Leeds Institute of Health Sciences
Academic Unit of Psychiatry and Behavioural Sciences
How do individuals process the information we provide?
Using verbal protocols to explore the user experience of brief
personalised e-intervention for alcohol use
Dr Bridgette M Bewick
Associate Professor
Society for Study of Addiction Travelling Scholar
Recipient of the SSA 2012 Fred Yates Prize
SSA Annual Symposium
York, 2014
Leeds Institute of Health Sciences
Academic Unit of Psychiatry and Behavioural Sciences
Acknowledgements
Unitcheck: Michael Barkham; Andrew J Hill; Brendan Mulhern; Karen Trusler; Robert West
ChangeDrinking: Duncan Raistrick; Gillian Tober; Kat Rumball; Jakki Birtwistle, Alina Serafin, Owen Johnson, Joe Shaw
Doctorate of Clinical Psychology student: Sarah Marley (co-supervisor: Hilary Bekker)
The above is a list of key individuals who contributed to material subsequently included in this presentation.
Acknowledgement is given that unfortunately it is not possible to list everyone who has had any input in to the projects –
therefore thanks to all that contributed in some shape or form.
Thanks to participants, student union executive members, university staff; Leeds Addiction Unit staff, and National Health
Service (NHS) staff who gave their time to be involved in the projects.
Conflicts of interest: In the past Bewick has received funding from the European Research Advisory Board, and has
received reimbursement from Anheuser-Busch and the International Centre for Alcohol Policies.
Leeds Institute of Health Sciences
Academic Unit of Psychiatry and Behavioural Sciences
Thanks to support from ...
ChangeDrinking was independent research funded by the National Institute of Health Research (NIHR) through the NIHR Collaboration for Leadership
in Applied Health Research and Care for Leeds, York and Bradford. The views expressed throughout this presentation are those of the authors and not
necessarily those of the NHS, NIHR or the Department of Health. The NIHR had no role in the study design, collection, analysis or interpretation of the
data, writing the presentation, or the decision to submit the article for dissemination. The views and opinions expressed in this presentation are those of
the authors and not necessarily those of the NHS, the Department of Health, or the NIHR.
Leeds Institute of Health Sciences
Academic Unit of Psychiatry and Behavioural Sciences
Leeds Institute of Health Sciences
Academic Unit of Psychiatry and Behavioural Sciences
Leeds Institute of Health Sciences
Academic Unit of Psychiatry and Behavioural Sciences
Intervening via the web:
Personalised feedback
Very brief
Single session (but can revisit)
Automated (no therapeutic input)
Instant
Ethos:
Social Norms Approach
Leeds Institute of Health Sciences
Academic Unit of Psychiatry and Behavioural Sciences
Leeds Institute of Health Sciences
Academic Unit of Psychiatry and Behavioural Sciences
Leeds Institute of Health Sciences
Academic Unit of Psychiatry and Behavioural Sciences
Leeds Institute of Health Sciences
Academic Unit of Psychiatry and Behavioural Sciences
Intervening via the web:
Personalised feedback
Very brief
Single session (but can revisit)
Automated (no therapeutic input)
Signposting to specialist face-to-face services
Instant
Ethos:
Motivational Interviewing
Leeds Institute of Health Sciences
Academic Unit of Psychiatry and Behavioural Sciences
Ethos:
Motivational Interviewing
“website and structure modelled on motivational dialogue
… personalised pre-determined dialogue with strong
theory-practice links … applying principles of conveying
empathy and reflection was challenging within the
confines of a predetermined dialogue. Reflective listening
in ChangeDrinking does not extend to inviting statements
of resistance to be entered”
(Bewick et al., 2014)
Leeds Institute of Health Sciences
Academic Unit of Psychiatry and Behavioural Sciences
Leeds Institute of Health Sciences
Academic Unit of Psychiatry and Behavioural Sciences
Thinking my thoughts aloud, thinking my thoughts
aloud, thinking my thoughts aloud …
Leeds Institute of Health Sciences
Academic Unit of Psychiatry and Behavioural Sciences
[Sarah Marley, Doctoral Student (Dclin)]
•
Verbal protocols
•
First year students
•
Drinking over recommended weekly limits
•
n=21 (n=14 ♀; n= 7 ♂)
•
Age range 18-21 years
•
Highly computer literate
•
Verbal protocols
•
Service users from specialist addiction treatment service
•
Over 16 years of age, fluent in English, alcohol as
substance of concern
•
n=10 (n=4 ♀; n= 6 ♂)
•
Age range 31-58 years
•
Computer literacy varied across sample
Leeds Institute of Health Sciences
Academic Unit of Psychiatry and Behavioural Sciences
Interaction with the website
Leeds Institute of Health Sciences
Academic Unit of Psychiatry and Behavioural Sciences
Successful interaction
• All n=10 had some successful navigation of the website
• All participants had some level of basic interaction with the website
“and I’m now submitting that so that should take me to page seven. Yep, page seven”
Technical barriers
• n=5 had persistent difficulty as they completed the website
• All n=5 had limited computer skills and infrequently accessed the internet
Leeds Institute of Health Sciences
Academic Unit of Psychiatry and Behavioural Sciences
Interaction with the programme
“I think that, I suppose as stupid as it sounds, because the website looks
professionally designed, it makes you .. Much more, much more willing to believe it
is accurate. The fact that it wasn’t covered in all sorts of annoying pop up adverts ..
Makes it more believable” [P12, MA]
Leeds Institute of Health Sciences
Academic Unit of Psychiatry and Behavioural Sciences
Active thinking
Leeds Institute of Health Sciences
Academic Unit of Psychiatry and Behavioural Sciences
Change drinking encourages thought relating to drinking behaviour
• All considered and reflected on past experiences with alcohol
• Active consideration of questions and responses
How ChangeDrinking was received
• Personal relevance, quantity of information, credibility, trustworthiness
Active thinking
• Engaging with the data and relating them to their own experience
• Often this resulted in evaluation of own drinking
• Actively reasoning where they stand in relation to information given
Leeds Institute of Health Sciences
Academic Unit of Psychiatry and Behavioural Sciences
...that's your life that's like life recommendations to you and it's
saying that I'm it's putting it that I weekly, yeh have arguments
with my girlfriend, I break the law, but you know that's and they
are because of drinking yeh, arguments with the Mrs are definitely
because of drinking she said on our one year anniversary she
said that I had a drinking problem, I was like well and I think that's
literally that's just hit me now.. which is s***, yeh, its literally just
hit me. [P7, MA]
(Marley, 2012)
Leeds Institute of Health Sciences
Academic Unit of Psychiatry and Behavioural Sciences
This evaluative process started early on in the Unitcheck
programme.
17 out of 21 participants negatively evaluated some aspect of
their drinking behaviour before receiving any feedback.
Um, so that would be 100ml um, 200ml er, lets call it . . . 15 –
actually and then I had a couple of shots when I got to the club
as well. God <pauses> that's really bad! (P16, MB)
(Marley, 2012)
Leeds Institute of Health Sciences
Academic Unit of Psychiatry and Behavioural Sciences
...It nearly put me in tears because you don’t realise, you know
what I mean, what damage you’re doing until you see it you know
like that [P8]
Leeds Institute of Health Sciences
Academic Unit of Psychiatry and Behavioural Sciences
Response to feedback
Leeds Institute of Health Sciences
Academic Unit of Psychiatry and Behavioural Sciences
ChangeDrinking elicits a response
• Actively engaged and did not agree
In a total of last week you drank eighty four units, well to be frank that is
a stupid answer because it would depend on the volume of alcohol and
the type of wine I was drinking and I tend to go for quite strong wine
[P6]
Leeds Institute of Health Sciences
Academic Unit of Psychiatry and Behavioural Sciences
ChangeDrinking elicits a response
• Actively engaged and agreed
Guilt and remorse is common, yes, because you’ve done and said
things, well I have that I’d really rather I hadn’t. Unable – unable to, yep
definitely happen to me because people have told me. I’ve harmed
someone, I’ve fell over, I’ve got marks actually and scars on me face
from me falling over. I’ve caused harm to other people, not physical but
I’ve upset them. Someone’s suggested you cut down, yeah I use to be
defensive but no I know, I’ve accepted I’ve got a problem [P3]
Leeds Institute of Health Sciences
Academic Unit of Psychiatry and Behavioural Sciences
Beliefs and knowledge about alcohol consumption
• What participants believe to be true, what they question, what they do not know
Um, I dunno, I think I always considered binge drinkers as like people
who don’t know how to control themselves and like out of control, and
their behaviours awful. And so being told I’m a binge drinker, I think its
quite insulting actually [P9, FA]
•
Inter-relationship of personal codes and context
…there’s a lot of factors in my life … if they weren’t there and I was
drinking the same … there would be more … reason to be worried …
my awareness is a lot higher than a lot of people … don’t’ mean to
sound like I know more than other people … from experience I feel …
more in control … I don’t ever crave a drink … I .. enjoy them. I don’t
need them … I think I’m all right personally [P17, FA]
Leeds Institute of Health Sciences
Academic Unit of Psychiatry and Behavioural Sciences
What did use of verbal protocols add?
Leeds Institute of Health Sciences
Academic Unit of Psychiatry and Behavioural Sciences
Leeds Institute of Health Sciences
Academic Unit of Psychiatry and Behavioural Sciences
• Relatively minor changes to the website could increase accessibility for those with
limited experience of using the internet
• Individuals with relatively low levels of computer literacy could complete the
assessments online and actively engage with feedback
• Possible to transfer aspects of the MI ethos into pre-determined dialogue
• Designs endorsed by service users ‘on paper’ may not transfer well to an e-format
• It is possible to engage those with relatively low literacy and/or some cognitive
impairment with the verbal protocol task
Leeds Institute of Health Sciences
Academic Unit of Psychiatry and Behavioural Sciences
• Good design resulted in design aspects not being attended to
• Individuals actively engage with the assessment and this engagement provides insight
into the monitoring effect observed in our trials
• The structure of the e-intervention facilitates self-reflection and engagement prior to
receipt of feedback
• Active comparison begins early in the process and deeper comparative reflection is
supported by the delivery of social norms feedback
• Personalisation is integral in participants engagement and assessment of personal
relevance
Leeds Institute of Health Sciences
Academic Unit of Psychiatry and Behavioural Sciences
•
Active engagement with assessment
•
Feedback elicits a response
•
Consideration of personal relevance
•
Reflection on opportunity (or not) to change
Thinking my thoughts aloud,
thinking my thoughts aloud,
thinking my thoughts aloud …
Leeds Institute of Health Sciences
Academic Unit of Psychiatry and Behavioural Sciences
Thanks for listening
Faculty of Medicine and Health, School of Medicine,
Charles Thackrah Building
101 Clarendon Road, Leeds, United Kingdom. LS2 9LJ
b.m.bewick@leeds.ac.uk
www.leeds.ac.uk/lihs
+44 (0) 113 343 0809
Leeds Institute of Health Sciences
Academic Unit of Psychiatry and Behavioural Sciences
Unitcheck
Bewick, B.M., Trusler, K., Barkham, M., Hill, A.J., Cahill, J. and Mulhern, B. (2008). The effectiveness of web-based
interventions designed to decrease alcohol consumption – a systematic review. Preventive Medicine,
Doi:10.1016/j.ypmed.2008.01.005.
Bewick, B.M. Trusler, K., Mulhern, B., Barkham, M. and Hill, A.J. (2008). Feasibility and effectiveness of a web-based
personalized feedback and social norms alcohol intervention in UK university students: a randomized control trial.
Addictive Behaviors, Doi:10.1016/j.addbeh.2008.05.002.
Bewick, B.M., West, R.M., Gill, J., O’May, F., Mulhern, B., Barkham, M. and Hill, A.J. (2010). Providing web-based feedback
and social norms information to reduce student alcohol intake: a multi-site investigation. Journal of Medical Internet
Research, 15(7), e137.
Bewick, B.M., West, R.M., Barkham, M., Mulhern, B., Marlow, R., Traviss, G. and Hill, A.J. (2013). The effectiveness of a webbased personalized feedback and social norms alcohol intervention on United Kingdom university students: Randomised
Controlled Trial. Journal of Medical Internet Research,
Marley, S.L. (2012). Understanding the role of social norms in a web-based personalised, feedback intervention for alcohol
use. Doctoral of Clinical Psychology, University of Leeds.
Leeds Institute of Health Sciences
Academic Unit of Psychiatry and Behavioural Sciences
ChangeDrinking
Bewick, B.M., Rumball, K., Birtwistle, J.C., Shaw, J.R., Johnson, O., Raistrick, D. and Tober, G. (2014). Developing a webbased intervention to increase motivation to change and encourage uptake of specialist face-to-face treatment by
hospital inpatients: ChangeDrinking. Drug and Alcohol Review.
Student alcohol consumption
Barrass, C.J. (2012). Drinking experiences of first year female students: Using narratives to explore the transition to university
life. Doctoral of Clinical Psychology, University of Leeds.
Bewick, B.M, Mulhern, B., Barkham, M., Trusler, K., Hill, A.J. and Stiles, W.B. (2008). Changes in undergraduate student
alcohol consumption as they progress through university. BMC Public Health, 8, 163, Doi:10.1186/1471-2458-8-163.
Craigs, C.L., Bewick, B.M., Gill, J., O’May, F. and Radley, D. (2011). UK student alcohol consumption: A cluster analysis of
drinking behaviour typologies. Health Education Journal, Doi:10.1177/00i7896911406967.