Computer-generated Feedback Letters Research Articles

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.

Can brief alcohol interventions in general hospital inpatients improve mental and general health over 2 years? Results from a randomized controlled trial.

Little is known about the impact of brief alcohol interventions on mental and general health. The aim was to investigate whether brief interventions for general hospital inpatients with at-risk drinking can improve mental and general health over 2 years; and whether effects are dependent on how they are delivered: in-person or through computer-generated feedback letters (CO). Three-arm randomized controlled trial with 6-, 12-, 18-, and 24-month follow-ups. Data were collected on 13 general hospital wards from four medical departments (internal medicine, surgical medicine, trauma surgery, and ear-nose-throat) of one university hospital in northeastern rural Germany. A consecutive sample of 961 18- to 64-year-old general hospital inpatients with at-risk alcohol use was recruited through systematic screening. Inpatients with particularly severe alcohol problems were excluded. Participants were allocated to: in-person counseling (PE), CO, and assessment only (AO). PE and CO included three contacts: on the ward, 1, and 3 months later. Mental and general health were assessed using the five-item mental health inventory (0-100) and a one-item general health measure (0, poor - 4, excellent). Latent growth models including all participants revealed: after 24 months and in contrast to AO, mental and general health were improved in PE (change in mean difference, ΔMmental = 5.13, p = 0.002, Cohen's d = 0.51; ΔMgeneral = 0.20, p = 0.005, d = 0.71) and CO (ΔMmental = 6.98, p < 0.001, d = 0.69; ΔMgeneral = 0.24, p = 0.001, d = 0.86). PE and CO did not differ significantly. Beyond drinking reduction, PE and CO can improve general hospital inpatients' self-reported mental and general health over 2 years.

In-person alcohol counseling versus computer-generated feedback: Results from a randomized controlled trial.

To investigate the comparative 2-year efficacy of brief alcohol interventions delivered in-person versus through computer-generated feedback letters among general hospital inpatients with at-risk alcohol use. In 2011-2012, all general hospital inpatients aged 18-64 years on 13 wards at 4 medical departments in 1 general hospital were systematically screened for at-risk alcohol use. Nine-hundred sixty-one inpatients who screened positive for at-risk alcohol use and negative for more severe alcohol problems were randomized by timeframe to in-person counseling (PE), computer-generated feedback letters (CO) and assessment only (AO). Both interventions included 3 contacts: on the ward and 1 and 3 months later and were based on the transtheoretical model (TTM). After 6, 12, 18, and 24 months computer-assisted telephone interviews assessed self-report outcomes: gram alcohol per week (primary), at-risk alcohol use and highest blood alcohol concentration (both secondary). Latent growth models were used. After 24 months, CO resulted in a greater reduction of self-reported gram alcohol per week than AO (p = .027); PE did not differ significantly from AO (p = .503) and CO (p = .088); and group differences concerning secondary outcomes were not statistically significant (ps > 0.07). After 6 months, the odds of at-risk alcohol use were reduced by half in PE versus AO (odds ratio = 0.50, 95% confidence interval: 0.25-0.98). No significant group differences between in-person counseling and computer-generated feedback letters were found. TTM-based computer-generated feedback letters reduced self-reported gram alcohol over 2 years and can be considered a long-term effective alternative in medical settings when addressing at-risk alcohol use. (PsycINFO Database Record

How alcohol use problem severity affects the outcome of brief intervention delivered in-person versus through computer-generated feedback letters

ObjectiveThe aim was to test if people with different alcohol use problem severity benefitted differentially from brief alcohol interventions delivered in-person versus through computer-generated feedback letters. MethodsNine hundred sixty-one 18–64year old general hospital inpatients with at-risk alcohol use (mean age=40.9years [standard deviation=14.1], 75% men) were randomized to a) in-person counseling, b) computer-generated individualized feedback letters, or c) assessment only. Both interventions were delivered on the ward and 1 and 3 months later. Outcome was the change in the self-reported alcohol use per day at 6-, 12-, 18-, and 24-month follow-up. The Alcohol Use Disorder Identification Test (AUDIT) score was tested as a moderator of the effect of in-person counseling and computer-generated feedback letters, with higher AUDIT scores indicating more severe alcohol problems. ResultsCompared to assessment only, computer-generated feedback letters more strongly reduced alcohol use over 24 months among persons with AUDIT scores of about 8 and lower (ps <0.05). In-person counseling tended to be superior over assessment only among persons scoring high on the AUDIT, but differences were not statistically significant. Six-, 12-, and 18-month differences between in-person counseling and computer-generated feedback letters were significant (ps<0.05) for persons with AUDIT scores below 7.1–7.7. The differences between both interventions attenuated at 24-month follow-up. ConclusionsComputer-based intervention delivery may be superior over in-person delivery for people with low levels of alcohol use problem severity, whereas those with more severe alcohol problems may require more intensive care.

Who benefits from computer-based brief alcohol intervention? Day-to-day drinking patterns as a moderator of intervention efficacy

Objectiveto test if people with different day-to-day drinking patterns benefitted differently from two brief alcohol interventions (BAIs). MethodsA total of 1243 job-seekers with at-risk alcohol use aged 18–64 years (64% men) were randomized to (a) intervention tailored to the motivational stage (ST), (b) non-stage tailored intervention (NST), or (c) assessment only (AO). ST and NST contained individualized computer-generated feedback letters. Follow-ups were conducted at months 3, 6, and 15. Using growth mixture models, day-to-day drinking patterns were identified based on the number of drinks consumed on each day in the week prior to baseline assessment. To test drinking pattern-specific intervention effects, zero-inflated growth models were used. Outcomes were (1) the 15-month change in the likelihood of any alcohol use and (2) the 15-month change in the total number of drinks per week when alcohol was consumed. ResultsFour day-to-day drinking patterns were found: daily medium use (2–4 drinks/day; 47%), daily low use (1–2 drinks/day; 29%), weekend only use (18%), and no use (6%). Only persons with daily low use benefitted from intervention, with higher odds of being abstinent after 15 months in the ST group compared to AO (odds ratio, OR=1.67, p=0.001) and NST group (OR=1.43, p=0.035). ST worked better among persons with daily low use compared to daily medium use (OR=1.91, p=0.001). ConclusionsAmong at-risk drinking persons with regular low-quantity alcohol use, stage tailored BAIs may be superior over no BAI and non-stage tailored BAIs.

Testing the efficacy of brief alcohol interventions provided through different delivery channels: study design

In the past 20 years, research has shown that brief interventions are effective in reducing health risk behaviors. Now we are in the second generation of brief intervention trials, investigating how to improve efficacy, including the investigation of cost-saving communication channels. Our aim was to investigate whether motivationally tailored interventions are more effective in reducing unhealthy alcohol use when delivered by computer or in person. Proactively recruited general hospital inpatients with unhealthy alcohol use (n=975) participated in a randomized controlled trial, and were allocated to one of three groups: 1) individualized theory-based computer generated feedback letters, 2) motivational interviewing based counselling, and 3) assessment only (controls). Both intervention groups received up to three interventions. All groups are followed up at 6, 12, 18 and 24 months. Between February 2011 and December 2012, recruitment and interventions have been completed. We have assessed 10,591 inpatients aged 18-64 years for eligibility. We have screened 6,236 inpatients regarding unhealthy alcohol use, corresponding to 91.1% of those eligible. Of all inpatients with unhealthy alcohol use, 80.6% gave informed consent to participate in the trial. So far, 71.3% to 81.5% of these have participated in the follow-ups. A large study has been successfully implemented at a general hospital. Satisfactory participation rates provide a solid basis to investigate the comparative efficacy of brief alcohol interventions delivered by computer versus in person. The follow-up period of up to 24 months provides an excellent opportunity to investigate gradually increasing effects.

The Impact of a Computer-Tailored Nutrition Intervention

Background.Nutrition education tailored to individual characteristics of people might be more effective than general nutrition education. Nowadays, the use of computers makes individualized feedback available for larger groups.Methods.The impact of tailored nutrition information on changes in fat, vegetable, and fruit consumption was tested in a randomized trial among 347 employees of a major oil company. Respondents in the experimental group received computer-generated feedback letters tailored to their personal dietary behavior, attitudes, perceived social influences, self-efficacy expectations, and awareness levels. Respondents in the control group received general nutrition information.Results.Respondents in the experimental group decreased their fat consumption significantly more than the control group between baseline and posttest. A significant effect of tailoring was also found for changes in attitudes and intentions toward reducing fat intake and increasing fruit and vegetable consumption. Furthermore, respondents in the experimental group were more satisfied with the nutrition information they received and more often reported changing their diet or intention as a result of the information.Conclusions.It is concluded that computer-tailored nutrition information is a promising means of stimulating people to change their diet toward dietary recommendations.