Recently, JMIR Mhealth Uhealth accepted our paper "A Smartphone App and Personalized Text Messaging Framework (InDEx) to Monitor and Reduce Alcohol Use in Ex-Serving Personnel: Development and Feasibility Study Just Published" which has now been published online. I wanted to share a little more about InDEx, and the study.

You can also read more about InDEx here.

InDEx was a project funded by the Medical Research Council to develop an effective electronic alcohol intervention delivered via a smartphone app. The aim was to help people leaving the Armed Forces to lower their alcohol consumption. This is done by sending user-level personalised messages via email, SMS and push-notifications. In addition, the app provides support for the user during the intervention.

The InDEx app was developed at the King's Centre for Military Health Research, with the project led by Dr Laura Goodwin at the University of Liverpool.

So what did we find out in this work?

What we know

Self-reported alcohol misuse is high in Armed Forces personnel even after they have left service. More than 50% of ex-serving personnel meet the criteria for hazardous alcohol use (measured using the AUDIT); however, many fail to acknowledge that they have a problem. Previous research indicates that interventions delivered via smartphone apps are suitable in promoting self-monitoring of alcohol use, have a broad reach, and may be more cost-effective than other types of brief interventions. There is currently no such intervention specifically designed for the armed forces.

Objective of the paper

The paper sought to describe the development of a tailored smartphone app and personalized text messaging (short message service, SMS) framework and to test the usability and feasibility (measured and reported as user engagement) of this app in a hard-to-engage ex-serving population.

How did we do it?

InDEx was developed using Agile methodology (an incremental, iterative approach used in software development) and was informed by behaviour change theory, participant feedback, and focus groups. Participants were recruited between May 2017 and June 2017 from an existing United Kingdom longitudinal military health and well-being cohort study, pre-screened for eligibility, and directed to download either Android or iOS versions of the InDEx app. Through InDEx, participants were asked to record alcohol consumption, complete a range of self-report measures, and set goals using implementation intentions (if-then plans).

Alongside the app, participants received daily automated personalized text messages (SMS) corresponding to specific behaviour change techniques with content informed by the health action process approach with the intended purpose of promoting the use of the drinks diary, suggesting alternative behaviours, and providing feedback on goals setting.

What did we find?

Invitations to take part in the study were sent to ex-serving personnel, 22.6% (31/137) of whom accepted and downloaded the app. Participants opened the InDEx app a median of 15.0 (IQR 8.5-19.0) times during the 4 week period (28 days), received an average of 36.1 (SD 3.2) text messages (SMS), consumed alcohol on a median of 13.0 (IQR 11.0-15.0) days, and consumed a median of 5.6 (IQR 3.3-11.8) units per drinking day in the first week, which decreased to 4.7 (IQR 2.0-6.9) units by the last week and remained active for 4.0 (IQR 3.0-4.0) weeks.

What next?

Personnel engaged and used the app regularly as demonstrated by the number of initializations, interactions, and time spent using InDEx. Future research is needed to evaluate the engagement with and efficacy of InDEx for the reduction of alcohol consumption and binge drinking in an armed forces population.

You can read the article here.