Dulin Patrick, Mertz Robyn, Edwards Alexandra, King Diane
Department of Psychology, University of Alaska Anchorage, Anchorage, AK, United States.
Center for Behavior Research and Services, University of Alaska Anchorage, Anchorage, AK, United States.
JMIR Form Res. 2022 May 16;6(5):e33037. doi: 10.2196/33037.
Mobile apps have shown considerable promise for reducing alcohol consumption among problem drinkers, but like many mobile health apps, they frequently report low utilization, which is an important limitation, as research suggests that effectiveness is related to higher utilization. Interactive chatbots have the ability to provide a conversational interface with users and may be more engaging and result in higher utilization and effectiveness, but there is limited research into this possibility.
This study aimed to develop a chatbot alcohol intervention based on an empirically supported app (Step Away) for reducing drinking and to conduct a pilot trial of the 2 interventions. Included participants met the criteria for hazardous drinking and were interested in reducing alcohol consumption. The study assessed utilization patterns and alcohol outcomes across the 2 technology conditions, and a waitlist control group.
Participants were recruited using Facebook advertisements. Those who met the criteria for hazardous consumption and expressed an interest in changing their drinking habits were randomly assigned to three conditions: the Step Away app, Step Away chatbot, and waitlist control condition. Participants were assessed on the web using the Alcohol Use Disorders Identification Test, Adapted for Use in the United States, Readiness to Change Questionnaire, Short Inventory of Problems-Revised, and Timeline Followback at baseline and at 12 weeks follow-up.
A total of 150 participants who completed the baseline and follow-up assessments were included in the final analysis. ANOVA results indicated that participants in the 3 conditions changed their drinking from baseline to follow-up, with large effect sizes noted (ie, η=0.34 for change in drinks per day across conditions). However, the differences between groups were not significant across the alcohol outcome variables. The only significant difference between conditions was in the readiness to change variable, with the bot group showing the greatest improvement in readiness (F=5.6; P=.004; η=0.07). The results suggested that the app group used the app for a longer duration (mean 50.71, SD 49.02 days) than the bot group (mean 27.16, SD 30.54 days; P=.02). Use of the interventions was shown to predict reduced drinking in a multiple regression analysis (β=.25, 95% CI 0.00-0.01; P=.04).
Results indicated that all groups in this study reduced their drinking considerably from baseline to the 12-week follow-up, but no differences were found in the alcohol outcome variables between the groups, possibly because of a combination of small sample size and methodological issues. The app group reported greater use and slightly higher usability scores than the bot group, but the bot group demonstrated improved readiness to change scores over the app group. The strengths and limitations of the app and bot interventions as well as directions for future research are discussed.
ClinicalTrials.gov NCT04447794; https://clinicaltrials.gov/ct2/show/NCT04447794.
移动应用程序在减少问题饮酒者的酒精摄入量方面显示出了巨大的潜力，但与许多移动健康应用程序一样，它们经常报告利用率较低，这是一个重要的局限性，因为研究表明有效性与更高的利用率相关。交互式聊天机器人能够为用户提供对话界面，可能更具吸引力，从而带来更高的利用率和有效性，但对此可能性的研究有限。
本研究旨在基于一个经实证支持的应用程序（远离）开发一种聊天机器人酒精干预措施，以减少饮酒量，并对这两种干预措施进行试点试验。纳入的参与者符合危险饮酒标准，且有兴趣减少酒精摄入量。该研究评估了两种技术条件以及一个等待名单对照组的使用模式和酒精摄入结果。
通过脸书广告招募参与者。那些符合危险饮酒标准并表示有兴趣改变饮酒习惯的人被随机分配到三个组：远离应用程序组、远离聊天机器人组和等待名单对照组。参与者在网络上使用美国版酒精使用障碍识别测试、改变意愿问卷、问题简短清单修订版以及基线和12周随访时的时间线追溯法进行评估。
最终分析纳入了150名完成基线和随访评估的参与者。方差分析结果表明，三组参与者从基线到随访期间饮酒量都有变化，效应量较大（即，各条件下每天饮酒量变化的η=0.34）。然而，在酒精摄入结果变量方面，组间差异不显著。各条件之间唯一显著的差异在于改变意愿变量，聊天机器人组在改变意愿方面改善最大（F=5.6；P=.004；η=0.07）。结果表明，应用程序组使用应用程序的时间（平均50.71天，标准差49.02天）比聊天机器人组（平均27.16天，标准差30.54天；P=.02）更长。在多元回归分析中，干预措施的使用被证明可以预测饮酒量的减少（β=.25，95%置信区间0.00 - 0.01；P=.04）。
结果表明，本研究中的所有组从基线到12周随访期间饮酒量都有显著减少，但组间在酒精摄入结果变量方面未发现差异，这可能是由于样本量小和方法学问题共同导致的。应用程序组报告的使用频率更高，可用性得分略高于聊天机器人组，但聊天机器人组在改变意愿得分方面比应用程序组有所提高。讨论了应用程序和聊天机器人干预措施的优势和局限性以及未来研究的方向。试验注册：ClinicalTrials.gov NCT04447794；https://clinicaltrials.gov/ct2/show/NCT04447794 。
