ii) A systematic literature review of technological interventions to reduce harmful drinking across unselected populations

Heavy drinking causes over 60 diseases in patients, as well as many accidents, injuries and early deaths each year. Brief advice or counselling, delivered by doctors or nurses, can help people cut down their drinking. A summary of 22 studies compared brief advice or counselling with usual care, and found that it helped reduce drinking by 4-5 units a week. This is around two pints of beer or half a bottle of wine each week. However, patients may be embarrassed by talking about alcohol with doctors or nurses. Many people use computers, smart phones or the internet to seek advice about health matters. We wanted to know if these gadgets can help people reduce their drinking. We carried out two systematic reviews. The first looked at whether any of the gadgets are better at reducing harmful drinking than doing nothing, or than having a face to face conversation about drinking. The second review summarised people’s view of these gadgets and what makes people more or less likely to use them in the first place. The studies we looked at for the first review included people in work places, colleges or health clinics and internet users. Everyone typed information about their drinking into a computer, telephone or internet site - which then gave half the people advice about how much they drank and the effect this has on health. This first group also got different suggestions about how to cut down on drinking. The other group did not get advice about their own drinking or suggestions about how to cut down. Sometimes they could read or print off a leaflet with general health information. Everyone was asked to return one to 12 months later to type in again how much they were drinking. Then the drinking levels in both groups were compared to each other. We found 55 studies which compared the drinking of people getting advice about alcohol from computers, telephones or internet sites against those that did not. We also described the types of advice that people got, to see if any was better than another at helping to reduce drinking. Most people did drink less if they received advice about alcohol from a computer, telephone or internet site compared to people who did not get this advice. The amount they cut down was about 1.5 pints of beer or a third of a bottle of wine each week. This difference was seen at 1, 6 and 12 months after the advice. There was not enough information to help us decide if advice was better from computers, telephones or the internet. We also do not know what particular bits of advice were the most important. However, advice from trusted places like doctors’ groups seemed helpful as well as suggestions about things to do instead of drinking. For the second review we found fourteen studies which recorded people’s views about how well they could use and understand advice delivered by computers, mobile telephones or the internet. A further 57 studies asked people to score their thoughts on short rating scales (for example 1=didn’t like at all to 5=liked a lot). We have focused here on the views reported by a wide range of people including patients in GP surgeries, students, pregnant women, disadvantaged men, American Indian women and Latino people. People’s use of technology to access advice about alcohol depends on three linked features: 1. How easy the technology is to use and understand and how attractive it is. People liked uncluttered screens, coloured pictures and the ability to check in regularly or be sent reminders. 2. The type of advice being delivered. Many people found it useful (and sometimes surprising) to get feedback on how much they drank, and they liked a friendly rather than a ‘telling off’ approach. 3. People also preferred advice that fit with their day-to-day lives or views about the world. Some felt that the advice was meant for people unlike them and so it did not seem relevant. Overall people seemed positive about advice delivered by computers or mobile telephone. Some preferred to talk to a doctor to help keep track of their drinking and some were nervous about entering personal information into computers. However, others some preferred the anonymity of using technology and felt it helped them to be more honest about their drinking.