title: Identification of Behavior Change Techniques and Engagement Strategies to Design a Smartphone App to Reduce Alcohol Consumption Using a Formal Consensus Method.
abstract: BACKGROUND
  Digital interventions to reduce excessive alcohol consumption have the potential to have a broader reach and be more cost-effective than traditional brief interventions. However, there is not yet strong evidence for their ability to engage users or their effectiveness.
  
  
  OBJECTIVE
  This study aimed to identify the behavior change techniques (BCTs) and engagement strategies most worthy of further study by inclusion in a smartphone app to reduce alcohol consumption, using formal expert consensus methods.
  
  
  METHODS
  The first phase of the study consisted of a Delphi exercise with three rounds. It was conducted with 7 international experts in the field of alcohol and/or behavior change. In the first round, experts identified BCTs most likely to be effective at reducing alcohol consumption and strategies most likely to engage users with an app; these were rated in the second round; and those rated as effective by at least four out of seven participants were ranked in the third round. The rankings were analyzed using Kendall's W coefficient of concordance, which indicates consensus between participants. The second phase consisted of a new, independent group of experts (n=43) ranking the BCTs that were identified in the first phase. The correlation between the rankings of the two groups was assessed using Spearman's rank correlation coefficient.
  
  
  RESULTS
  Twelve BCTs were identified as likely to be effective. There was moderate agreement among the experts over their ranking (W=.465, χ(2) 11=35.8, P<.001) and the BCTs receiving the highest mean rankings were self-monitoring, goal-setting, action planning, and feedback in relation to goals. There was a significant correlation between the ranking of the BCTs by the group of experts who identified them and a second independent group of experts (Spearman's rho=.690, P=.01). Seventeen responses were generated for strategies likely to engage users. There was moderate agreement among experts on the ranking of these engagement strategies (W=.563, χ(2) 15=59.2, P<.001) and those with the highest mean rankings were ease of use, design - aesthetic, feedback, function, design - ability to change design to suit own preferences, tailored information, and unique smartphone features.
  
  
  CONCLUSIONS
  The BCTs with greatest potential to include in a smartphone app to reduce alcohol consumption were judged by experts to be self-monitoring, goal-setting, action planning, and feedback in relation to goals. The strategies most likely to engage users were ease of use, design, tailoring of design and information, and unique smartphone features.
authors.affiliation: Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom. c.garnett.12@ucl.ac.uk.
authors.forename: Claire
authors.identifier: http://orcid.org/0000-0002-6589-299X
authors.initials: C
authors.lastname: Garnett
authors.forename: David
authors.identifier: http://orcid.org/0000-0002-9755-0214
authors.initials: D
authors.lastname: Crane
authors.forename: Robert
authors.identifier: http://orcid.org/0000-0001-6398-0921
authors.initials: R
authors.lastname: West
authors.forename: Jamie
authors.identifier: http://orcid.org/0000-0002-2797-5428
authors.initials: J
authors.lastname: Brown
authors.forename: Susan
authors.identifier: http://orcid.org/0000-0003-0063-6378
authors.initials: S
authors.lastname: Michie
keywords: Delphi technique; alcohol consumption; behavior change techniques; consensus; smartphone apps