1. Behaviour change in 160 characters: A novel brief intervention for disadvantaged men Professor Iain K Crombie

2. Alcohol brief interventions  substantial evidence of effectiveness  10-20 minutes of encouragement and goal setting  usually delivered by a doctor  tested on middle-aged men  usually in healthcare settings  reduce weekly consumption

3. Drinking and disadvantaged men: 25-44 years  hard to reach group  seldom attend health care  low participation in research  limitations of the intervention method  amount of information  opportunities for interaction  monitoring intervention delivery

4.  2 recruitment strategies  GP registers  Respondent-driven sampling – community outreach, chain referral  Evidence-based techniques to increase recruitment  financial incentives  multiple attempts at contact  personalised approaches, assurances of confidentiality Recruitment target: 60 - Achieved 67 Recruitment strategies

5. Comparing the recruitment strategies GPCommunity Outreach Married75%36% Employed78%54% Mean consumption (units previous month) 66140 Frequent sessions of ≥8 units (>5 per month) 17%57% Frequent sessions of ≥16 units (>5 per month) 5%37% Forgot what happened (> 1 per month) 6%54%

6. Intervention development Behaviour change theory Text message studies Alcohol brief interventions Communication theory Focus groups Design team

7.  experience of alcohol harms widespread  mature drinker role  recognition of social expectations employer, partner, family  discrepancy  binge drinking and mature drinker role  don’t preach Focus group findings

8.  mid-week sobriety  personalise harms, benefits of moderated drinking  early Friday evening  encourage moderated drinking  Sunday afternoon/evening  reflect on adverse consequences  mid-week sobriety  seek commitment to change Focus group: windows of opportunity

9. Causal model for behaviour change

10. What’s the main reason U drink? a.It’s a Habit b.To feel better c.To have fun d.To cope e.To wash down your chips. Text me your answer! Engagement humour reflection interactivity

11. Dave from Dundee says – “Many a weekend I’ve thought if I’d just went home at 8-9pm, I wouldn’t be sitting here now feeling like a bag of shite”. Discrepancy

12. Andy from Dundee says –“I cut back on drinking because my father-in-law died of it”. What would be a good reason for U to cut back? Text me back! Motivate change

13. Can U think of someone who’d be happy if U made a change! What would U hear them say? Please text me your answer! Views of others Reinforce intention to change

14. Responses to texts

15.  Reasons for drinking less  “I really wanna stay out of trouble and not become the person I can be after a few too many”  Money saved  “£200 a month or more easy. That would be on carry outs and the pub.”  Buy with money saved  “Trek 2.5 road bike - cost £1650.00 RR”  Benefits to others  “My dad. Its good ur no phoning me for a lift at 2am!” Content of the responses

16. Summary  exceeded recruitment target  recruited hazardous drinkers  96% retention  outcomes measured  theoretically and empirically based text messages  in 160 characters  high level of engagement  key components behaviour change strategy  full trial underway The views and opinions expressed herein are those of the authors and do not necessarily reflect those of the NIHR PHR programme or the Department of Health. Funded by the National Institute for Health Research Public Health Research programme (project numbers 09/3001/09).

17. Collaborators Professor Iain CrombieEpidemiologist Dr Carol EmslieSociologist Dr Josie EvansEpidemiologist Professor Gerry HumphrisHealth Psychologist Dr L IrvineResearch methodologist Ms Claire JonesSoftware Engineer Professor John NorrieStatistician and Trialist Dr Dennis PetrieHealth economist Dr Peter RiceConsultant Psychiatrist Professor Ian RickettsComputer Scientist Dr Peter SlaneGP Dr Falko SniehottaHealth Psychologist Ms Selena LawGraphic Designer Professor Brian WilliamsMedical Sociologist