title: Drinker prototype alteration and cue reminders as strategies in a tailored web-based intervention reducing adults' alcohol consumption: randomized controlled trial.
abstract: BACKGROUND
  Excessive alcohol use is a prevalent and worldwide problem. Excessive drinking causes a significant burden of disease and is associated with both morbidity and excess mortality. Prototype alteration and provision of a cue reminder could be useful strategies to enhance the effectiveness of online tailored interventions for excessive drinking.
  
  
  OBJECTIVE
  Through a Web-based randomized controlled trial, 2 strategies (ie, prototype alteration and cue reminders) within an existing online personalized feedback intervention (Drinktest) aimed to reduce adults' excessive drinking. It was expected that both strategies would add to Drinktest and would result in reductions in alcohol consumption by intrinsic motivation and the seizure of opportunities to act.
  
  
  METHODS
  Participants were recruited online and through printed materials. Excessive drinking adults (N=2634) were randomly assigned to 4 conditions: original Drinktest, Drinktest plus prototype alteration, Drinktest plus cue reminder, and Drinktest plus prototype alteration and cue reminder. Evaluation took place at 1-month posttest and 6-month follow-up. Differences in drinking behavior, intentions, and behavioral willingness (ie, primary outcomes) were assessed by means of longitudinal multilevel analyses using a last observation carried forward method. Measures were based on self-reports.
  
  
  RESULTS
  All conditions showed reductions in drinking behavior and willingness to drink, and increased intentions to reduce drinking. Prototype alteration (B=-0.15, P<.05) and cue reminder usage (B=-0.15, P<.05) were both more effective in reducing alcohol consumption than when these strategies were not provided. Combining the strategies did not produce a synergistic effect. No differences across conditions were found regarding intentions or willingness.
  
  
  CONCLUSIONS
  Although individuals' awareness of their cue was reasonable, their reported alcohol consumption was nevertheless reduced. Individuals appeared to distance their self-image from heavier drinking prototypes. Thus, prototype alteration and cue reminder usage may be feasible and simple intervention strategies to promote reductions in alcohol consumption among adults, with an effect up to 6 months.
  
  
  BACKGROUND
  Nederlands Trial Register (NTR): 4169; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4169 (Archived by WebCite at http://www.webcitation.org/6VD2jnxmB).
authors: Erasmus MC, Department of Public Health, Rotterdam, Netherlands.
authors: Britt
authors: http://orcid.org/0000-0002-8009-6860
authors: B
authors: van Lettow
authors: Hein
authors: http://orcid.org/0000-0002-3640-2517
authors: H
authors: de Vries
authors: Alex
authors: http://orcid.org/0000-0003-3129-2862
authors: A
authors: Burdorf
authors: Brigitte
authors: http://orcid.org/0000-0003-2999-4443
authors: B
authors: Boon
authors: Pepijn
authors: http://orcid.org/0000-0002-9809-7650
authors: P
authors: van Empelen
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000517:prevention & control* / Q000523:psychology; D000437:Alcoholism / Q000523:psychology / Q000628:therapy; D003463:Cues; D030141:Feedback, Psychological; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged
keywords: Internet; adults; drinking; intention; intervention studies; prototypes; randomized controlled trial; willingness
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