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      Factors Influencing Usability of a Smartphone App to Reduce Excessive Alcohol Consumption: Think Aloud and Interview Studies

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          Abstract

          Background

          Interventions delivered by smartphone apps have the potential to help drinkers reduce their consumption of alcohol. To optimize engagement and reduce the high rates of attrition associated with the use of digital interventions, it is necessary to ensure that an app’s design and functionality is appropriate for its intended purposes and target population.

          Aims

          To understand the usability of an app to help people reduce their alcohol consumption.

          Method

          The app, Drink Less, contains a core module focusing on goal setting, supplemented by five additional modules: self-monitoring and feedback, identity change, cognitive bias re-training, action planning, and social comparison. Two studies were conducted, a “think aloud” study performed with people using the app for the first time and a semistructured interview study performed after users had had access to the app for at least 2 weeks. A thematic analysis of the “think aloud” and interview transcripts was conducted by one coder and verified by a second.

          Results

          Twenty-four participants, half of whom were women and half from disadvantaged groups, took part in the two studies. Three main themes identified in the data were “Feeling lost and unsure of what to do next,” “Make the app easy to use,” and “Make the app beneficial and rewarding to use.” These themes reflected participants’ need for (i) guidance, particularly when first using the app or when entering data; (ii) the data entry process to be simple and the navigation intuitive; (iii) neither the amount of text nor range of options to be overwhelming; (iv) the app to reward them for effort and progress; and (v) it to be clear how the app could help alcohol reduction goals be reached.

          Conclusion

          First-time and experienced users want an alcohol reduction app to be easy, rewarding, and beneficial to use. An easy-to-use app would reduce user burden, offer ongoing help, and be esthetically pleasing. A rewarding and beneficial app would provide positive reinforcement, give feedback about progress, and demonstrate credibility. Users need help when first using the app, and they need a compelling reason to continue using it.

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          Most cited references60

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          What is user engagement? A conceptual framework for defining user engagement with technology

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            A review of eHealth interventions for physical activity and dietary behavior change.

            To review eHealth intervention studies for adults and children that targeted behavior change for physical activity, healthy eating, or both behaviors. Systematic literature searches were performed using five databases: MEDLINE, PsychInfo, CINAHL, ERIC, and the Cochrane Library to retrieve articles. Articles published in scientific journals were included if they evaluated an intervention for physical activity and/or dietary behaviors, or focused on weight loss, used randomized or quasi-experimental designs, measured outcomes at baseline and a follow-up period, and included an intervention where participants interacted with some type of electronic technology either as the main intervention or an adjunct component. All studies were published between 2000 and 2005. Eighty-six publications were initially identified, of which 49 met the inclusion criteria (13 physical activity publications, 16 dietary behaviors publications, and 20 weight loss or both physical activity and diet publications), and represented 47 different studies. Studies were described on multiple dimensions, including sample characteristics, design, intervention, measures, and results. eHealth interventions were superior to comparison groups for 21 of 41 (51%) studies (3 physical activity, 7 diet, 11 weight loss/physical activity and diet). Twenty-four studies had indeterminate results, and in four studies the comparison conditions outperformed eHealth interventions. Published studies of eHealth interventions for physical activity and dietary behavior change are in their infancy. Results indicated mixed findings related to the effectiveness of eHealth interventions. Interventions that feature interactive technologies need to be refined and more rigorously evaluated to fully determine their potential as tools to facilitate health behavior change.
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              Shape of the relapse curve and long-term abstinence among untreated smokers.

              To describe the relapse curve and rate of long-term prolonged abstinence among smokers who try to quit without treatment. Systematic literature review. Cochrane Reviews, Dissertation Abstracts, Excerpt Medica, Medline, Psych Abstracts and US Center for Disease Control databases plus bibliographies of articles and requests of scientists. Prospective studies of self-quitters or studies that included a no-treatment control group. Two reviewers independently extracted data in a non-blind manner. The number of studies was too small and the data too heterogeneous for meta-analysis or other statistical techniques. There is a paucity of studies reporting relapse curves of self-quitters. The existing eight relapse curves from two studies of self-quitters and five no-treatment control groups indicate most relapse occurs in the first 8 days. These relapse curves were heterogeneous even when the final outcome was made similar. In terms of prolonged abstinence rates, a prior summary of 10 self-quitting studies, two other studies of self-quitters and three no-treatment control groups indicate 3-5% of self-quitters achieve prolonged abstinence for 6-12 month after a given quit attempt. More reports of relapse curves of self-quitters are needed. Smoking cessation interventions should focus on the first week of abstinence. Interventions that produce abstinence rates of 5-10% may be effective. Cessation studies should report relapse curves.
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                Author and article information

                Contributors
                Journal
                Front Public Health
                Front Public Health
                Front. Public Health
                Frontiers in Public Health
                Frontiers Media S.A.
                2296-2565
                03 April 2017
                2017
                : 5
                : 39
                Affiliations
                [1] 1Department of Clinical, Educational and Health Psychology, University College London , London, UK
                [2] 2Cancer Research UK Health Behaviour Research Centre, University College London , London, UK
                Author notes

                Edited by: Floriana Grasso, University of Liverpool, UK

                Reviewed by: Pier Luigi Lopalco, University of Pisa, Italy; Piiastiina Tikka, University of Oulu, Finland

                *Correspondence: David Crane, david.crane.13@ 123456ucl.ac.uk

                Specialty section: This article was submitted to Digital Health, a section of the journal Frontiers in Public Health

                Article
                10.3389/fpubh.2017.00039
                5376568
                28229066
                df332c70-a916-4947-99a6-2ec34f85a015
                Copyright © 2017 Crane, Garnett, Brown, West and Michie.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 01 November 2016
                : 20 February 2017
                Page count
                Figures: 9, Tables: 0, Equations: 0, References: 105, Pages: 19, Words: 13317
                Funding
                Funded by: National Institute for Health Research 10.13039/501100000272
                Categories
                Public Health
                Original Research

                app,digital health,mhealth,alcohol,think aloud,interview study,qualitative

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