). The results confirm the potential of the intervention programme to close, or at least significantly reduce the Covid learning gap in basic maths skills, without the need for additional teacher work—which is an important aspect of successful implementation—in areas which are the most challenging for 9-to-11-year-old pupils in the domain of mathematics.

Computer-Based Cognitive Training in Children with Primary Brain Tumours: A Systematic Review.

Simple SummaryBrain tumour survivors are often burdened by late sequelae, especially neurocognitive deficits, ultimately affecting their quality of life. For many years, treatments for neurocognitive impairments have been limited to educational, pharmacological, home-based interventions, or clinic-based cognitive rehabilitation, but these treatment modalities showed several limits. More recently, cognitive rehabilitation through digital tools to increase cognitive performance through exercises and games is spreading in experimental clinical settings. However, since these are innovative interventions, there is a need to further investigate their effects on cognitive outcomes and quality of life for children with brain tumours. Therefore, in this systematic review, we analyse the current evidence and trends regarding computer-based cognitive rehabilitation in paediatric patients diagnosed with, or survivors of, brain tumours. To our knowledge, this is the first systematic review investigating these new approaches to cognitive rehabilitation in children with brain tumours.Background: Late neurocognitive sequelae are common among long-term brain tumour survivors, resulting in significantly worse quality of life. Cognitive rehabilitation through specific APP/software for PC/tablets represents an innovative intervention spreading in recent years. In this study, we aim to review the current evidence and trends regarding these innovative approaches. Methods: A systematic literature review was performed. Inclusion criteria were: (i) Studies recruiting patients diagnosed with any brain tumour before 21 years of age; (ii) studies assessing the role of digital interventions on cognitive outcomes. Case reports, case series, reviews, letters, conference proceedings, abstracts, and editorials were excluded. Results: Overall, nine studies were included; 152 patients (67.8% males) with brain tumours underwent a digital intervention. The mean age at diagnosis and the intervention enrolment ranged from 4.9 to 9.4 years and 11.1 to 13.3 years, respectively. The computer-based software interventions employed were: Cogmed, Captain’s Log, Fast ForWord, and Nintendo Wii. Most of these studies assessed the effects of cognitive training on working memory, attention, and performance in daily living activities. Conclusions: The studies suggest that this type of intervention improves cognitive functions, such as working memory, attention, and processing speed. However, some studies revealed only transient positive effects with a significant number of dropouts during follow-up. Trials with greater sample sizes are warranted. Motivating families and children to complete cognitive interventions could significantly improve cognitive outcomes and quality of life.

Adding Mobile Elements to Online Physical Activity Interventions Targeted at Adults Aged 50 Years and Older: Protocol for a Systematic Design.

BackgroundPhysical activity (PA) can increase mental and physical health in adults aged 50 years and older. However, it has been shown that PA guidelines are often not met within this population. Therefore, our research group developed 2 computer-tailored intervention programs in the last decade to stimulate PA: Active Plus and I Move. Although these programs were proven effective, positive effects diminished over time and attrition rates were relatively high. To respond to this, we will integrate 3 interactive mobile elements into the existing programs: activity tracker, ecological momentary intervention program, and virtual coach app.ObjectiveThe goal of the research is to define systematic and evidence-based steps for extending our online computer-based PA intervention programs with 3 interactive mobile elements.MethodsComponents often included in other (eHealth) design models were identified as key components and served as a base for the definition of systematic steps: exploration of context, involvement of the target population, prototype and intervention testing, and implementation. Based on these key components, 10 systematic steps were defined. The initial step is a literature search, with the results serving as a base for development of the low-fidelity prototypes in step 2. The pilot phase comprises the 3rd to 6th steps and includes semistructured interviews, pilot tests, and adaptations of the prototypes with intensive involvement of the target population of adults aged 50 years and older, where particular attention will be paid to lower educated persons. The 7th step is an effect evaluation in the form of a randomized controlled trial. During the 8th step, the most effective intervention programs will be selected and reinforced. These reinforced intervention programs will be used during the design of an implementation plan in the 9th step and the subsequent field study in the 10th step.ResultsThe project will be executed from December 2019 to December 2023. During this period, the systematic approach presented will be practically executed according to the methodological procedures described.ConclusionsBased on the 4 identified key components, we were able to design an evidence-based systematic design approach for separately adding 3 mobile elements to our existing online PA intervention programs. The 10 steps are presented as a useful approach to guide future eHealth design studies.International Registered Report Identifier (IRRID)DERR1-10.2196/31677

An Internet-delivered Cognitive-Behavioral Therapy (iCBT) for Prolonged Grief Disorder (PGD) in adults: A multiple-baseline single-case experimental design study

The death of a loved one has physical, psychological, and social consequences. Between 9.8 and 21.5 % of people who lose a loved one develop Prolonged Grief Disorder (PGD). Internet- and computer-based interventions (i.e., Internet-delivered Cognitive-Behavioral Therapy, iCBT) are cost-effective and scalable alternatives that make it possible to reach more people with PGD. The main goal of the present investigation was to examine the effect and feasibility (usability and satisfaction) of an iCBT (GROw program) for adults with PGD. A secondary objective was to detect adherence to the app (Emotional Monitor) used to measure daily grief symptoms. The study had a single-case multiple-baseline AB design with six participants. The GROw program is organized sequentially in eight modules, and it is based on the dual-process model of coping with bereavement. Evaluations included a pre-to-post treatment assessment of depression, grief symptoms, and typical grief beliefs, along with daily measures of symptom frequency and intensity on the Emotional Monitor App. Treatment opinions and adherence to the App were also collected. Efficacy data were calculated using a Nonoverlap of All Pairs (NAP) analysis and Reliable Change Index (RCI). The mean age of the sample was 29.5 years (SD = 8.19). Two participants dropped out of the study. Adherence to the App varied across patients (4.8 % -77.8 %). Most participants (75 %) showed a clinically significant change (recovered) in depression, and 50 % obtained a clinically significant improvement (recovered) in symptoms of loss and typical beliefs in complicated grief. The participants reported high usability and satisfaction with the treatment content and format. In sum, the GROw program was very well accepted and generally feasible, and it has strong potential for treating PGD. The results support scaling up the treatment by using more complex designs with larger samples (i.e., randomized controlled trials comparing GROw with active conditions).

The Effects of a Computer Game (Healthy Rat King) on Preschool Children's Nutritional Knowledge and Junk Food Intake Behavior: Nonrandomized Controlled Trial.

BackgroundPlaying computer-aided games could enhance children’s interest in learning about nutritional knowledge and eventually promote healthy dietary intake behavior.ObjectiveThis study aims to evaluate the effectiveness of a computer game (Healthy Rat King) in improving the knowledge on nutrition and junk food intake among preschool children in Taiwan.MethodsThis was a quasi-experimental study that utilized the computer game Healthy Rat King as the nutrition education tool. We recruited 104 preschool children (aged 5-6 years) from preschools in central Taiwan, who were assigned to either the experimental group (n=56) or the control group (n=48). In the experimental group, a 1-hour computer-based educational game intervention was included in the course for 4 consecutive weeks. The control group did not receive this intervention.ResultsThe level of nutritional knowledge for children in the experimental group was significantly higher than those in the control group after 4 weeks (P=.002). Furthermore, the frequency of consumption of chocolate, candies, and ice cream (high-calorie junk food) was reduced in the experimental group. There was also no significant difference in the consumption of candy and chocolate (P=.54), ice cream and ice pops (P=.21), cake (P=.92), biscuit (P=.98), soft drinks (P=.52), and fruit juice and sugary drinks (P=.31) between the 2 groups in the posttest.ConclusionsTeaching using a computer game could improve children’s nutritional knowledge. However, the intake frequency of junk food among children in the experimental group showed no significant difference from those in the control group.

The Moderating Effect of Educational Background on the Efficacy of a Computer-Based Brief Intervention Addressing the Full Spectrum of Alcohol Use: Randomized Controlled Trial.

BackgroundThe alcohol-attributable burden of disease is high among socially disadvantaged individuals. Interventional efforts intending to have a public health impact should also address the reduction of social inequalities due to alcohol.ObjectiveThe aim was to test the moderating role of educational background on the efficacy of a computer-based brief intervention addressing the full spectrum of alcohol use.MethodsWe recruited 1646 adults from the general population aged 18 to 64 years (920 women, 55.9%; mean age 31 years; 574 with less than 12 years of school education, 34.9%) who reported alcohol use in the past year. The participants were randomly assigned a brief alcohol intervention or to assessment only (participation rate, 66.9%, 1646/2463 eligible persons). Recruitment took place in a municipal registry office in one German city. All participants filled out a self-administered, tablet-based survey during the recruitment process and were assessed 3, 6, and 12 months later by study assistants via computer-assisted telephone interviews. The intervention consisted of 3 computer-generated and individualized feedback letters that were sent via mail at baseline, month 3, and month 6. The intervention was based on the transtheoretical model of behavior change and expert system software that generated the feedback letters automatically according to previously defined decision rules. The outcome was self-reported change in number of alcoholic drinks per week over 12 months. The moderator was school education according to highest general educational degree (less than 12 years of education vs 12 years or more). Covariates were sex, age, employment, smoking, and alcohol-related risk level.ResultsLatent growth modeling revealed that the intervention effect after 12 months was moderated by educational background (incidence rate ratio 1.38, 95% CI 1.08-1.76). Individuals with less than 12 years of school education increased their weekly alcohol use to a lesser extent when they received the intervention compared to assessment only (incidence rate ratio 1.30, 95% CI 1.05-1.62; Bayes factor 3.82). No difference was found between groups (incidence rate ratio 0.95, 95% CI 0.84-1.07; Bayes factor 0.30) among those with 12 or more years of school education.ConclusionsThe efficacy of an individualized brief alcohol intervention was moderated by the participants’ educational background. Alcohol users with less than 12 years of school education benefited, whereas those with 12 or more years did not. People with lower levels of education might be more receptive to the behavior change mechanisms used by brief alcohol interventions. The intervention approach may support the reduction of health inequalities in the population at large if individuals with low or medium education can be reached.Trial RegistrationGerman Clinical Trials Register DRKS00014274; https://www.drks.de/DRKS00014274

Effectiveness of computer-assisted virtual cognitive retraining in improving reading, dictation, and copying skills among school-going children

A randomized control trial with repeated measures was used with 60 bilingual learners aged 8-10 years from English medium schools to evaluate the effectiveness of Computer-Assisted virtual Cognitive Retraining (CACR) on school-going children with average or above-average IQ and no identified learning impairment. Data collection was done virtually. The experimental group received CACR for five weeks, with 15 sessions of an hour’s duration. Learners in the control group did not receive any training. The dependent variables were evaluated by 15 minutes of reading, copying, and dictation test from their grade level English textbook and using the Language subtests of Diagnostic Test for Learning Disability (DTLD), a test for diagnosing learning disability validated in the Indian population. Results showed improvements in the learners’ academic skills, such as reading fluency, copying, and dictation. The outcome of this study has implications for using virtual computer-based interventions to enhance the academic skills of school-going children.

The Nexus Between Diabetes and Depression: A Narrative Review.

Comorbid diabetes and depression are a significant public health burden as the consequences of both diseases are worsened by each other. In this study, we have compiled and analyzed findings from various studies to demonstrate that diabetes has a strong association with depression. Both have a significant impact on the quality of life, although the exact mechanisms through which these two chronic diseases affect each other remain unknown. This article discussed the shared etiological factors of comorbidity between diabetes and depression, including physiological (e.g., deregulation of the hypothalamic-pituitary-adrenal (HPA) axis, sympathetic nervous system (SNS) overactivity, microvascular dysfunction, arterial stiffening, inflammation, and cytokines), behavioral (e.g., diet and lifestyle modifications), and environmental (e.g., childhood adversity, poverty, and neighborhood environment). Included data from a range of settings have suggested that the prognosis of both diabetes and depression, in terms of complications, treatment efficacy, morbidity, and mortality, is worse for either disease when they occur concurrently than individually. The implication for the physical, mental, and social well-being of depression in diabetes causes poor self-care and adherence to medical treatment. This article also highlights the importance of regular screening and prompts the treatment of comorbid diabetes and depression with pharmacotherapy, face-to-face psychotherapy, and non-face-to-face models of alternative psychological interventions, including information and communication technologies (ICTs), computer-based diabetes self-management interventions, and digital mental health intervention, to improve the outcomes of both diseases.

Usability and Acceptability of a Computer-Based Social Communication Intervention for Persons with Traumatic Brain Injury: A Mixed-Methods Study.

Computer-based interventions for persons with traumatic brain injury (TBI) are a rapidly developing treatment modality. However, the usability and acceptability of such treatments have not been thoroughly studied. We describe the user-experience of a computerized intervention in persons with TBI called the Work-Related Communication (WoRC) program. Two coders used qualitative analysis of semi-structured interviews to complete a thematic content analysis along with a cost-benefit analysis. Ten participants with severe TBI more than 1-year postinjury were interviewed. Seven participants were male, and three were female. Their mean age was 41.6 years (standard deviation: 13.1). All had 4 years of college or less and experienced severe TBIs. A qualitative analysis of the WoRC program usability resulted in the categories of Content (aspects of treatment approach), Interface (aspects of presentation), and Abilities (aspects of the cognitive disorder). WoRC program acceptability categories emerged as Specific (trained strategies can be applied to specific scenarios) and Personal (individual factors related to willingness to implement the trained strategies). The cost-benefit analysis demonstrated a 50.2% reduction in treatment costs, indicating that computer-enhanced interventions are a potentially cost-effective way to increase behavioral outcomes. We discuss these findings as they relate to future development of computer-enhanced programs for persons with TBI.

Acceptability, Adaptability, and Feasibility of a Novel Computer-Based Virtual Counselor-Delivered Alcohol Intervention: Focus Group and In-depth Interview Study Among Adults With HIV or Tuberculosis in Indian Clinical Settings.

BackgroundUnhealthy alcohol use is associated with increased morbidity and mortality among persons with HIV and tuberculosis (TB). Computer-based interventions (CBIs) can reduce unhealthy alcohol use, are scalable, and may improve outcomes among patients with HIV or TB.ObjectiveWe assessed the acceptability, adaptability, and feasibility of a novel CBI for alcohol reduction in HIV and TB clinical settings in Pune, India.MethodsWe conducted 10 in-depth interviews with persons with alcohol use disorder (AUD): TB (6/10), HIV (2/10), or HIV-TB co-infected (1/10) selected using convenience sampling method, no HIV or TB disease (1/10), 1 focus group with members of Alcoholics Anonymous (AA; n=12), and 2 focus groups with health care providers (HCPs) from a tertiary care hospital (n=22). All participants reviewed and provided feedback on a CBI for AUD delivered by a 3D virtual counselor. Qualitative data were analyzed using structured framework analysis.ResultsThe majority (9/10) of in-depth interview respondents were male, with median age 42 (IQR 38-45) years. AA focus group participants were all male (12/12), and HCP focus group participants were predominantly female (n=15). Feedback was organized into 3 domains: (1) virtual counselor acceptability, (2) intervention adaptability, and (3) feasibility of the CBI intervention in clinic settings. Overall, in-depth interview participants found the virtual counselor to be acceptable and felt comfortable honestly answering alcohol-related questions. All focus group participants preferred a human virtual counselor to an animal virtual counselor so as to potentially increase CBI engagement. Additionally, interaction with a live human counselor would further enhance the program’s effectiveness by providing more flexible interaction. HCP focus group participants noted the importance of adding information on the effects of alcohol on HIV and TB outcomes because patients were not viewed as appreciating these linkages. For local adaptation, more information on types of alcoholic drinks, additional drinking triggers, motivators, and activities to substitute for drinking alcohol were suggested by all focus group participants. Intervention duration (about 20 minutes) and pace were deemed appropriate. HCPs reported that the CBI provides systematic, standardized counseling. All focus group and in-depth interview participants reported that the CBI could be implemented in Indian clinical settings with assistance from HIV or TB program staff.ConclusionsWith cultural tailoring to patients with HIV and TB in Indian clinical care settings, a virtual counselor–delivered alcohol intervention is acceptable and appears feasible to implement, particularly if coupled with person-delivered counseling.

E-learning with multiple-try-feedback: Can hints foster students’ achievement during the semester?

E-learning opportunities have become an increasingly important component of university education. Various laboratory studies have shown that e-learning environments can meaningfully enhance learning by incorporating various interventions and design choices (e.g., providing feedback and scaffolds). However, many computer-based interventions have not yet been applied in authentic university courses, raising questions about whether and how the provision of certain forms of feedback works and scales in an applied context. In this paper, we addressed this research gap. Specifically, we investigated whether including an elaborative component (hints) in multiple-try feedback increases student learning in e-learning exercises in an undergraduate statistics course. In one exercise, after completing a statistical problem, one group received feedback that conveyed knowledge about the correct response, while the other group additionally received elaborative feedback in the form of hints. We conducted an experimental comparison of these two types of feedback with third-semester sociology students in the tutorial component of an introductory statistics course. The results show that additional feedback helps students perform better during the session and on a delayed test one week later. Implications for further research and the application of such e-learning environments in university settings are discussed.

A Scoping Review of Computer-Based and Telecommunication Technology Interventions to Address Drug and Alcohol Misuse and Smoking in Women

Background Computer-based and telecommunication technology has become increasingly common to address addiction among women. This review assessed the effect of technology-based interventions on substance misuse, alcohol use, and smoking outcomes among women. Methods The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews (PRISMA-ScR) guideline was used to conduct the scoping review. Four databases (PubMed, Web of Science, PsycINFO, and Scopus) were used to search for peer-reviewed articles published in English on computer-based and telecommunication technology use to address substance misuse, alcohol use, and smoking among women. Results A total of 30 articles were selected after the final full-text review from the U.S., England, Japan, and the Netherlands. The types of technology used in the interventions included computer software (standalone or web-based), mobile applications, video calling, phone, and text messaging. Intervention outcomes included alcohol and other substance misuse reduction as polysubstance misuse (n = 5), smoking cessation (n = 10), substance misuse reduction only (n = 6), and alcohol use reduction only (n = 9). The populations reached included women who were pregnant (n = 13), postpartum (n = 4), or non-pregnant (n = 14) ranging from adolescent to adulthood. Interventions that targeted polysubstance misuse showed statistically significant reductions (p < .05). Conclusion Although effective in reducing alcohol and other substance misuse, mixed findings were identified for other outcomes targeting a single substance. Technology-based interventions might maximize their effects by targeting polysubstance misuse and addressing associated contextual issues in the form of a computer-delivered module(s).

Comparison of Computer-Based and Therapeutic Activity Interventions for Improving Visual Motor Abilities of Preschoolers with Autism: A Randomized Control Study

Background: The purpose of this study was to evaluate the effectiveness of a computer-based and a traditional activity/practice-based intervention for improving the visual motor abilities of children with autism.

Occupational therapy for cognitive impairment in stroke patients.

Occupational therapy for cognitive impairment in stroke patients.

Assessing the Virtual Early Intervention for Children with Learning Disabilities

Learning strategies are undergoing a revolution in producing successful learners. However, some children academically demonstrate inability from an early stage. The current solution to increase the academic performance of those groups of students while learning the national language at vernacular schools in Malaysia remains ineffective. Most vernacular school learners with learning disabilities have difficulty mastering the national language, containing various vocabulary and language styles. The study discusses the effectiveness of using computer-assisted early intervention in sharpening the language skill of those students. The study was conducted in three phases; identifying the current teaching method applied to learning disabilities students, experimental assessment for the technology-mediated early intervention, and analysis of those results. The experiment reveals a significant relationship between intervention implementation and national language mastering skills. Indeed, it also indicated that the computer-assisted learning styles could give positive exam results among learners with learning disabilities. The evidence from the study suggests that learning disabilities need early exposure to specific computer-based intervention as alternative learning material. Moreover, the study supports that virtual intervention would positively enhance the adaptive function for learning disabilities.

Effect of a portable computer-based educational intervention video on the outcomes of patients undergoing percutaneous coronary intervention

Effect of a portable computer-based educational intervention video on the outcomes of patients undergoing percutaneous coronary intervention

Social Equity in the Efficacy of Computer-Based and In-Person Brief Alcohol Interventions Among General Hospital Patients With At-Risk Alcohol Use: A Randomized Controlled Trial

BackgroundSocial equity in the efficacy of behavior change intervention is much needed. While the efficacy of brief alcohol interventions (BAIs), including digital interventions, is well established, particularly in health care, the social equity of interventions has been sparsely investigated.ObjectiveWe aim to investigate whether the efficacy of computer-based versus in-person delivered BAIs is moderated by the participants’ socioeconomic status (ie, to identify whether general hospital patients with low-level education and unemployed patients may benefit more or less from one or the other way of delivery compared to patients with higher levels of education and those that are employed).MethodsPatients with nondependent at-risk alcohol use were identified through systematic offline screening conducted on 13 general hospital wards. Patients were approached face-to-face and asked to respond to an app for self-assessment provided by a mobile device. In total, 961 (81% of eligible participants) were randomized and received their allocated intervention: computer-generated and individually tailored feedback letters (CO), in-person counseling by research staff trained in motivational interviewing (PE), or assessment only (AO). CO and PE were delivered on the ward and 1 and 3 months later, were based on the transtheoretical model of intentional behavior change and required the assessment of intervention data prior to each intervention. In CO, the generation of computer-based feedback was created automatically. The assessment of data and sending out feedback letters were assisted by the research staff. Of the CO and PE participants, 89% (345/387) and 83% (292/354) received at least two doses of intervention, and 72% (280/387) and 54% (191/354) received all three doses of intervention, respectively. The outcome was change in grams of pure alcohol per day after 6, 12, 18, and 24 months, with the latter being the primary time-point of interest. Follow-up interviewers were blinded. Study group interactions with education and employment status were tested as predictors of change in alcohol use using latent growth modeling.ResultsThe efficacy of CO and PE did not differ by level of education (P=.98). Employment status did not moderate CO efficacy (Ps≥.66). Up to month 12 and compared to employed participants, unemployed participants reported significantly greater drinking reductions following PE versus AO (incidence rate ratio 0.44, 95% CI 0.21-0.94; P=.03) and following PE versus CO (incidence rate ratio 0.48, 95% CI 0.24–0.96; P=.04). After 24 months, these differences were statistically nonsignificant (Ps≥.31).ConclusionsComputer-based and in-person BAI worked equally well independent of the patient’s level of education. Although findings indicate that in the short-term, unemployed persons may benefit more from BAI when delivered in-person rather than computer-based, the findings suggest that both BAIs have the potential to work well among participants with low socioeconomic status.Trial RegistrationClinicalTrials.gov NCT01291693; https://clinicaltrials.gov/ct2/show/NCT01291693