Thomas Kristin, Linderoth Catharina, Bendtsen Marcus, Bendtsen Preben, Müssener Ulrika
Division of Community Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
JMIR Mhealth Uhealth. 2016 Oct 20;4(4):e119. doi: 10.2196/mhealth.5863.
Drinking of alcohol among university students is a global phenomenon; heavy episodic drinking is accepted despite several potential negative consequences. There is emerging evidence that short message service (SMS) text messaging interventions are effective to promote behavior change among students. However, it is still unclear how effectiveness can be optimized through intervention design or how user interest and adherence can be maximized.
The objective of this study was to develop an SMS text message-based intervention targeting alcohol drinking among university students using formative research.
A formative research design was used including an iterative revision process based on input from end users and experts. Data were collected via seven focus groups with students and a panel evaluation involving students (n=15) and experts (n=5). Student participants were recruited from five universities in Sweden. A semistructured interview guide was used in the focus groups and included questions on alcohol culture, message content, and intervention format. The panel evaluation asked participants to rate to what degree preliminary messages were understandable, usable, and had a good tone on a scale from 1 (very low degree) to 4 (very high degree). Participants could also write their own comments for each message. Qualitative data were analyzed using qualitative descriptive analysis. Quantitative data were analyzed using descriptive statistics. The SMS text messages and the intervention format were revised continuously in parallel with data collection. A behavior change technique (BCT) analysis was conducted on the final version of the program.
Overall, students were positive toward the SMS text message intervention. Messages that were neutral, motivated, clear, and tangible engaged students. Students expressed that they preferred short, concise messages and confirmed that a 6-week intervention was an appropriate duration. However, there was limited consensus regarding SMS text message frequency, personalization of messages, and timing. Overall, messages scored high on understanding (mean 3.86, SD 0.43), usability (mean 3.70, SD 0.61), and tone (mean 3.78, SD 0.53). Participants added comments to 67 of 70 messages, including suggestions for change in wording, order of messages, and feedback on why a message was unclear or needed major revision. Comments also included positive feedback that confirmed the value of the messages. Twenty-three BCTs aimed at addressing self-regulatory skills, for example, were identified in the final program.
The formative research design was valuable and resulted in significant changes to the intervention. All the original SMS text messages were changed and new messages were added. Overall, the findings showed that students were positive toward receiving support through SMS text message and that neutral, motivated, clear, and tangible messages promoted engagement. However, limited consensus was found on the timing, frequency, and tailoring of messages.
大学生饮酒是一种全球现象；尽管存在一些潜在的负面后果，但大量饮酒仍被接受。越来越多的证据表明，短信干预措施对于促进学生行为改变是有效的。然而，仍不清楚如何通过干预设计优化效果，或者如何最大限度地提高用户兴趣和依从性。
本研究的目的是通过形成性研究开发一种针对大学生饮酒行为的基于短信的干预措施。
采用形成性研究设计，包括基于终端用户和专家意见的迭代修订过程。通过与学生进行的7个焦点小组讨论以及一项涉及学生（n = 15）和专家（n = 5）的小组评估收集数据。学生参与者从瑞典的五所大学招募。焦点小组讨论中使用了半结构化访谈指南，包括关于饮酒文化、信息内容和干预形式的问题。小组评估要求参与者按照从1（非常低程度）到4（非常高程度）的量表对初步信息在多大程度上易于理解、可用且语气良好进行评分。参与者还可以为每条信息写下自己的评论。定性数据采用定性描述性分析进行分析。定量数据采用描述性统计进行分析。短信内容和干预形式在数据收集过程中并行不断修订。对该项目的最终版本进行了行为改变技术（BCT）分析。
总体而言，学生对短信干预措施持积极态度。中立、有激励性、清晰且具体的信息能够吸引学生。学生表示他们更喜欢简短、简洁的信息，并确认6周的干预时长是合适的。然而，在短信发送频率、信息个性化以及发送时间方面，共识有限。总体而言，信息在理解度（平均3.86，标准差0.43）、可用性（平均3.70，标准差0.61）和语气（平均3.78，标准差0.53）方面得分较高。参与者对70条信息中的67条添加了评论，包括对措辞改变、信息顺序的建议，以及关于某条信息为何不清楚或需要大幅修改的反馈。评论中也包括确认信息价值的积极反馈。例如，在最终项目中确定了23项旨在解决自我调节技能的行为改变技术。
形成性研究设计很有价值，并导致干预措施发生了重大变化。所有原始短信都进行了修改，并添加了新信息。总体而言，研究结果表明学生对通过短信获得支持持积极态度，中立、有激励性、清晰且具体的信息能够促进参与。然而，在信息的发送时间、频率和个性化定制方面，共识有限。
