personalised normative feedback
Overall, statistical analyses with the high risk sub-sample, and for all students, showed no significant effects of the intervention, at either time-point, in a completed case analysis and a multiple imputation analysis. Cochrane Database of Systematic Reviews. Below are the links to the authors’ original submitted files for images. 4. A recent Cochrane review [20] found some limited evidence for the effectiveness of computer-based PNF in University students though questions remain about the generalizability of these findings to other countries, including the U.K. [21], [22]. Social norms theory [11] suggests that correcting this misperception will lead young people to attenuate their drinking behaviour. The innovative design and sampling aspects of this study: the Solomon three-group design to test for measurement effects, and the whole sample and higher risk sub-sample analyses to test the prevention paradox prediction, were illuminating. All questionnaires were completed remotely via web-based forms, and so outcome assessment was blinded. Information about how much students actually consume, accurate statistics about the frequency of negative consequences among them and basic information relating to alcohol are part of the approach [4]. 2001, Geneva: World Health Organisation, Jernigan D: Global Status Report: Alcohol and Young People. This analysis indicates that there was no effect on drinking behaviour of the baseline measures and questions about alcohol use and problems. Attrition in this study was lower than in other European research on email- or web-based social normative feedback interventions with university students [44]–[46] though higher than in some Australian or U.S. studies [40], [42]. Kypri also suggested that a social desirability response bias may have influenced the results. By . The aim of the trial is to determine the effectiveness of an on-line personalized feedback intervention for reducing alcohol consumption amongst undergraduate University students when compared with a control group, in both the UK and Portugal. Google Scholar, Perkins HW: Social Norms and the Prevention of Alcohol Misuses in Collegiate Contexts. The brief personalised normative feedback given to each intervention group participant will comprise the results of their drinking behaviour assessment alongside information about alcohol and how it might affect them at their current drinking levels. Demographic questions will be answered by all three groups before randomization. All other scores (Audit, Alcohol-related Problems, Drinking Norms and Positive Expectancies) were analyzed with linear/log-linear regression using xtmixed (StataCorp). In the completed case analyses (i.e. Taking account of known prevalence rates for hazardous drinkers in this population, and with cautious estimates for participation and attrition rates, we aimed to recruit 4000 students. Therefore, other problems were measured in a newly-developed self-reported scale with nine possible problems, listed on a yes/no scale: 1. However, Kypri has not been able to establish whether the normative feedback intervention, or simply measuring drinking behaviour using the alcohol use disorders identification test (AUDIT) screening tool, was the active ingredient accounting for this effect. The effects of the intervention were larger for veterans whose drinking was more problematic at baseline. The computer-based randomisation ensured that researchers and participants were not aware of allocated group. follow-up respondents only) for high risk drinkers 104/116 universities and 550/1187 individuals were followed up and analysed at 6-months, and 97/116 universities and 444/1187 individuals at 12-months. Furthermore, students will also be recruited via Facebook, a social networking website. Undergraduate students in year one and two of their course will be invited to participate via poster, flyer, email or via university student information systems at the beginning of the academic year 2007/8. Spiegelhalter D, Myles J, Jones D, Abrams K: An introduction to bayesian methods in health technology assessment. statement and Using a Bayesian approach [7], we have estimated that the change in alcohol related problem scores from Kypri's study might equate to a 5% prevalence reduction in alcohol disorders (DSM dependence and abuse), which would be a marked and important consequence [8]. Article The AUDIT scale is scored between 0 and 40, with a higher score indicating higher levels of drinking. PubMed Oxford, Oxford Brookes, Nottingham and Plymouth Universities in the UK and Portucalense, Lusiada, Fernando Pessoa, Autonoma and ISMAI Universities from Portugal have agreed to collaborate. All these other European trials have had low follow-up rates from those randomised and assessed at baseline, and with similar non-significant effects to our study. This trial will provide information on the effectiveness of an on-line personalized normative feedback intervention for alcohol misuse in university students. Personalized Normative Feedback (PNF) One promising strategy in reducing college student drinking involves reducing overestimated descriptive drinking normative perceptions. The feedback also provided general information about alcohol and how it might affect them at their current drinking levels, including how long it could take to return to a zero blood alcohol level after a typical drinking occasion. Similarly, we found no evidence that a population wide intervention was more effective than a targeted intervention with a higher risk sub-sample of students but, given that we found no effects of the PNF intervention across a range of alcohol outcomes, this is not surprising. Alongside demographic questions (including: age, gender, weight, nationality, university year) we have carefully selected validated measurement instruments: Alcohol Use Disorders Inventory Test (AUDIT) and brief version (AUDIT-C), Alcohol Expectancies Questionnaire (AEQ, brief version), Social Desirability Scale (SDS, brief version), Self-report measures on alcohol consumption (from ESPAD and Centre for Addiction and Mental Health (CAMH), Toronto) [12, 13], Perceived norms (validated adaptation of the two versions of the Drinking Norms Rating Form). The intervention and main control group were followed up at 6- and 12-months, and the delayed control group at 12-months only. PubMed Intention to treat was applied in all analyses. Overall, there is a consistent pattern of no effect across most outcome measures and time points. The collected scores about the “Frequency of drinking” and the “Quantity of drinking” were analysed with a mixing distribution of the Poisson regression with a Gamma mixture for panel data using the Stata 10.1 (StataCorp, College Station, Texas). In the second random effects model we carried out a sensitivity analysis using multiple imputation. In conclusion, our results show no evidence for the effectiveness of personalised normative feedback for the prevention of alcohol misuse and alcohol-related problems in a UK student population. Normative feedback as an approach to alcohol misuse prevention is based on Social Norming Theory. Students were recruited into the study at the beginning of the academic year 2007/8, and followed up for 6- and 12-months. personalized normative feedback, such as information about personal drinking patterns and drinking risk status relative topeerdrinkingnormativedata(Larimeretal.,2001;Marlatt et al., 1998). 5. Medical Statistics Programme, Oxford Brookes University, Oxford, Oxfordshire, United Kingdom, Affiliation A second objective was to assess the relative effectiveness of whole population (universal) versus screening and brief intervention (SBI; targeted) normative feedback in reducing alcohol related problems. volume 8, Article number: 113 (2008) Multivariate analyses will be conducted with gender, nationality, University year (one and two), social desirability and study country as covariates. Instituto Superior de Saúde do Alto Ave, Póvoa de Lanhoso, Braga, Portugal, Affiliation PNF was provided by email. Data from the ESPAD Project. Trouble with local or campus authorities; 9. Yes Google Scholar, Foxcroft D, Kypri K, Simonite V: Bayesian estimates of population prevalence using the AUDIT diagnostic test for alcohol abuse and dependence. Randomisation occurs after students have read the consent form, with affirmative consent given proceeding to the on-line questionnaire. = 6) for females [38], and power = .9 and α = .05 (2-tailed tests). Working with Kypri, we have used his dataset to model the potential of normative feedback to reduce alcohol related problems. Participants are undergraduate university students (first and second year) enrolled in UK and Portuguese universities. Michael Bernstein, University of Rhode Island. We have not included the delayed control group in attrition assessment or statistical analysis of effects because there were no statistical differences between the main control and the delayed control groups at 12-month follow-up for any drinking behaviour measures (frequency of drinking, χ2 = 6.29, df = 6, p = 0.39; usual quantity of alcohol, t = 0.075, df = 699, p = 0.94; AUDIT, t = 0.63, df = 699, p = 0.53; alcohol-related problems, t = −0.181, df = 699, p = 0.86; perceived drinking norms, t = −0.609, df = 699, p = 0.54). The Harvard College Alcohol study of more than 49,000 U.S. students [25] found that most alcohol-related harms arise from those who are not higher risk drinkers, and this finding is supported by evidence from other countries [26]. 2007. The interaction between these different components, and how they are presented to participants, may be important in determining effectiveness. This randomized controlled trial evaluated a computer-delivered, norms-based personalized feedback intervention which systematically varied the focus on whether specific drinking behaviors were described as common or uncommon (a descriptive norm), whether the drinking behaviors were healthy versus unhealthy, and whether the drinking behaviors were positively or negatively framed (an injunctive norm). Copyright: © Moreira et al. Eligible participants were undergraduate university students (first and second year students; academic year 2008/9) from U.K. universities, recruited through university information systems (posters, email messages, bulletin boards) and through online social networking sites. Solomon three-group randomised controlled trial. Online personalized normative feedback (PNF) interventions have been found to reduce college drinking, yet few studies have investigated the effect of event-specific PNF on drinking. At the same time, binge drinking rates amongst young people are high in the UK and Holland, and are increasing in the UK where alcohol related violence and crime is a major cause for concern. Manage cookies/Do not sell my data we use in the preference centre. Analyses focused on high-risk drinkers, as well as all students, because of research evidence for the prevention paradox in student drinkers. Wrote the paper: DRF MTM RO. There was no direct human involvement in the randomization process. https://doi.org/10.1371/journal.pone.0044120.g001. Individual-level strategies aim to produce changes in attitudes or behaviors related to alcohol use rather than the environments in which alcohol use occurs. 1999, 319: 508-512. We have not been able to assess impact on acute harms, violence and crime because of insufficient information for modelling. 2002, 164-172. Over the past few years, innovative approaches to implementing brief motivational interventions have been developed, with a growing number of controlled studies Rossow I, Romelsjo A: The extent of the 'prevention paradox' in alcohol problems as a function of population drinking patterns. Journal of American College Health. Scores ranged between 0 and 21, with a higher score indicating more positive expectancies. Providing feedback is not an essential element of MI but it can be useful for raising topics and beginning a conversation with clients in a pre-contemplative stage (Miller & Rollnick, 2009; p134). The intervention's personalized normative feedback immediately affected participants' perceptions of norms of drinking among their peers, and its effects on drinking and alcohol-related consequences persisted through the 1-month follow-up. Respondents completed the Alcohol Use Disorders Identification Test (AUDIT) which is a 10-item scale with good validity that is designed to assess hazardous and harmful drinking [31]. All data collection is done online, through the trial website, accessed via a web-link promoted in all forms of advertisement. Personalised normative feedback (PNF) aims to correct this misperception by providing information about personal drinking levels and patterns compared with norms in similar aged peer groups. PNF uses norms clarification to correct drinking norms misperceptions by highlighting discrepancies between personal alcohol use, perceived peer alcohol use, and actual peer alcohol use. Frequency of alcohol consumption was assessed with one question asking how often the respondent drank, with responses ‘Never’, ‘1–2 per year’, ‘Once a Month’, ‘Twice a Month’, ‘Once a Week’, ‘Twice a Week’, or ‘Daily’. Our results fail to replicate the findings of the New Zealand, Australian and U.S. trials of brief, web-based, social normative feedback [40]–[42]. The following assumptions [39] guided the multiple imputation: 1. all randomised participants were followed-up even if they did not participate in the intervention (i.e. Identify at least two web-based brief interventions that provide brief MET 7. 10.1111/j.1360-0443.2005.01294.x. Personalized Normative Feedback and the Moderating Role of Personal Norms: A Field Experiment to Reduce Residential Water Consumption - P. Wesley Schultz, Alyssa Messina, Giuseppe Tronu, Eleuterio F. Limas, Rupanwita Gupta, Mica Estrada, 2016. One line of thought is that the accumulating evidence on social normative feedback is an example of initially positive research findings ultimately being found to be false [47]. During university or college years, students can escalate their alcohol use to dangerous levels [1], and student alcohol consumption levels are typically higher than their non-university peers [2]–[6]. Data from the remotely completed online questionnaires were automatically entered and stored in a web based server. No, PLOS is a nonprofit 501(c)(3) corporation, #C2354500, based in San Francisco, California, US, https://doi.org/10.1371/journal.pone.0044120, http://www.cabinetoffice.gov.uk/sites/default/files/resources/Behaviour-Change-Insight-Team-Annual-Update_acc.pdf, http://www.camh.net/About_Addiction_Mental_Health/Drug_and_Addiction_Information/evaluate_your_drinking.html, https://docs.google.com/folder/d/0B6qFfRezLfa4SlYyWVB6MHZwTEU/edit, http://wwwaddiction-ssaorg/2011/McCambridgeJ%20Presentationppt. The internal consistency for this scale was alpha = 0.71. Define the components of personalized normative feedback 6. The main control group undertook a baseline alcohol assessment, and the delayed control group only provided demographic details at baseline. Other parts of this study were supported by Alcohol Research UK and the European Foundation for Alcohol Research. Brief and cost-effective, PNF consists of an individualized report in which national or campus-wide drinking statistics are Yes Results: Among participants in the intervention group, 95.8% responded to text-message 1, and 95.8% responded to text-message 2. they withdrew from the allocated treatment); 2. The effectiveness of brief personalized normative feedback in reducing alcohol-related problems amongst University students: protocol for a randomized controlled trial. Blackout or memory lapse; 2. Article This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Participants were incentivised to respond through entry into a prize draw, with prizes including games consoles, mp3 players and store vouchers. But our results are generally in agreement with other work from the UK and Sweden, where randomised trials aimed at assessing the effectiveness of an electronic web-based personalised feedback intervention have found little or no effect for most outcome measures [43]–[46]. PNF is intended to raise motivation for behaviour change [16], [17] and has been highlighted as a promising intervention by the British Government Behavioural Insight Team [18], [19]. specific personalized normative feedback (PNF) and protective behavioral strategies (PBS), respectively. TM wrote the first and final drafts of the protocol. In the first random effects model we treated all missing values as missing at random (MAR). Annual Symposium of the Society for the Study of Addiction 2007; York. Feedback is a technique that is commonly used when providing education around a wide range of health topics, with the aim of stimulating motivation for change. The intervention group will receive the brief personalized normative feedback via email within a few weeks of completing the assessment and will be followed up at 6 months, along with the first control group. Free Online Library: Personalized normative feedback to reduce drinking among college students: a social norms intervention examining gender-based versus standard feedback. Currently there is no published Cochrane systematic review on the effectiveness of social norms approaches, though a Cochrane protocol on this topic has been published [5]. Firstly, evidence of the potential to reduce hazardous and harmful drinking amongst University students might lead to better prevention programmes across Europe. Higher risk drinkers were those who, at baseline, scored 8 or more on the AUDIT scale (the cut-off for hazardous drinking) and also drank more than the recommended weekly consumption limits. The main objective of this study was to examine the effectiveness of computer-based PNF, compared with (i) screening/assessment only, for reducing alcohol-related problems in first and second year UK university undergraduate students. PLoS ONE 7(9): Citation: Moreira MT, Oskrochi R, Foxcroft DR (2012) Personalised Normative Feedback for Preventing Alcohol Misuse in University Students: Solomon Three-Group Randomised Controlled Trial. Second, evidence regarding the differential effectiveness of social norms interventions in countries with different drinking cultures and patterns. Both authors have contributed to the development of this protocol. Sustained an injury; 8. A personalized normative feedback text-message intervention to reduce 21st birthday alcohol use and problems. Kypri K, Saunders J, Williams S, McGee R, Langley J, Cashell-Smith M, Gallagher S: Web-based screening and brief intervention for hazardous drinking: a double-blind randomized controlled trial. For the proportions of students exceeding 21 units a week (men) or 14 units a week (women), we used generalized linear mixed models with the xtlogit procedure. Data will be analysed by a researcher blinded to experimental group. Social desirability responsiveness was also assessed using the short form of the Marlowe Crown scale 2 [37]. A Solomon Three Group Design [11] will be used in each country (UK and Portugal) where participants will be randomly assigned, with concealed allocation, to one of three groups (see Figure 1). We performed sensitivity analyses to explore the effect of departures from the assumption made in the main analysis. Performed the experiments: MTM. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. PFIs aim to reduce drinking by providing feedback to recipients that is personalized and often includes multiple components, including feedback comparing the recipients own drinking and perceived norms to actual norms (i.e, personalized normative feedback). In reaction to the national health objective of reducing the proportion of college students engaging in heavy at-risk drinking, the addition of a stress and coping component to a Personalized Normative Feedback (PNF) intervention was examined. Personalized normative feedback (PNF) is a brief intervention designed to correct misperceptions regarding the prevalence of problematic behavior by showing individuals engaging in such behaviors that their own behavior is atypical with respect to actual norms. Recruitment, consent, randomisation and data collection are all on-line. https://doi.org/10.1371/journal.pone.0044120.t005, https://doi.org/10.1371/journal.pone.0044120.t006. All three groups will be followed up at 12 months. Table 2 describes participants lost to follow-up, with very similar rates in both intervention and the main control groups, suggesting that there was no differential or systematic bias in attrition. Clues as to the differences in effect across different studies might lie in the differences in intervention content and delivery. broad scope, and wide readership – a perfect fit for your research every time. We found no evidence that simply asking people about their drinking behaviour, in the absence of any intervention, led to any change in behaviour. School of Health and Social Care, Oxford Brookes University, Oxford, OX3 0FL, UK, You can also search for this author in The authors evaluated the efficacy of a computer-delivered personalized normative feedback intervention in reducing alcohol consumption among heavy-drinking college students. https://doi.org/10.1371/journal.pone.0044120.s001, https://doi.org/10.1371/journal.pone.0044120.s002. Moreover, this one effect should not be over-interpreted given the consistent pattern of no effect across most outcome measures and time points. Objective: Twenty-first birthdays are associated with extreme levels of heavy drinking and alcohol-related harm. Addiction. This self-report questionnaire assesses positive expectancies related to alcohol consumption (social changes, cognitive improvement, sexual enhancement and relaxation) with 21 statements and a true/false answer format. Individual-Level Strategies. Correspondence to Abstract. The feedback will also compare their drinking – in graphical format – to the drinking of their student peers. Usual quantity of alcohol consumption was assessed with one question asking how many drinks/units a respondent usually consumed on a drinking occasion, with responses 0, 1, 2, 3, 4, 5, 6, or 7 or more. PNF is intended to raise motivation for behaviour change and has been highlighted for alcohol misuse prevention by the British Government Behavioural Insight Team. Data are collected at baseline, six months and 12 months. Privacy 2007, 102 (1): 62-70. Feedback, personalised & normative on Vimeo Yes A specimen feedback is available to download [30]. Personalized normative feedback (PNF) has shown promise as a stand-alone intervention for reducing alcohol use among college students. Once consent was given, participants were randomized by computer. DF has contributed to the drafting process. The results are presented as relative risks, odds ratios and difference in regression coefficients, respectively.