Evaluating Co-Designed vs Researcher-Driven Personalized Feedback Formats in a Brief Digital Alcohol Use Intervention: Mixed Methods Study

Background: Increasingly, brief digital interventions are being implemented to combat alcohol misuse. While the utility of incorporating personalized feedback into these interventions has been explored, less work has concentrated on how consumer-driven research might be harnessed to better tailor personalized feedback. Critically, the relative efficacy of co-designed interventions vs those designed by research teams without stakeholder input has not typically been explored. Objective: This study aimed to use an exploratory sequential mixed methods approach to elicit user-designed personalized feedback to incorporate into an existing brief digital intervention developed to combat hazardous drinking; investigate differences in capacity, opportunity, and motivation (as per the Capacity, Opportunity, Motivation–Behavior model) to alter alcohol use behavior; examine whether participants prefer the co-designed product over those designed by research teams; and evaluate change in actual consumption over time as a function of co-designed (image-based) vs researcher-designed (image- or text-based) personalized feedback. Methods: Part 1 used an online co-design process involving a convenience sample of young adult focus group participants (N=40; mean age 21.87, SD 7.51 years). Part 2 surveyed a convenience sample of young adults who drank alcohol regularly (N=222; mean age 21.14, SD 4.69 years). Participants were assigned to 1 of 3 personalized feedback conditions (researcher designed, text-based; researcher-designed, image-based; and co-designed, image-based) using block allocation with stratification based on alcohol intake and impulsivity level. Feedback was delivered via email, and impact on capacity, opportunity, and motivation to alter alcohol use behavior, plus preferred format of feedback, was examined (10.76, SD 14.05 days) via mixed and 1-way ANOVAs and post hoc tests. Change in alcohol consumption (89.70, SD 21.59 days) was investigated via a series of repeated-measures ANOVA and post hoc tests. Results: In Part 1, qualitative thematic analysis of focus group data identified 6 overarching themes: visual representation, clarity, accessibility, brevity, peer comparison, and harm. Following this analysis, personalized feedback regarding alcohol intake and brain health was available in 3 formats: researcher designed, text-based; researcher-designed, image-based; and co-designed, image-based. In Part 2, there were no differences in capacity, opportunity, and motivation to alter alcohol use behavior as a function of feedback format (η_p²=0.01). Participants preferred co-designed, image-based feedback over researcher-designed, image-based (d=0.55) or researcher designed, text-based (d=0.83) feedback. Regardless of feedback format, all participants significantly reduced total alcohol intake (η_p²=0.11) and alcohol-related harm (η_p²=0.05). Participants in image-based conditions (researcher-designed or co-designed) reduced frequency of drinking to a greater extent (d=0.56) than those in the researcher-designed, text-based feedback condition (d=0.39). Conclusions: Though the principles of co-design are undeniably valuable, the efficacy of co-designed interventions, over and above those designed by research teams without user input, requires further research. Trial Registration: OSF Registries osf.io/rnbv8; https://osf.io/y4bhs