Identification of behaviour change techniques and engagement strategies to design a smartphone app to reduce alcohol consumption using a formal consensus method

Background: Digital interventions to reduce excessive alcohol consumption have the potential to have a broader reach and be more cost-effective than traditional brief interventions. However, there is not yet a strong evidence base on their ability to engage users or on their effectiveness. Objective: This study aimed to identify the behaviour change techniques (BCTs) and engagement strategies most worthy of further study by inclusion in a smartphone application (app) to reduce alcohol consumption, using formal expert consensus methods. Methods: The first phase of the study consisted of a Delphi exercise with three rounds. It was conducted with seven international experts in the field of alcohol and/or behaviour change. In the first round, experts identified BCTs most likely to be effective at reducing alcohol consumption and strategies most likely to engage users with an app; these were rated in the second round; and those rated as effective by at least four out of seven participants were ranked in the third round. The rankings were analysed using Kendall’s W coefficient of concordance, which indicates consensus between participants. The second phase consisted of a new, independent group of experts (n=43) ranking the BCTs that were identified in the first phase. The correlation between the rankings of the two groups was assessed using Spearman’s rank correlation coefficient. Results: Twelve BCTs were identified as likely to be effective. There was moderate agreement among the experts over their ranking (W=.465, χ2(11)=35.77, P<.001) and the BCTs receiving the highest mean rankings were self-monitoring, goal-setting, action planning, and feedback in relation to goals. There was a significant correlation between the ranking of the BCTs by the group of experts who identified them and a second independent group of experts (Spearman’s rho=.690, P=.01). Seventeen responses were generated for strategies likely to engage users. There was moderate agreement among experts on the ranking of these engagement strategies (W=.563, χ2(15)=59.16, P<.001) and those with the highest mean rankings were ease of use, design – aesthetic, feedback, function, design – ability to change design to suit own preferences, tailored information, and unique smartphone features. Conclusions: The BCTs with greatest potential to include in a smartphone app to reduce alcohol consumption were judged by experts to be self-monitoring, goal-setting, action planning, and feedback in relation to goals. The strategies most likely to engage users were ease of use, design, tailoring of design and information, and unique smartphone features

Starbursts and Star Clusters in the Ultraviolet

Hubble Space Telescope ultraviolet (UV) images of nine starburst galaxies reveal them to be highly irregular, even after excluding compact sources (clusters and resolved stars). Most (7/9) are found to have a similar intrinsic effective surface brightnesses, suggesting that a negative feedback mechanism is setting an upper limit to the star formation rate per unit area. All starbursts in our sample contain UV bright star clusters indicating that cluster formation is an important mode of star formation in starbursts. On average about 20% of the UV luminosity comes from these clusters. The brightest clusters, or super star clusters (SSC), are preferentially found at the very heart of starbursts. The size of the nearest SSCs are consistent with those of Galactic globular clusters. The luminosity function of SSCs is well represented by a power law with a slope alpha ~ -2. There is a strong correlation between the far infrared excess and the UV spectral slope. The correlation is well modeled by a geometry where much of their dust is in a foreground screen near to the starburst, but not by a geometry of well mixed stars and dust.Comment: 47 pages, text only, LaTeX with aaspp.sty (version 3.0), compressed postscript figures available at ftp://eta.pha.jhu.edu/RecentPublications/meurer

The Mid-infrared Fine-structure Lines of Neon as an Indicator of Star For mation Rate in Galaxies

The fine-structure lines of singly ([Ne II] 12.8 micron) and doubly ([Ne III] 15.6 micron) ionized neon are among the most prominent features in the mid-infrared spectra of star-forming regions, and have the potential to be a powerful new indicator of the star formation rate in galaxies. Using a sample of star-forming galaxies with measurements of the fine-structure lines available from the literature, we show that the sum of the [Ne II] and [Ne III] luminosities obeys a tight, linear correlation with the total infrared luminosity, over 5 orders of magnitude in luminosity. We discuss the formation of the lines and their relation with the Lyman continuum luminosity. A simple calibration between star formation rate and the [Ne II]+[Ne III] luminosity is presented.Comment: To appear in ApJ. 8 page

High Carbon in I Zwicky 18: New Results from Hubble Space Telescope Spectroscopy

We present new measurements of the gas-phase C/O abundance ratio in both the NW and SE components of the extremely metal-poor dwarf irregular galaxy I Zw 18, based on ultraviolet spectroscopy of the two H II regions using the Faint Object Spectrograph on the Hubble Space Telescope. We determine values of log C/O = -0.63 +/- 0.10 for the NW component and log C/O = -0.56 +/- 0.09 for the SE component. In comparison, log C/O = -0.37 in the sun, while log C/O = -0.85 +/- 0.07 in the three most metal-poor irregular galaxies measured by Garnett et al. (1995a). Our measurements show that C/O in I Zw 18 is significantly higher than in other comparably metal-poor irregular galaxies, and above predictions for the expected C/O from massive star nucleosynthesis. These results suggest that carbon in I Zw 18 has been enhanced by an earlier population of lower-mass carbon producing stars; this idea is supported by stellar photometry of I Zw 18 and its companion, which demonstrate that the current bursts of massive stars were not the first. Despite its very low metallicity, it is likely that I Zw 18 is not a ``primeval'' galaxy.Comment: 14 pages including 4 figures; uses aaspp4.sty. Accepted for publication in ApJ. Postscript version also available by e-mail request to author at [email protected]

The development of Drink Less: an alcohol reduction smartphone app for excessive drinkers

Excessive alcohol consumption poses a serious problem for public health. Digital behavior change interventions have the potential to help users reduce their drinking. In accordance with Open Science principles, this paper describes the development of a smartphone app to help individuals who drink excessively to reduce their alcohol consumption. Following the UK Medical Research Council’s guidance and the Multiphase Optimization Strategy, development consisted of two phases: (i) selection of intervention components and (ii) design and development work to implement the chosen components into modules to be evaluated further for inclusion in the app. Phase 1 involved a scoping literature review, expert consensus study and content analysis of existing alcohol apps. Findings were integrated within a broad model of behavior change (Capability, Opportunity, Motivation-Behavior). Phase 2 involved a highly iterative process and used the “Person-Based” approach to promote engagement. From Phase 1, five intervention components were selected: (i) Normative Feedback, (ii) Cognitive Bias Re-training, (iii) Self-monitoring and Feedback, (iv) Action Planning, and (v) Identity Change. Phase 2 indicated that each of these components presented different challenges for implementation as app modules; all required multiple iterations and design changes to arrive at versions that would be suitable for inclusion in a subsequent evaluation study. The development of the Drink Less app involved a thorough process of component identification with a scoping literature review, expert consensus, and review of other apps. Translation of the components into app modules required a highly iterative process involving user testing and design modification

Estimating effectiveness of components of a smartphone app – Drink Less – to reduce excessive alcohol consumption

Background: Smartphone apps have the potential to help drinkers reduce hazardous and harmful alcohol consumption. However, there have been few evaluations of the effectiveness of these apps and none to our knowledge that estimates the effects of individual intervention components. This study aimed to evaluate the effectiveness of intervention components of an alcohol reduction app, Drink Less. Materials and Methods: Drink Less is a freely available app to any individual in the UK making an attempt to reduce their drinking. The app was structured around goal setting with information on the UK drinking guidelines, units and alcohol-related harms. The app offered access to five additional intervention modules – Normative Feedback, Cognitive Bias Re-training, Self-monitoring and Feedback, Action Planning and Identity Change – to help them achieve their goal. Excessive drinkers (AUDIT >=8) who were aged 18+ were orthogonally randomised to receive ‘enhanced’ or ‘minimal’ versions of each of the five modules (to a total of 25 experimental conditions). The primary outcome measure was change in past week consumption at one-month follow-up. Secondary measures were change in AUDIT score, usage data and usability ratings. A factorial between-subjects ANOVA assessed main and interactive effects of the app modules using an intention-to-treat analysis. Results: Of 672 study participants, 27% responded to follow-up. At baseline, the mean past week consumption was 39.9 units (SD=27.34) and mean AUDIT score was 19.1 (SD=6.56). There were no significant main effects of the intervention modules on either measure. There were two-way interactions between enhanced Self-monitoring and Feedback and Action Planning on AUDIT score (F=5.818, p=0.016) and between enhanced Normative Feedback and Cognitive Bias Re-training on past week consumption (F=4.676, p=0.031). Enhanced Self-monitoring and Feedback was used more often and rated more positively for helpfulness, satisfaction and recommendation than the minimal version. Conclusions: Individual enhanced modules were not more effective compared with their minimal condition. The combinations of Self-monitoring and Feedback with Action Planning, and Normative Feedback with Cognitive Bias Re-training resulted in significant reductions in alcohol-related outcomes when both modules were enhanced. Users rated the Self-monitoring and Feedback module significantly more positively when it was enhanced