Behaviour change in 160 characters: a novel brief alcohol intervention for disadvantaged men

Abstract Background Men from disadvantaged areas experience substantial alcohol-related harm. However such men can be missed by the conventional method of delivering brief alcohol interventions through primary care. This feasibility study designed and evaluated the potential of a brief alcohol intervention delivered by text message. The intervention aims to reduce the frequency of binge drinking. Methods Disadvantaged men aged 25–44 years who had two or more episodes of binge drinking (≥8 units of alcohol in a single session) in the preceding month were recruited and randomised to receive either text messages designed to encourage moderated drinking (intervention group) or general health messages (control group). We report here on the feasibility of study methods. Two recruitment strategies were used: general practice registers and community outreach. The intervention drew on literature on alcohol brief interventions, text message studies, communication theory, and behaviour change theories and techniques. Tailored text messages were developed through focus groups with disadvantaged men. Findings Both recruitment strategies proved successful, with 67 men recruited (target=60). At baseline many men had regular heavy drinking episodes interspersed with several days of sobriety. About a quarter of men had frequent episodes of failing to remember the night before. Men recruited through community outreach drank more than double that of men recruited through general practices (mean 137·1 units per month [SD 134·9] vs 61·7 [50·0], p=0·006). More men recruited through community outreach than through practices had greater than 5 binge drinking days per month (17/30 [57%] vs 6/37 [17%], p=0·02). Retention at follow-up was 96% (64/67). Extensive process evaluation showed that 1053 (95%) of 1108 text messages were successfully delivered to participants' phones. In addition, a high level of engagement with text messages was noted, with 30 (88%) of 34 participants in the intervention group responding to messages that asked questions. Content analysis of responses showed engagement with key components of the behaviour change strategy. Post-study evaluation showed high levels of satisfaction with the intervention. Interpretation Disadvantaged men were successfully recruited and retained in an alcohol intervention study. A theoretically and empirically based intervention was successfully delivered by text message. Furthermore, the messages were well received and elicited the types of response intended. This feasibility study suggests that the intervention offers a low-cost method of reaching large numbers of hazardous drinkers. Funding This project was funded by the National Institute for Health Research Public Health Research programme (project number 09/3001/09).