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Effectiveness of a proactive mail-based alcohol Internet intervention for university students: dismantling the assessment and feedback components in a randomized controlled trial
Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Acute Health Care. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Department of Medical Specialist.
London School of Hygiene and Tropical Medicine, United Kingdom.
Linköping University, Department of Computer and Information Science, Human-Centered systems. Linköping University, The Institute of Technology.ORCID iD: 0000-0002-8678-1164
Linköping University, Department of Medical and Health Sciences, Work and Rehabilitation. Linköping University, Faculty of Health Sciences.ORCID iD: 0000-0003-0279-5903
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2012 (English)In: Journal of Medical Internet Research, ISSN 1438-8871, Vol. 14, no 5Article in journal (Refereed) Published
Abstract [en]

Background: University students in Sweden routinely receive proactive mail-based alcohol Internet interventions sent from student health services. This intervention provides personalized normative feedback on alcohol consumption with suggestions on how to decrease drinking. Earlier feasibility trials by our group and others have examined effectiveness in simple parallel-groups designs.Objective: To evaluate the effectiveness of electronic screening and brief intervention, using a randomized controlled trial design that takes account of baseline assessment reactivity (and other possible effects of the research process) due to the similarity between the intervention and assessment content. The design of the study allowed for exploration of the magnitude of the assessment effects per se.Methods: This trial used a dismantling design and randomly assigned 5227 students to 3 groups: (1) routine practice assessment and feedback, (2) assessment-only without feedback, and (3) neither assessment nor feedback. At baseline all participants were blinded to study participation, with no contact being made with group 3. We approached students 2 months later to participate in a cross-sectional alcohol survey. All interventions were fully automated and did not have any human involvement. All data used in the analysis were based on self-assessment using questionnaires. The participants were unaware that they were participating in a trial and thus were also blinded to which group they were randomly assigned.Results: Overall, 44.69% (n = 2336) of those targeted for study completed follow-up. Attrition was similar in groups 1 (697/1742, 40.01%) and 2 (737/1742, 42.31% retained) and lower in group 3 (902/1743, 51.75% retained). Intention-to-treat analyses among all participants regardless of their baseline drinking status revealed no differences between groups in all alcohol parameters at the 2-month follow-up. Per-protocol analyses of groups 1 and 2 among those who accepted the email intervention (36.2% of the students who were offered the intervention in group 1 and 37.3% of the students in group2 ) and who were risky drinkers at baseline (60.7% follow-up rate in group 1 and 63.5% in group 2) suggested possible small beneficial effects on weekly consumption attributable to feedback.Conclusions: This approach to outcome evaluation is highly conservative, and small benefits may follow the actual uptake of feedback intervention in students who are risky drinkers, the precise target group.Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 24735383; (Archived by WebCite at

Place, publisher, year, edition, pages
2012. Vol. 14, no 5
Keyword [en]
Alcohol drinking, Web-based intervention, proactive intervention;, university students
National Category
Medical and Health Sciences
URN: urn:nbn:se:liu:diva-87727DOI: 10.2196/jmir.2062OAI: diva2:600057
Available from: 2013-01-23 Created: 2013-01-22 Last updated: 2014-11-28

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Bendtsen, PrebenBendtsen, MarcusKarlsson, NadineNilsen, Per
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Division of Preventive and Social Medicine and Public Health ScienceFaculty of Health SciencesDepartment of Acute Health CareDepartment of Medical SpecialistHuman-Centered systemsThe Institute of TechnologyWork and RehabilitationHealth Technology Assessment and Health Economics
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