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Trial registered on ANZCTR
Registration number
ACTRN12618001194257
Ethics application status
Approved
Date submitted
16/07/2018
Date registered
17/07/2018
Date last updated
16/10/2019
Date data sharing statement initially provided
16/10/2019
Type of registration
Retrospectively registered
Titles & IDs
Public title
Evaluating a smartphone app focussed on helping people reduce their drinking.
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Scientific title
A randomised controlled trial of a smartphone app which uses personalised implementation intentions to reduce alcohol consumption.
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Secondary ID [1]
294763
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Nil known
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Universal Trial Number (UTN)
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Trial acronym
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Risky drinking
307696
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Alcohol-related harms
307697
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Condition category
Condition code
Public Health
306756
306756
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0
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Health promotion/education
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Mental Health
307778
307778
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0
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Addiction
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
The intervention is a smartphone app (iOS and Android compatible) that delivers a structured 4-week intervention program with the aim of reducing alcohol consumption among individuals who engage in harmful drinking. The app has an embedded follow-up 4 weeks later. The app delivers four evidence-based intervention components: consumption monitoring, consumption feedback, goal-setting, and Implementation Intentions (“If-Then Plans”).
Monitoring occurs via a daily alert that asks participants to report what type of drink they consumed on the previous day, and how much.
The feedback component, delivered within the same daily alert (and is also always available), shows a daily consumption bar graph spanning the entire intervention (indicating whether each day’s entry was above or below Australian safe drinking guidelines) and a cumulative average line graph (indicating whether the consumption average is above or below Australian safe drinking guidelines).
The goal-setting component is comprised of four goals that serve to both limit drinking times and drinking speed.
Finally, the Implementation Intention component is comprised of a guided setup that involves selecting and personalising If-Then Plans associated with each of the above goals.
Adherence to the intervention is monitored via compliance to self-reported daily drinking reports and the collection of app usage analytics in relation to practicing the implementation intentions.
The time-course of the program is as follows: Week 1 (‘Drinking as Usual’) involves consumption monitoring only (a single daily alert, as in monitoring component above); Weeks 2, 3, and 4 (‘Learning How to Cut Down’) are comprised of the full intervention (with the four key components, as outlined above); Weeks 5, 6, 7, and 8 (‘Practicing Independently’) constitute the post-intervention phase, whereby the app is mostly disabled. During this phase, participants receive a single weekly alert to remind them to engage in practicing their If-Then Plans, and during week 8 they receive a daily consumption monitoring alert. Following completion of the follow-up survey, the fully functional app is reinstated, along with some addition settings for ongoing use.
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Intervention code [1]
301083
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Treatment: Devices
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Intervention code [2]
301084
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Behaviour
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Comparator / control treatment
The app group will be compared to a waitlist group. The waitlist period is for 4 weeks (duration between Pre and Post surveys), following which waitlist participants acquire the app.
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Control group
Active
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Outcomes
Primary outcome [1]
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Primary outcome 1: Average number of Standard Drinks consumed per drinking day over a 7-day period.
Type of data: Daily EMA consumption reports.
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Assessment method [1]
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Timepoint [1]
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Time points: Baseline (during Week 1), Post-intervention (during Week 4).
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Primary outcome [2]
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Primary outcome 2: Self-reported alcohol problems.
Type of data: Self-report questionnaire, the Alcohol Use Disorders Identification Test (AUDIT).
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Assessment method [2]
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Timepoint [2]
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Time points: Baseline (prior to randomisation), Post-intervention (at end of week 4).
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Secondary outcome [1]
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Secondary outcome 1: Number of Risky Single Occasion Drinking events (RSOD, defined as drinking more than 4 standard drinks on one occasion for males and females) over 1-week period.
Type of data: Daily EMA consumption reports.
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Assessment method [1]
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Timepoint [1]
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Time points: Baseline (during Week 1), Post-intervention (during Week 4).
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Secondary outcome [2]
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Secondary outcome 2: Number of Alcohol-Free Days (AFDs) over 1-week period.
Type of data: Daily EMA consumption reports.
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Assessment method [2]
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Timepoint [2]
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Time points: Baseline (during Week 1), Post-intervention (during Week 4).
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Secondary outcome [3]
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Secondary outcome 3: Self-reported alcohol-related consequences
Type of data: Self-report, modified 8-item version of Young Adults Alcohol Consequence Questionnaire (YAACQ).
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Assessment method [3]
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Timepoint [3]
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Time points: Baseline (prior to randomisation), Post-intervention (at end of week 4).
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Secondary outcome [4]
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Secondary outcome 4: Self-reported psychological health
Type of data: Self-report, 12-item version of the General Health Questionnaire (GHQ-12).
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Assessment method [4]
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Timepoint [4]
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Time points: Baseline (prior to randomisation), Post-intervention (at end of week 4).
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Secondary outcome [5]
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Moderator analysis 1: Baseline variables that moderate Primary outcome 1 or 2.
Type of data: Self-report item: Motivation to reducing drinking; measured with single in-app item on a visual analogue scale.
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Assessment method [5]
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Timepoint [5]
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Timepoints: Baseline (prior to randomisation), Post-intervention (Week 4).
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Secondary outcome [6]
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Moderator analysis 2: Baseline variables that moderate Primary outcome 1 or 2.
Type of data: Self-report item: Confidence in ability to reducing drinking; measured with single in-app item on a visual analogue scale.
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Assessment method [6]
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Timepoint [6]
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Timepoints: Baseline (prior to randomisation), Post-intervention (Week 4).
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Secondary outcome [7]
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Moderator analysis 3: Baseline variables that moderate Primary outcome 1 or 2.
Type of data: Self-report questionnaires: Negative Urgency, measured with 4-item subscale of the SUPPS
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Assessment method [7]
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Timepoint [7]
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Timepoints: Baseline (prior to randomisation), Post-intervention (Week 4).
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Secondary outcome [8]
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Moderator analysis 4: Baseline variables that moderate Primary outcome 1 or 2.
Type of data: Self-report questionnaires: Positive Urgency, measured with 4-item subscale of the SUPPS
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Assessment method [8]
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Timepoint [8]
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Timepoints: Baseline (prior to randomisation), Post-intervention (Week 4).
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Secondary outcome [9]
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Moderator analysis 5: Baseline variables that moderate Primary outcome 1 or 2.
Type of data: Self-report questionnaires: Lack of Perseverance, measured with 4-item subscale of the SUPPS
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Assessment method [9]
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Timepoint [9]
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Timepoints: Baseline (prior to randomisation), Post-intervention (Week 4).
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Secondary outcome [10]
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Mediator analysis: Intervention engagement variables that mediate Primary outcome 1 or 2.
Type of data: In-app composite score of:
• 3-week mean daily If-Then Booster Memorizer score.
• 3-week mean daily If-Then Booster Visualizer score.
• 3-week mean daily If-Then Plan Use score.
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Assessment method [10]
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Timepoint [10]
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Timepoints: During active intervention (during Weeks 2, 3, and 4), and Post-intervention (Week 4).
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Secondary outcome [11]
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Follow-up outcome: Follow-up scores, collapsed across both Intervention and Waitlist groups.
Type of data: Daily EMA consumption reports: Number of Standard Drinks consumed over 1-week period.
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Assessment method [11]
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Timepoint [11]
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Time point: Baseline (prior to randomisation), Follow-up (Week 8).
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Secondary outcome [12]
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Follow-up outcome: Follow-up scores, collapsed across both Intervention and Waitlist groups.
Type of data: questionnaire: AUDIT (modified 3-week version) score.
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Assessment method [12]
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Timepoint [12]
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Time point: Baseline (prior to randomisation), Follow-up (Week 8).
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Secondary outcome [13]
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Follow-up outcome: Follow-up scores, collapsed across both Intervention and Waitlist groups.
Type of data: Daily EMA consumption reports: Number of RSOD events over 1-week period.
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Assessment method [13]
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Timepoint [13]
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Time point: Baseline (prior to randomisation), Follow-up (Week 8).
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Secondary outcome [14]
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Follow-up outcome: Follow-up scores, collapsed across both Intervention and Waitlist groups.
Type of data: Daily EMA consumption reports: Number of AFDs over 1-week period.
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Assessment method [14]
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Timepoint [14]
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Time point: Baseline (prior to randomisation), Follow-up (Week 8).
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Eligibility
Key inclusion criteria
Problematic alcohol use – 5 to 10 inclusive as measured by AUDIT-C
Permanent access to iOS or Android smartphone
Express an intention to reduce or quit drinking alcohol
Between the ages of 18 - 60
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Minimum age
18
Years
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Maximum age
60
Years
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
None
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Study design
Purpose of the study
Treatment
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
Allocation is computerised and so once baseline is completed participants are automatically allocated to treatment or waitlist group. Researcher has no control over allocation, and is not involved in communicating allocation to participant.
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
Randomisation occurs via computerised sequence generation.
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Masking / blinding
Blinded (masking used)
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Who is / are masked / blinded?
The people administering the treatment/s
The people assessing the outcomes
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Intervention assignment
Parallel
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Other design features
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Phase
Not Applicable
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Type of endpoint/s
Efficacy
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Statistical methods / analysis
Multi-level modelling will be utilised to assess primary and secondary outcomes and predictors. Appropriate missing data will be imputed using multiple imputation. Power analysis showed that a final sample of 139 participants per group was required to have .8 power to detect the expected (d=.3) effect size - total sample of 278. Given the attrition rate of app-based studies we will recruit a further 25% if necessary.
We will conduct an intent to treat analysis and a per protocol analysis.
Per Protocol analysis includes participants who complete the daily report 70% of the time during the critical weeks (i.e., Week 1, Week 4, and Week 8).
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Recruitment
Recruitment status
Recruiting
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Date of first participant enrolment
Anticipated
20/07/2018
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Actual
13/07/2018
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Date of last participant enrolment
Anticipated
1/12/2019
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Actual
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Date of last data collection
Anticipated
24/04/2020
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Actual
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Sample size
Target
278
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Accrual to date
450
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Final
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Recruitment in Australia
Recruitment state(s)
ACT,NSW,NT,QLD,SA,TAS,WA,VIC
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Funding & Sponsors
Funding source category [1]
299367
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University
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Name [1]
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Deakin University
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Address [1]
299367
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221 Burwood Highway
Burwood VIC 3125
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Country [1]
299367
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Australia
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Primary sponsor type
University
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Name
Deakin University
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Address
221 Burwood Highway
Burwood VIC 3125
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Country
Australia
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Secondary sponsor category [1]
298646
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None
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Name [1]
298646
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Address [1]
298646
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Country [1]
298646
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Australia
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Other collaborator category [1]
280243
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Individual
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Name [1]
280243
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Paul Liknaitzky
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Address [1]
280243
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School of Psychology
Faculty of Health
Deakin University
221 Burwood Highway
Burwood VIC 3125
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Country [1]
280243
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Australia
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Other collaborator category [2]
280244
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Individual
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Name [2]
280244
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Renee O'Donnell
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Address [2]
280244
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School of Psychology
Faculty of Health
Deakin University
221 Burwood Highway
Burwood VIC 3125
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Country [2]
280244
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Australia
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Other collaborator category [3]
280245
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Individual
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Name [3]
280245
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Kate Hall
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Address [3]
280245
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School of Psychology
Faculty of Health
Deakin University
221 Burwood Highway
Burwood VIC 3125
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Country [3]
280245
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Australia
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Other collaborator category [4]
280246
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Individual
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Name [4]
280246
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Matthew Fuller-Tyszkiewicz
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Address [4]
280246
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School of Psychology
Faculty of Health
Deakin University
221 Burwood Highway
Burwood VIC 3125
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Country [4]
280246
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Australia
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Other collaborator category [5]
280247
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Individual
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Name [5]
280247
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Ben Richardson
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Address [5]
280247
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Cairnmiller Institute
391 Tooronga Rd
Hawthorn East VIC 3123
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Country [5]
280247
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Australia
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
300272
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Deakin University Human Research Ethics Committee
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Ethics committee address [1]
300272
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Deakin University 221 Burwood Highway Burwood VIC 3125
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Ethics committee country [1]
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Australia
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Date submitted for ethics approval [1]
300272
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Approval date [1]
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23/04/2018
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Ethics approval number [1]
300272
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2016-059
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Summary
Brief summary
Background: Over 35% of Australians who drink in excess of NHMRC guideline levels (AIHW, 2008). Individuals who drink at harmful levels can experience a range of negative physical, psychological and social consequences (NHMRC, 2009; LaBrie et al. 2009) but are generally unlikely to seek professional help to reduce their alcohol consumption (Reavley et al, 2010). Smartphone health-related apps may mitigate many identified barriers to help-seeking, such as concerns about privacy and stigma, treatment cost and time commitment and a preference for self-reliance (Ballon et al., 2004; Saunders et al., 2006). Additionally, other advantages include their low cost, convenience and accessibility. However, while numerous apps purport to reduce alcohol consumption, most show poor evidence-based content quality (Penzenstadler et al. 2016). Only nine apps have been subject to assessment and only four of these have demonstrated promising outcomes, albeit most with major methodological limitations (Gajecki et al., 2017; Gonzalez & Dulin, 2015; Gustafson et al., 2014; You et al., 2017). This intervention: To address this intervention gap, a team of clinicians and researchers at the Centre of Drug, Alcohol and Addiction Research (CEDAAR) at Deakin University developed a unique evidence-based smartphone app. Through an iterative process involving clinical expert input, consumer feedback, user-testing and piloting, we have developed an app that uses an effective behaviour change technique–Implementation Intentions (Gollwitzer & Sheeran, 2006)–in addition to goals, monitoring, feedback. Implementation Intentions have the ability to bridge the intention-behaviour gap, and are associated with strong and consistent behaviour change outcomes, including for risky drinking (e.g. Armitage, 2009). Implementation Intentions work by pairing a key obstacle (‘If my friends pressure me to drink’) with a concrete alternative behaviour (‘Then I will say I have a big day tomorrow and decline’). Through memory cues and scripted responses, Implementation Intentions replace automatic unhelpful habits with helpful alternative responses that become increasingly automatic. General procedure: This Randomised Controlled Trial (RCT) aims to investigate whether personalised Implementation Intentions delivered through an app are efficacious for reducing alcohol consumption and related harms among risky drinkers. It will also examine a number of potential mediators and moderators. Participants will be randomised to one of two groups: Intervention or Waitlist. Outcomes: The RCT will assess whether alcohol consumption and related harm are reduced post intervention in the Intervention group compared with the Waitlist group and whether these reductions are maintained at 4-weeks follow-up. In addition, the study will assess whether a range of secondary outcomes are impacted by the intervention and whether certain baseline and change variables predict outcome.
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Trial website
alcoholapp.org.au
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Trial related presentations / publications
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Public notes
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Contacts
Principal investigator
Name
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A/Prof Petra Staiger
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Address
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School of Psychology
Faculty of Health
Deakin University
221 Burwood Highway
Burwood VIC 3125
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Country
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Australia
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Phone
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+61 3 9244 6876
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Fax
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Email
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[email protected]
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Contact person for public queries
Name
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Petra Staiger
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Address
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School of Psychology
Faculty of Health
Deakin University
221 Burwood Highway
Burwood VIC 3125
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Country
83111
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Australia
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Phone
83111
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+61 3 9244 6876
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Fax
83111
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Email
83111
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[email protected]
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Contact person for scientific queries
Name
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Petra Staiger
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Address
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School of Psychology
Faculty of Health
Deakin University
221 Burwood Highway
Burwood VIC 3125
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Country
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Australia
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Phone
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+61 3 9244 6876
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Fax
83112
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Email
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[email protected]
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Data sharing statement
Will individual participant data (IPD) for this trial be available (including data dictionaries)?
No
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No/undecided IPD sharing reason/comment
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What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
No additional documents have been identified.
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