A Smartphone App and Personalized Text Messaging Framework (InDEx) to Monitor and Reduce Alcohol Use in Ex-Serving Personnel: Development and Feasibility Study

Daniel James Leightley, Jo-Anne Puddephatt, Norman Owen Jones, Toktam Mahmoodi, Zoe Emily Chui, Matt Field, David Colin Drummond, Roberto Jorge Rona, Nicola Townsend Fear, Laura Goodwin

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Background: Self-reported alcohol misuse remains high among Armed Forces personnel even after they have left service. More than 50% of ex-serving personnel meet the criteria for hazardous alcohol use, however many fail to acknowledge that they have a problem. Previous research indicates that interventions delivered via smartphone applications (apps) are suitable in promoting self-monitoring of alcohol use, have a broad reach and may be more cost-effective than other types of brief interventions. There is currently no such intervention specifically designed for the Armed Forces.
Objective: This study sought to i) describe the development of a tailored smartphone app, personalised text messaging framework, and ii) to test the usability and feasibility (measured and reported as user engagement), of this app, in an hard-to-engage ex-serving population.
Methods: App development used Agile methodology (an incremental, iterative approach used in software development) and was informed by behaviour change theory, participant feedback and focus groups. Participants were recruited between May and June 2017 from an existing UK longitudinal military health and wellbeing cohort study, pre-screened for eligibility, and, directed to download either Android or iOS versions of Information about Drinking for Ex-serving personnel (InDEx) app. Through the app, participants were asked to record alcohol consumption, complete a range of self-report measures and set goals using implementation intentions (if-then plans). Alongside the app, participants received daily automated personalised text messages corresponding to specific behaviour change techniques, with content informed by the Health Action Process Approach, with the intended purpose of promoting the use of the drinks diary, suggesting alternative behaviours and to provide feedback on goals setting.
Results: 150 ex-serving personnel were invited to take part in the study, 31 (22.6%) of whom accepted and downloaded the app. Participants opened the InDEx app a median of 15.0 (IQR 8.5-19.0) times during the 4-week period (28-days), received an average of 36.1 (SD 3.2) text messages, consumed alcohol on 13.0 (IQR 11.0-15.0) days, consumed a median of 5.6 (IQR 3.3-11.8) units per drinking day in the first week, decreasing to 4.7 (IQR 2.0-6.9) units by the last week and remained active for 4.0 (IQR 3.0-4.0) weeks.
Conclusion: Personnel engaged and used the app regularly as demonstrated by the number of initialisations, interactions and time spent using InDEx. Future research is needed to evaluate the engagement with and efficacy of InDEx for the reduction of alcohol consumption and binge drinking in an Armed Forces population.
Original languageEnglish
Article numbere10074
JournalJMIR mHealth and uHealth
Issue number9
Publication statusPublished - 11 Sept 2018


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