Supplementary Material:Intervention Length, Content & Groups, Measures & Follow-Up, Reported
Can technology be effective in interventions targeting sexual health and substance use; a systematic review. Health and Technology. Julie McLellan & Hannah Dale, University of St Andrews and NHS Fife.
Supplementary material:intervention length, content & groups, measures & follow-up, reported results and conclusions for all studies
Author & location / Participant demographics / Intervention length, content & groups / Measures & follow-up / Reported results / Author’s conclusionsBarnett et al. 2007
USA / N=225
New EnglandUniversity students.
Mean age=18.8 years. / 1 month.
1.Computer delivered intervention with CD-ROM and booster session.
2.Computer delivered intervention with CD-ROM and without booster session.
3.Motivational interviewing with CD-ROM and booster session.
4.Motivational interviewing with CD-ROM and without booster session. / Measures taken at baseline, 3 months and 12 months.
Timeline Followback (measures alcohol use); Young Adult Alcohol Problems Screening Test; Help seeking behaviours were measured with 5 items derived for the study. Recidivism was measured by the report of any alcohol-related violations or medical treatment. University records also reviewed for these outcomes. / Participants who received motivational interviewing reported more help seeking behaviours and behavioural strategies whilst at 12 month follow-up Motivational Interview participants were consuming alcohol more often and computer intervention participants were consuming a greater number of drinks per occasion than at baseline. Booster session did not affect outcomes and there were no positive intervention effects. / ‘There was no intervention effect on alcohol problems, and the booster condition did not significantly affect outcomes. Promoting specific behaviours in the context of in-person brief interventions may be a promising approach to reducing drinking volume among identified at-risk students.’
Bewick et al. 2008
UK / N=317
University Students.
Mean age= 21.29 years. / 12 weeks.
1. Web-based personalised feedback and social norms alcohol intervention.
2. Control (assessment only). / Measures taken at baseline; and at week 12.
CAGE measure (screens for alcohol use disorders).
Self- report measure of number of alcoholic drinks consumed over the last week and average per drinking occasion
Personalised feedback items derived for the study. / Compared to controls, those in the experimental group had a significantly larger mean decrease in the in the difference between the amount of alcohol consumed pre and post survey. There was no effect upon number of alcohol units consumed per week or CAGE scores. 63% of the participants who received the intervention rated it as useful. / ‘The intervention reported on here lends support to the efficacy and potential effectiveness of using online interventions to reduce alcohol consumption per occasion amongst the UK student population.’
Bilardi et al. 2009
Austraila / N=120
Young people visiting GP.
Age: 16 - 24 Mean age=21 years. / 6 months.
1. Intervention group: GPs asked to refer all patients aged 16-24 to use the Youth Check Your Risk (YCYR) website.
Three months later, information leaflets provided to the GP practices. / Measures taken 6 months prior to intervention and the 6 months during intervention.
Frequencies of young people tested for Chlamydia. The number of GP visits by patients in the target group. / There was no significant increase in males or females aged between 16-24 years who were tested for Chlamydia. There was a small significant increase in the sub-sample of number of females aged 16-19 years who were tested. / ‘…given the issues and barriers evident in this study and reflected the development of any future interventions, including YCYR, must first address these barriers if they are to effectively increase screening in general practice’
Bowen et al. 2007
USA / N=90
Homosexual men.
Age: 18 – 25. / 7 days.
1. Intervention group: Internet-delivered HIV information presented as a conversation in 2x20 minute sessions interspersed with interactive activities and graphics illustrating key points of information.
2. Wait list control group received intervention between 7 and 14 days after baseline. / Measures taken at baseline, 7-14 days following baseline and 7- 14 days following time 2.
HIV/Aids knowledge measured using questionnaire developed for the study.
Outcome expectancies of condom use and outcomes of insisting on safe sex, self-efficacy for safe sex assertiveness and safe sex communication all using Likert scale questions developed for the study. / The intervention group had significantly higher knowledge, Outcomes of Condom Use, Outcomes of Insisting on Safe Sex, Safe Sex Communication and Safe Sex Assertiveness scores at Time 2 compared to the waitlist controls. / ‘The most promising outcomes of this study were the significant increases in HIV/ AIDS-related knowledge and safer sex attitudes…both groups’ knowledge, self-efficacy and outcome expectancies increased contingent upon participation in the intervention’.
Bull et al. 2009
USA / N=1565
Sexual Health clinic patients and young people recruited on the Internet.
Age: 18 – 24. / 1 month.
1. Intervention Group: completed questions around perceived HIV risk, in 5 modules. Between each module participants in the intervention group watched role-model stories related to theoretical constructs about condoms and condom use.
2. Control Group: same procedure as intervention group except role model stories were replaced with text-based HIV information. / Measures taken at baseline and at 2 month follow-up for participants recruited online and at 3 months. follow-up for those recruited at clinics.
Frequencies for protected sexual activity.
Positive and negative outcome expectations towards condom use, condom use norms, self-efficacy for condom negotiation and self-efficacy for condom use were measured using Likert scale questions developed for the study. / Participants recruited online had low baseline HIV related risk compared with higher risk values for the clinic sample. The analysis was divided between these two samples.
For the internet sample, condom norms had the largest effect on behaviour for the intervention and control groups; the intervention showed a small additional effect size of 0.06. There was no difference between the intervention and control groups for the clinic sample. / ‘We face multiple challenges before we can say that the internet and computers can be used as a tool to impact HIV prevention behaviours for larger samples and in brief interventions.’
Chewning et al. 1999
USA / N=949 Females
with an interest in using oral contraceptives. Age: 20 years or less
Mean age=17 years. / 1 year.
All groups received the standard patient education practice of their respective participating clinics.
1. Madison Experimental:
Viewed the Aid For Contraceptive Decision-making (ACD) programme.
2. Madison control group.
3. Chicago Experimental group: Viewed the ACD programme.
4. Chicago Control group. / Measures taken at baseline (time 1), immediately following intervention and physical exam (time 2) and 1 year following intervention (time 3).
Knowledge about the side effects of oral contraception (OC) was measured via a five-item scale devised for the study at time 1 and also at time 2 & 3 if OC was patient’s chosen contraception. Patient’s expectation for OC efficacy measured each time.
Time 3: telephone interviews conducted to measure the effect of the ACD intervention on the adoption of OCs, their discontinuation and possible pregnancies. / Experimental groups had significantly higher oral contraceptive knowledge at Time 2. This finding extended for only the Madison group at Time 3.
Perceived efficacy of oral contraceptive was significantly higher for the experimental group at T2 but not at T3.
Chicago group control were significantly less likely to follow through on their intention to use OCs.
After 1 year 29% of the Madison patients and 38% of the Chicago patients were no longer using the oral contraceptive. / ‘Overall findings suggest the usefulness of informatic tools as a supplement to patient-provider interactions.’
Croom et al. 2008
USA / N= 1917
First year university students.
Age: 17-19 years. / 1 session.
Short-term evaluation of an RCT of a web-based alcohol education programme:
1.Intervention group received online course prior to arriving on campus
2. Waiting list control group invited to take part in online course after study finished. / Measured at baseline and at 30-45 days post-intervention.
Using self-report measures designed specifically for the study the following variables were examined. Prevalence of alcohol use, prevalence of high-risk behaviour, prevalence of protective behaviour, harm experienced and alcohol knowledge. / The intervention group had significantly higher alcohol-related post course knowledge compared to the control group and were significantly less likely to play drinking games. There was no effect of the intervention on protective behaviour, risk related behaviour, high risk drinking and alcohol-related harm. / ‘Alcohol knowledge alone was insufficient to mitigate alcohol-related high risk behaviours in this student population.’
Fang et al.2010
Canada / N=108
Asian–American girls.
Age: 10–14 years. / 9 sessions.
1. Intervention group: web-based substance use prevention program which their mothers also completed.
2. Control group: (no intervention). / Measures taken at baseline and post-test (average of 6.25 months after baseline).
Self-report of substance use and future intentions to use substances, Children’s Depression Inventory, self-efficacy via stages of change questionnaire, refusal skills, inventory of parent and peer attachment, Iowa family interaction rating scales and perceptions of family rules against substance abuse. / At post-test the intervention group had less depressed mood, better self-reported self-efficacy, refusal skills, mother-and daughter closeness and mother-daughter communication and maternal monitoring and higher levels of family rules against substance abuse as well as fewer instances of substance abuse and lower intentions to use substances in the future. / ‘A family-orientated, web-based substance use prevention program was efficacious in preventing substance use behaviour among early Asian-American adolescent girls.’
Hustad et al. 2010
USA / N= 82
University students.
Mean age= 18.1 years. / 1 session.
1. AlcoholEdu intervention
2. Alcohol eCHECKUP TO GO (e-Chug).
3. Control group
(no intervention). / Measures taken at baseline and 1 month follow-up.
Self-report measures of typical week consumption, heavy episodic drinking and typical and peak alcohol consumption. The Young Adult Consequences Questionnaire. / Participants in the intervention groups had lower levels of alcohol use across multiple measures at 1-month follow-up.
Participants in the AlcoholEdu intervention group had significantly fewer lower alcohol-related consequences than controls and this was also seen as a trend in the e-Chug group. / ‘Given the results supporting the efficacy of electronic interventions (Els), and the low administrative burden to deliver Els, web-based alcohol education programs like AlcoholEdu and e-Chug appear to be a promising approach to reduce alcohol use…’
Lightfoot et al. 2007
USA / N=133 Students
From alternative education schools (pupils unsuccessful in mainstream education & at risk of/were involved with the juvenile justice system).
Age: 14 -18 years. / 1 session.
1. Computer-based version of Project LIGHT.
2. Small groups.
3. Control. / Measures taken at baseline and 3 month follow-up.
Primary outcome was sexual behaviour (sexual intercourse in the previous 3 months) and the type of sexual activity the student had in the past 3 months (number and sex of sexual partners, occasions, types of acts, and frequency of condom use). / Participants in the computer- based condition were significantly less likely to engage in sexual activity over time in comparison to the small-group condition. Participants in the computer-based and small-group conditions had significantly fewer sexual partners than participants in the control condition. / ‘This study suggested that for youths who are outside mainstream schools and who may respond poorly to didactic instruction, computers are a viable way to deliver prevention information and promote skill development.’
Kahn et al.
1987
USA / N=391 School students.
Mean age= 15.42 years. / 3 sessions.
1. Experimental group received stimulation based (CAI).
2. Control group 1 received regular classroom instruction (RCI).
3. Control group 2 received no intervention. / Measures taken at baseline, immediately following intervention and 5 weeks later. Self-report questionnaire measuring decision-making, knowledge and behaviour, assertiveness knowledge, attitude, and behaviour, and interpersonal communication knowledge, attitude, and behaviour. / The CAI intervention effectively improved decision-making knowledge and behaviour, assertiveness knowledge and behaviour, and interpersonal communication knowledge, attitude, and behaviour. However, over a 5 week period the effect of CAI on the knowledge variables diminished and only sustained for females, older school years and community school settings. / ‘These study results reveal that, when instruction focuses intensively on appropriate, realistic, and specific goals, positive knowledge, attitude, and behaviour changes can occur in a relatively short period.’
Kiene et al. 2006
USA / N=157 College students.
Mean age=18.86 years. / 2 sessions.
1. Condom use information, motivation and behavioural skills content. Goal setting using Motivational Interviewing.
2. Control group received time-matched nutrition intervention. / Measures taken at baseline and 2 weeks following the intervention.
Condom use frequency, condom knowledge, motivation to use prepare for and condoms, and condom use behavioural skill. / Significantly greater increases in condom use information and keeping condoms handy and condom use in intervention group. / ‘… established components of effective sexual risk-reduction interventions can be effectively translated to a computer-delivered format…’
Kypri et al. 2004
New Zealand / N=104 University students.
Age: 17-26 years. / 1 session.
1. e-SBI intervention group (Web-based assessment and personalized feedback on drinking).
2. Pamphlet only control group. / Measures taken at baseline, 4 & 6 weeks and 6 months.
Measures included retrospective 14-day drinking diary, self reported weight and peer drinking norm perceptions, Alcohol Use Disorders Identification Test (AUDIT), frequency of drinking and very heavy episodes, typical occasion quantity, Academic Role Expectations and Alcohol Scale, Alcohol problems scale. / At 6 week follow-up participants in the intervention group reported significantly lower total consumption, lower heavy episode frequency and fewer personal problems. At 6 month follow-up personal problems remained lower and academic problems were lower in the intervention group. / ‘e-SBI reduced hazardous drinking among university students, to an extent similar to that found for practitioner-delivered brief interventions in the general population. e-SBI offers promise as a strategy to reduce alcohol related harm in a way that is non-intrusive, appealing to the target group, and capable of being incorporated into primary care.’
Kypri et al. 2008
New Zealand / N= 576
University students.
Age= 17-29 years. / 1- 3 sessions.
1.Single-dose e-SBI.
2. Multi-dose e-SBI (Intervention booster sessions at 1 and 6 months).
3. Pamphlet only control group. / Measures taken at baseline, 6 & 12 months.
AUDIT taken for screening and randomisation.
Measures included retrospective 14-day drinking diary, self-reported weight and peer drinking norm perceptions. frequency of drinking and very heavy episodes, total volume consumed in the previous two weeks, personal, social, sexual, and legal consequences of heavy drinking. / Compared to the control group at 6 months, the single and multi dose e-SBI groups reported lower frequency of drinking, less total consumption and fewer academic problems; the later sustained at 12 months The multi-dose e-SBI also had reduced episodic heavy drinking at 6 months. The single-dose e-SBI group also sustained significantly less total consumption of alcohol. / ‘Single-dose e-SBI reduces hazardous drinking, and the effect lasts 12 months. Additional sessions seem not to enhance the effect.’
Lee et al. 2010
USA / N= 341 University students.
Age: 17-19 years. / 1 session.
1. Personalized
feedback intervention.
2. Control condition. / Measures taken at baseline and 3 and 6 months.
Global Appraisal of Individual Needs-I, Rutgers Marijuana Problem Index, Readiness to change questionnaire, brief drinker profile. / No overall effect of the intervention however moderator analysis found that a family history of drug problems and, to a lesser effect, students who were higher in contemplation of changing marijuana use at baseline were more likely to have lower levels of marijuana use following the intervention. / ‘The current results support the potential promise of brief, feedback based interventions for marijuana use, and serve to increase awareness of the need to carefully evaluate moderators of efficacy.’
Maio et al. 2005. USA / N= 580
ER patients with minor injury.
Age: 14-18 years
Mean age=16.1 years. / 1 session.
1. Emergency department (ED)–based laptop computer
Intervention.
2. Standard care. / Measures taken at baseline and follow-up at 3 and 12 months. Alcohol Misuse Index (Amidx), binge drinking episodes and Alcohol Frequency/ Quantity Index. / No significant differences were found between the intervention group and the control group however subgroup analysis revealed a potential effect on subjects with experience drinking and driving. / ‘This study shows that an ED-based interactive program to limit adolescent alcohol misuse had no significant effect… Subgroup analysis suggested that there may be a benefit among those participants admitting to drinking and driving at baseline.’
Moore et al.
2005
USA / N= 117
University students.
Age: 18-25 years. / 4 weeks.
1. Internet binge drinking prevention intervention.
2.Print-based intervention delivered via postal mail. / Measures taken at baseline and 30 days after completing the intervention.
“The Alcohol and you” web based survey. / The intervention was found to be efficacious, regardless of mode of delivery, for students already binge drinking. There were no significant differences between the internet and postal delivery methods in outcome measures. / ‘Using the Internet for health promotion efforts is a feasible and proactive approach that may have more appeal than traditional face-to-face or print-based approaches...’
Newton et al. 2009a Australia / N=764
School students.
Mean age=
13.08 years. / 6 x 40 minute sessions.
1. Computerized prevention program.
2. Classes as usual. / Measures taken at baseline and immediately following the intervention, and 6 months. SHAHRP survey instrument (School Health and Alcohol Harm Reduction Project), Alcohol Expectance Questionnaire-Adolescent form (AEQ-A). / The intervention group demonstrated significant improvements in knowledge regarding alcohol use at immediate and 6 month follow-up. Average weekly alcohol intake was reduced immediately after the intervention. / ‘The present results support the Clinical Management and Treatment Education (CLIMATE) Schools: alcohol module as an effective intervention in increasing alcohol knowledge and reducing alcohol use...’