Khadjesari, Z.C.S.; (2012) Use of the Internet for the delivery and evaluation of interventions aimed at reducing alcohol consumption. Doctoral thesis , UCL (University College London).

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Abstract

Alcohol is the most harmful drug in the UK, with harm extending beyond the individual to affect other people, society and the economy. Interventions effective at reducing alcohol intake are hindered by barriers to delivery. This thesis aimed to explore the use of the Internet for the delivery and evaluation of interventions for reducing alcohol intake, with a view to widening the availability of services. The effectiveness of stand-alone computer-based interventions was determined in the first systematic review in this field to present clinically meaningful outcomes, i.e. grams per week and binge frequency (Chapter 2). A number of limitations of the literature were identified, most of which were subsequently addressed in the Down Your Drink (DYD) online trial. This online trial of an Internet-based intervention provided the context for the exploration of methodological challenges introduced by the Internet setting (Chapter 3). Conventional measures of alcohol intake may not retain their validity when transferred online. An online measure of past-week alcohol consumption was created and validated for use as the primary outcome measure in the DYD trial (Chapter 4). Low rates of follow-up are common in online trials and increase the possibility of bias. Two sequential online trials found low value incentives (e.g. £5) did not improve follow-up in the DYD trial, whereas higher values incentives (e.g. £10) were effective and more cost-effective (Chapter 5). Qualitative interviews with DYD trial participants provided a unique insight into the experiences of a previously unstudied group of hazardous drinkers seeking help online (Chapter 6). The Internet setting was found to mitigate some of the barriers to seeking help in-person, attracting a large group of ‘e-help-seekers’ whose varied needs are unmet by existing services. The implications of these findings on the development of online services were discussed along with directions for future research.

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