Feedback Intervention Research Articles

Physician perspectives of clinical performance feedback and impact on well-being: a qualitative exploration

ObjectivesProviding clinical performance feedback to physicians is an established method to improve care, but the impact on physician well-being is unclear. This evaluation aimed to better understand physician perspectives on...

Artificial synthetic gene circuits for dynamic monitoring and feedback intervention of chemotherapy resistance in bladder cancer

Artificial synthetic gene circuits for dynamic monitoring and feedback intervention of chemotherapy resistance in bladder cancer

Peak Flow Feedback Intervention Improves Under-Perception of Airflow Limitation in Pediatric Asthma: A Randomized Clinical Trial.

Under-perception of asthma symptoms is associated with poor asthma outcomes. We assessed the effects of a behavioral intervention for improving perception of airflow limitation and asthma outcomes. A two-arm randomized controlled trial compared peak expiratory flow (PEF) feedback versus supportive counseling. Latino and Black adolescents with asthma ages 10-17 years old and caregivers were recruited from hospitals in the Bronx, NY. PEF feedback sessions reviewed accuracy of PEF guesses and medication adherence data, and targeted behavior change using motivational interviewing and problem-solving skills training. Supportive counseling received emotional support related to asthma. Both groups received 3 sessions across 6 weeks. All participants were blinded to PEF while guessing PEF during pre-intervention, 1, 6, and 12-month follow-up. Children in PEF feedback saw actual PEF after guesses were locked in during the 6-week intervention. Participants and assessors were blinded to group assignment. The primary outcome was under-perception of airflow limitation (divergence between actual PEF and guesses) on home spirometers. Secondary outcomes included daily PEF and forced expiratory volume in 1 second (FEV1), inhaled corticosteroid adherence measured by electronic monitors, Asthma Control Test, and emergency healthcare use for asthma. The sample comprised 354 children (M = 13.2±2.2 years; 62% Latino, 38% Black) and caregivers. PEF feedback (N = 153 analyzed) demonstrated greater improvements at 1-month follow-up on under-perception of airflow limitation (difference-in-differences, -12.64; 95% CI, -17.54 to -7.74), % personal best PEF (9.89; 95% CI, 7.13 to 12.65), % predicted FEV1 (4.93; 95% CI, 0.95 to 8.90) and ICS adherence (16.02; 95% CI, 7.15 to 24.89) compared with supportive counseling (N = 152 analyzed). At 12-month follow-up PEF feedback maintained improvements on under-perception of airflow limitation (-13.87; 95% CI, -19.03 to -8.71), higher PEF (14.23; 95% CI, 11.37 to 17.08) and %FEV1 (5.62; 95% CI, 1.56 to 9.67), and had smaller declines in ICS adherence (17.51; 95% CI, 7.12 to 27.89) versus pre-intervention than supportive counseling. No between-group differences existed for asthma control or healthcare use. The efficacy and sustainability of PEF feedback was established in improving children's perception of airflow limitation, pulmonary function, and medication adherence. Clinical trial registration available at www. gov, ID: NCT02702687.

The effects of supervisory negative feedback and coaching on employees' responses to feedback: The moderating role of mindset

AbstractFeedback is a vital human resource development (HRD) practice, extensively researched and used to regulate employee behavior and performance. However, despite a century of research and immense significance and use, we still do not fully know why some accept feedback while others reject it. Critics blame both providers and recipients, as well as feedback message format, for this failure. In this study, I investigated whether the focus of the supervisory feedback (negative vs. negative and facilitative) could enhance employees' responses to feedback (e.g., acceptance and use). I also examined whether employees' mindset (i.e., fixed vs. growth) would moderate these relationships. I proposed that employee coaching (i.e., negative and facilitative) would be more accepted than negative feedback alone. In addition, I expected a positive moderating role of the growth mindset between supervisory feedback and employees' responses. To test these assumptions, I conducted a laboratory experimental vignette study (N = 69). In line with propositions, employee coaching had a larger effect on the employees' responses to feedback (e.g., feedback acceptance; M = 4.95, SD = 1.24) than negative feedback alone (M = 4.08, SD = 1.35). In addition, simple slope results showed that employee coaching was significantly higher than negative feedback for growth mindset (i.e., +1 SD). Finally, path analysis revealed that the interaction between negative feedback, employee coaching, and mindset yielded the strongest positive effect on employees' responses to feedback. Overall, findings add to and endorse calls for more future‐focused HRD practices during feedback interventions. In addition, for effective feedback, this study calls for HRD practitioners to account for all critical factors involved in feedback exchanges, from provider to recipient and feedback message.

Adoption, acceptance, and use of a decision support tool to promote timely investigations for cancer in primary care.

The complexities of diagnosing cancer in general practice has driven the development of quality improvement (QI) interventions, including clinical decision support (CDS) and auditing tools. Future Health Today (FHT) is a novel QI tool, consisting of CDS at the point-of-care, practice population-level auditing, recall, and the monitoring of QI activities. Explore the acceptability and usability of the FHT cancer module, which flags patients with abnormal test results that may be indicative of undiagnosed cancer. Interviews were conducted with general practitioners (GPs) and general practice nurses (GPNs), from practices participating in a randomized trial evaluating the appropriate follow-up of patients. Clinical Performance Feedback Intervention Theory (CP-FIT) was used to analyse and interpret the data. The majority of practices reported not using the auditing and QI components of the tool, only the CDS which was delivered at the point-of-care. The tool was used primarily by GPs; GPNs did not perceive the clinical recommendations to be within their role. For the CDS, facilitators for use included a good workflow fit, ease of use, low time cost, importance, and perceived knowledge gain. Barriers for use of the CDS included accuracy, competing priorities, and the patient population. The CDS aligned with the clinical workflow of GPs, was considered non-disruptive to the consultation and easy to implement into usual care. By applying the CP-FIT theory, we were able to demonstrate the key drivers for GPs using the tool, and what limited the use by GPNs.

Improving the teacher feedback process in primary education: evidence from randomized controlled trials in schools in rural China

ABSTRACT RCTs in primary schools in rural China show frequent personalized teacher feedback improves exam scores for Grade 3 (age 9), including those ‘left behind’ by migrating parents. Two terms of biweekly feedback increase math and language scores by 0.15 standard deviations, with an RCT texting results to parents giving 0.26 sd extra math improvement for the left-behind. Some math improvements maintain even 30 months later. Direct costs are under $5/student. Yet identical feedback produces nothing for Grade 5. Information feedback interventions thus have excellent potential, but their fall in impact with age suggests efforts must begin early.

"I Had No Idea This Happened": Electronic Feedback on Clinical Reasoning for Hospitalists.

Feedback on the diagnostic process has been proposed as a method of improving clinical reasoning and reducing diagnostic errors. Barriers to the delivery and receipt of feedback include time constraints and negative reactions. Given the shift toward asynchronous, digital communication, it is possible that electronic feedback ("e-feedback") could overcome these barriers. We developed an e-feedback system for hospitalists around episodes of care escalation (transfers to ICU and rapid responses). The intervention was evaluated by measuring hospitalists' satisfaction with e-feedback and commitment to change. A qualitative survey study conducted at one academic medical center from February to June 2023. Hospitalists - physicians and advanced practice providers. Two hospitalists, one internal medicine resident, and a nurse reviewed escalations of care on the hospitalist service each week using the Revised Safer Dx framework. Confidential feedback was emailed to the hospitalists involved in the patient's care. Hospitalists were asked to rate and explain their satisfaction with the e-feedback and whether they might modify their clinical practice based on the e-feedback. The open-ended text comments from the hospitalists were analyzed using a thematic analysis framework. Forty-nine out of fifty-eight hospitalists agreed to participate. One hundred five out of one hundred twenty-four (85%) e-feedback surveys that were sent were returned by the hospitalists. Hospitalists were highly satisfied with 67% (n = 70) of the e-feedback reports, moderately satisfied with 23% (n = 24), and not satisfied with 10% (n = 11). Six themes were identified based on analysis of the comments. Themes related to satisfaction with the intervention included appreciation for learning about patient outcomes, general appreciation of feedback on clinical care, and importance of detailed and specific feedback. Themes related to changing clinical practice included reflection on clinical decision-making, value of new insights, and anticipated future behavior change. E-feedback was well received by hospitalists. Their perspectives offer useful insights for enhancing electronic feedback interventions.

A randomized controlled trial testing the efficacy of the eCHECKUP TO GO on drinking games participation and behavior among high school seniors

BackgroundAmong high school students, seniors report the highest levels of hazardous drinking behavior, including playing drinking games. Technology-based interventions are a promising approach for reducing hazardous drinking behavior among this age group. Objectives: This randomized controlled trial investigated the efficacy of the eCHECKUP TO GO, an online personalized feedback intervention, on reducing the frequency of playing drinking games, the number of drinks consumed while playing drinking games, and the number of drinks consumed on occasions when drinking games were played among high school seniors (ClinicalTrials.gov Identifier NCT03613818). Method: Participants were recruited from two high schools. Class periods were randomized to the intervention condition or an assessment-only control condition. Participants completed online surveys at baseline, 30-day, and 6-month assessments. The subsample in this study (N = 109) consisted of high-risk drinkers (i.e., students reporting binge drinking in the past two weeks at baseline). Results: We did not find any significant differences in frequency of playing drinking games between the intervention and control conditions. For number of drinks consumed, students in the intervention condition reported a significant reduction in the number of drinks consumed while playing drinking games (p < 0.01) and total number of drinks consumed on drinking game occasions (p < 0.04) at the 30-day follow-up relative to students in the control condition. Reductions within the intervention group were sustained at the 6-month follow-up. Conclusions: Results support the efficacy of the eCHECKUP TO GO for decreasing hazardous alcohol use among high school seniors.

Preliminary Efficacy of Positive Change(+Change): A Pilot Randomized Controlled Trial of an Integrated Alcohol and Sexual Assault Prevention Program Tailored by Gender and Sexual Orientation.

The current study presents preliminary efficacy findings of a pilot randomized controlled trial of Positive Change© (+Change© ). +Change© utilizes personalized normative feedback to target alcohol use, sexual assault (SA) victimization, SA perpetration, and bystander intervention tailored for heterosexual cisgender men, heterosexual cisgender women, and sexual and gender-minoritized (SGM) groups. Participants included 165 undergraduate students aged 18 to 25 years old from a large public university in the Southwestern U.S. who engaged in past month heavy episodic drinking. Participants (57 cisgender heterosexual men; 54 cisgender heterosexual women; and 54 SGM) were randomized to +Change© (n = 83) or an assessment-only control (n = 82) and completed surveys online at baseline and 3-month follow-up in a parallel design with a 1:1 ratio (NCT04089137). The current study presents the secondary outcomes of the pilot randomized controlled trial which include alcohol use, SA victimization, SA perpetration, and bystander intervention behavior. +Change© was associated with significantly less severe SA victimization and more bystander intervention behavior at 3-month follow-up relative to the control. There were no significant differences between conditions in alcohol use at 3-month follow-up, however, the magnitude of decreases in drinking in the +Change© condition in this pilot study were consistent with other personalized normative feedback interventions. The present study was unable to assess differences in SA perpetration due to low base rates. No adverse effects among those receiving the intervention were observed. Findings suggested that +Change© may be a feasible strategy to prevent SA, by reducing student SA victimization and increasing bystander intervention. A fully powered randomized clinical trial is needed to examine the effects of +Change©.

Alcohol Feedback, Reflection, and Morning Evaluation (A-FRAME): Refining and testing feasibility and acceptability of a smartphone-delivered alcohol intervention for heavy-drinking young adults.

Young adults drink heavily and experience negative alcohol consequences. To capitalize on mornings after drinking as an optimal time to intervene, we developed a novel, theory-based personalized feedback intervention (PFI) called Alcohol Feedback, Reflection, and Morning Evaluation (A-FRAME), to reduce heavy drinking. An initial prototype was refined via feedback from college students who drink heavily. The goal of the present study was to conduct an open trial to establish feasibility and acceptability of the refined PFI. The refined PFI was delivered for 4 weeks to 18 heavy-drinking young adults (Mage = 22.61, 44% women, 66.7% White, 27.8% Black, 16.7% Asian, 5.6% Native American/Alaskan Indian, 22.2% Hispanic/Latino). Participants completed a goal-setting procedure, followed by 28 daily surveys. Surveys indicating prior-day drinking were followed by the option to view personalized feedback (e.g., goal attainment, blood alcohol concentration [BAC], peer norms, protective behaviors). Aggregated feedback was also delivered at the 14- and 28-day marks. Participants completed a post-test acceptability survey and individual interviews to inform further refinement. The response rate to daily surveys was 93.8% and all participants completed study procedures, demonstrating feasibility. Daily feedback was reviewed about half (45.5%) of the time it was offered (i.e., following drinking days). Biweekly feedback was viewed 50% and 56% of the time at 14- and 28-day marks, respectively. Other benchmarks for acceptability were supported by survey and interview results. Open trial results support the feasibility and acceptability of this theory-based intervention for heavy-drinking young adults. A planned randomized controlled trial will evaluate efficacy.

Raising the barcode: improving medication safety behaviours through a behavioural science-informed feedback intervention. A quality improvement project and difference-in-difference analysis

Barcode medication administration (BCMA) technology can improve patient safety by using scanning technology to ensure the right drug and dose are given to the right patient. Implementation can be challenging,...

Shaping stable support: Leveraging digital feedback interventions to elicit socio-Political acceptance of renewable energy

In democratic countries, the success of energy policies hinges on citizens' support and their acceptance of policy outcomes. In this study, we develop a digital feedback intervention to prompt citizens with information that visualizes the geographical distribution of wind turbines and to evaluate the effects on socio-political acceptance. In an online experiment, we exposed 430 German citizens to a personalized digital feedback intervention and elicited their acceptance of renewable wind energy. The results are threefold: First, citizens' acceptance of renewable wind energy that results from digital feedback is lower than initially claimed. Second, citizens who meaningfully engage with the digital feedback intervention are more likely to revise their acceptance of wind energy. Third, and surprisingly, citizens’ ecological attitude and place attachment to their current residence had no significant effect on the extent to which they revised their acceptance of renewable wind energy. Our results demonstrate that digital feedback interventions can act as a “sensor” for socio-political acceptance. This contributes to informing citizens about energy policy outcomes and provides valuable insights for policymakers promoting a participatory democracy paradigm.

Evaluating video feedback to improve eSports performance in Street Fighter V

AbstracteSports is a newly rising field with rapidly increasing cultural validity. Despite the wide array of similarities between eSports and traditional sports, behavioral skill acquisition interventions have yet to be applied to video game skills. Although video feedback has been established as effective for traditional sports, further research is needed to validate its efficacy as a standalone intervention. In this study, the effects of video feedback were analyzed with three participants in a nonconcurrent multiple baseline across subjects design. Participants performed a specific in‐game behavior (an anti‐air attack) in a controlled match against the researcher, then viewed recordings of their performance and received positive and corrective feedback from the researchers. The generalization of the skill improvement was evaluated through the rate of successful skill implementation in ranked online matches. Results showed that the video feedback intervention improved performance over baseline for all participants and generalized to online matches.

Process evaluation of two large randomized controlled trials to understand factors influencing family physicians’ use of antibiotic audit and feedback reports

BackgroundUnnecessary antibiotic prescriptions in primary care are common and contribute to antimicrobial resistance in the population. Audit and feedback (A&F) on antibiotic prescribing to primary care can improve the appropriateness of antibiotic prescribing, but the optimal approach is uncertain. We performed two pragmatic randomized controlled trials of different approaches to audit and feedback. The trial results showed that A&F was associated with significantly reducing antibiotic prescribing. Still, the effect size was small, and the modifications to the A&F interventions tested in the trials were not associated with any change. Herein, we report a theory-informed qualitative process evaluation to explore potential mechanisms underlying the observed effects.MethodsOntario family physicians in the intervention arms of both trials who were sent A&F letters were invited for one-on-one interviews. Purposive sampling was used to seek variation across interested participants in personal and practice characteristics. Qualitative analysis utilized inductive and deductive techniques informed by the Clinical Performance Feedback Intervention Theory.ResultsModifications to the intervention design tested in the trial did not alter prescribing patterns beyond the changes made in response to the A&F overall for various reasons. Change in antibiotic prescribing in response to A&F depended on whether it led to the formation of specific intentions and whether those intentions translated to particular behaviours. Those without intentions to change tended to feel that their unique clinical context was not represented in the A&F. Those with intentions but without specific actions taken tended to express a lack of self-efficacy for avoiding a prescription in contexts with time constraints and/or without an ongoing patient relationship. Many participants noted that compared to overall prescribing, A&F on antibiotic prescription duration was perceived as new information and easily actionable.ConclusionOur findings indicate that contextual factors, including the types of patients and the setting where they are seen, affect how clinicians react to audit and feedback. These results suggest a need to test tailored feedback reports that reflect the context of how, where, and why physicians prescribe antibiotics so that they might be perceived as more personal and more actionable.Trial registrationClinical Trial registration IDs: NCT04594200, NCT05044052.

Effects of Haptic Feedback Interventions in Post-Stroke Gait and Balance Disorders: A Systematic Review and Meta-Analysis.

Background: Haptic feedback is an established method to provide sensory information (tactile or kinesthetic) about the performance of an activity that an individual can not consciously detect. After a stroke, hemiparesis usually leads to gait and balance disorders, where haptic feedback can be a promising approach to promote recovery. The aim of the present study is to understand its potential effects on gait and balance impairments, both after interventions and in terms of immediate effects. Methods: This research was carried out using the following scientific databases: Embase, Scopus, Web of Science, and Medline/PubMed from inception to May 2024. The Checklist for Measuring quality, PEDro scale, and the Cochrane collaboration tool were used to assess the methodological quality and risk of bias of the studies. Results: Thirteen articles were chosen for qualitative analysis, with four providing data for the meta-analysis. The findings did not yield definitive evidence on the effectiveness of haptic feedback for treating balance and gait disorders following a stroke. Conclusions: Further research is necessary in order to determine the effectiveness of haptic feedback mechanisms, with larger sample sizes and more robust methodologies. Longer interventions and pre-post design in gait training with haptic feedback are necessary.

Perioperative pain management intervention in older patients with hip fracture in an orthogeriatric unit. A controlled before/after study assessing an audit and feedback intervention (PAIN-AGE)

BackgroundPostoperative pain delays ambulation, extends hospital stay, reduces the probability of recovery, and increases risk of long-term functional impairment. Pain management in hip fractured patients poses a challenge to the healthcare teams. Older adults are more vulnerable to opioid-associated side effect and it is primordial to minimize their exposure to opioids. Acetaminophen is associated with reduced opioid use so we need to focus on acetaminophen use in first-line analgesia.MethodsWe conducted a controlled before/after study to assess the ability of an audit and feedback (A&F) intervention built with nurses to improve the quality of perioperative pain management in older patients hospitalized for hip fracture in an orthogeriatric unit (experimental group) versus a conventional orthopedic unit (no A&F intervention). The primary endpoint was the percentage of patients who received 3 g/day of acetaminophen during the three postoperative days, before and after the A&F intervention. Secondary endpoints included nurses’ adherence to medical prescriptions, clinical data associated with patients and finally factors associated with intervention. The significative level was set at 0.05 for statistical analysis.ResultsWe studied data from 397 patients (mean age 89 years, 75% female). During the postoperative period, 16% of patients from the experimental group received 3 g/day of acetaminophen before the A&F intervention; the percentage reached 60% after the intervention. The likelihood of receiving 3 g/day of acetaminophen during the postoperative period and adhering to the medical prescription of acetaminophen were significantly increased in the experimental group as compared with the control group. The patient’s functional status at discharge (assessed by Activities of Daily Living scores) was significantly better and the length of hospital stay significantly reduced after the A&F intervention.ConclusionOur controlled before/after study showed that an A&F intervention significantly improved perioperative pain management in older adults hospitalized for hip fracture. Involving teams in continuous education programs appears crucial to improve the quality of pain management and ensure nurses’ adherence to medical prescriptions.

Do Physicians Improve More from Positive or Negative Feedback?

We use clinical data on more than 240,000 surgeries and quasi-experimental methods to examine how physicians respond to the surprise release of a performance “report card.” Such feedback interventions are commonly used to encourage physicians to improve performance yet show limited evidence of success. Our results show that these limited effects mask heterogeneous behavioral responses to feedback valence. In particular, physicians improve more from positive feedback than from negative feedback, with negative feedback even reducing performance for a nontrivial share of patients. Experiments with laypersons replicate these results and show that struggles with negative feedback can be mitigated by giving incentives directly tied to improvement and by adding qualitative information that helps individuals interpret past performance. These results are consistent with behavioral models that suggest cognitive and emotional difficulties limit how well individuals use negative feedback. Thus, feedback interventions in healthcare should be carefully designed to mitigate these counterproductive behavioral responses. This paper was accepted by Ranjani Krishnan, accounting. Funding: We acknowledge generous funding provided by Tilburg University and the University of Massachusetts Amherst to run the laboratory experiments. Supplemental Material: The online appendices and data files are available at https://doi.org/10.1287/mnsc.2023.01340 .

The Impact of Feedback on First-Year University Students' Writing Development: A Study at A University in Hanoi, Vietnam

This study investigates the impact of feedback on the writing development of first-year university students, employing a mixed-methods approach to provide a comprehensive analysis. The quantitative phase involved pre- and post-tests of 118 students, revealing significant improvements in coherence, clarity, grammar, and overall writing quality. The paired samples test results showed mean differences of -2.076 for coherence, -1.983 for clarity, -0.441 for grammar, and -2.119 for overall quality, all with p-values of 0.000, indicating substantial enhancements due to the feedback intervention. The qualitative phase explored students' perceptions of feedback through surveys and semi-structured interviews with 20 students. Findings indicated that detailed, constructive, and timely feedback positively influenced students' motivation, engagement, and reduced writing anxiety. Conversely, vague or overly critical feedback had detrimental effects on these aspects. This study provides valuable insights into the feedback mechanisms that best support first-year students' writing development, offering evidence-based recommendations for educators to enhance teaching strategies and improve academic outcomes.

Empirical Research on AI Technology-Supported Precision Teaching in High School Science Subjects

The empowerment of educational reform and innovation through AI technology has become a topic of increasing interest in the field of education. The advent of AI technology has made comprehensive and in-depth teaching evaluation possible, serving as a significant driving force for efficient and precise teaching. There were few empirical studies on the application of high-quality precision teaching models in the field of compulsory education, and the learning difficulty of technology and the teaching burden on teachers have become significant factors hindering the use of technology to support education. This study analyzed teaching models from the perspectives of teachers’ teaching burdens and students’ learning obstacles, and was committed to relying on intelligent technology to construct a new precision teaching model, an educational diagnosis–feedback–intervention path that covered the entire teaching process, from the dimensions of teacher behavior, student behavior, and parent behavior, aiming to assist teachers in efficient teaching and students in personalized learning. This study was conducted with nine science classes, including about 540 people in the second year of high school at a Middle School in China; six classes were the intervention groups while the last three classes were control groups, and a survey of 19 teachers from the intervention classes was carried out. The results showed that this model can significantly improve students’ academic performance in science subjects, especially in mathematics and chemistry. It has increased the proportion of high-achieving students, reduced the proportion of low-achieving students, stimulated students’ self-directed learning ability, cultivated a positive attitude towards science learning, and explained the key points of using a precision teaching model in different disciplines. It has achieved a deep integration of education and technology, helping to increase the efficiency and reduce the burden of teaching.

Reducing Alcohol Misuse and Promoting Treatment Initiation Among Veterans Through a Brief Internet-Based Intervention: Protocol for a Randomized Controlled Trial.

Young adult veterans who served after the September 11 attacks on the United States in 2001 (ie, post-9/11) are at heightened risk for experiencing behavioral health distress and disorders including hazardous drinking, posttraumatic stress disorder, and depression. These veterans often face significant barriers to behavioral health treatment, and reaching them through brief mobile phone-based interventions may help reduce drinking and promote treatment engagement. Following a successful pilot study, this randomized controlled trial (RCT) aims to further test the efficacy of a brief (ie, single session) mobile phone-delivered personalized normative feedback intervention enhanced with content to promote treatment engagement. We will conduct an RCT with 800 post-9/11 young adult veterans (aged 18 to 40 years) with potentially hazardous drinking and who have not recently received treatment for any behavioral health problems. Participants will be randomly assigned to the personalized intervention or a control condition with resources for seeking care. The personalized normative feedback module in the intervention focuses on the correction of misperceived norms of peer alcohol use and uses empirically informed approaches to increase motivation to address alcohol use and co-occurring behavioral health problems. Past 30-day drinking, alcohol-related consequences, and treatment-seeking behaviors will be assessed at baseline and 3, 6, 9, and 12 months post intervention. Sex, barriers to care, posttraumatic stress disorder, depression, and severity of alcohol use disorder symptoms will be explored as potential moderators of outcomes. We expect recruitment to be completed within 6 months, with data collection taking 12 months for each enrolled participant. Analyses will begin within 3 months of the final data collection point (ie, 12 months follow-up). This RCT will evaluate the efficacy of a novel intervention for non-treatment-seeking veterans who struggle with hazardous drinking and possible co-occurring behavioral health problems. This intervention has the potential to improve veteran health outcomes and overcome significant barriers to treatment. ClinicalTrials.gov NCT04244461; https://clinicaltrials.gov/study/NCT04244461. DERR1-10.2196/59993.