! School of Health and Social Care Food Alcohol and Calorie Tracker (FACT): A Feasibility Study and Beyond Dr John Foster – Reader in Alcohol Policy and Mental Health. September 2017 @johnfoster58

Introduction: International Evidence to support brief interventions to reduce hazardous harmful alcohol use. (Joseph and Basu 2017) and obesity (National Obesity Observatory 2011). Promotes Self-Efficacy Greater sense of engagement Self Management of Conditions (Convenience) Cost effective. Prevents hospital admissions and use of GP services/primary care.

Barriers to Up take/Implementation of Brief Interventions by Professionals: “Not my role”: Generally medical professional “Too Busy” Lack of training Lack of Evidence re Cost Effectiveness Obtrusive Questioning that could have an impact on relationship with user. So could more distant technological interventions have a place in the delivery of brief interventions?

International Evidence Concerning Facilitators/Barriers to Phone App Use in quasi-healthcare/health care settings. More likely if users were younger, more educated, current smart phone users and saw a perceived benefit to the app. Main barriers were insufficient function, difficulty of use, extra cost and security concerns (Sun et al 2017) Lack of engagement with the users real word and failure to engage with the user when they are most likely to respond. (Nitesh et al 2013). e.g. Reminders/notifications coming on at inconvenient times.

Description of FACT (1) Food Alcohol and Calorie Tracker: Currently aimed at student/adult populations User is asked to provide information concerning their food and alcohol intake. Converted into calories by a logarithm Normative advice is provided concerning sensible drinking/calorie intake limits. Individual sets own goals for calorie/alcohol intake. If they don’t then the NHS/Dept Guidance is set as a default: i.e. 14 units of alcohol (week) or 2500 calories (male), 2000 calories (female) (daily)

Description of FACT (2) Feedback provided by traffic light system (Danger) (Harm) (Good) If individual wishes further advice link to direct phone number with trained motivational interviewers. General advice. Information concerning local and national support services and e.g. dates of healthy living events. Links to web pages.

Participants and Aims and Objective of the study : To encourage participants to use the app for one month: Each was given a financial incentive to use the app for one month 40 undergraduate students (Health and Computing) - (22 Females, 18 males )  

Response Rates Only 7 filled in the full 4 sets of feedback (17.5%)   10 provided partial feedback: (25%) No one provided 3 sets of feedback only 4 provided 2 sets of feedback only (10%) 6 provided 1 sets of feedback only (15%) Participants were given a weekly prompt to provide feedback

Research Questions How easy is the app to use? Whether the app is useful? How motivated do you feel to use the app daily? All questions were structured and open text:

Open Texts: What did you like? 20 responses liked the dietary information 7 Liked the alcohol information Other Comments Praised the following: Design and Layout Goal Setting Provides information on calories Gets easier to use as time progresses

Open Texts: What did you dislike? Design Issues- tendency to log out   Need to swipe Lack of back button Too much text: Some limitations over food selection

Open Text: Suggestions for Improvement: Keep signed/logged in x2 Provide Option for non-drinkers (to skip much of the information) Facility to save user name and password Less Text Needs to look a bit more professional and easier to use – show results as you type Improve Swiping Function/Provide a back button Provide more visual prompts: pictures and icons

Conclusions: Tentative Evidence that an app targeting alcohol and obesity is acceptable to users and easy to use. Tentative Evidence that the app motivates some users to consider their alcohol and food intake. The concerns with the app are largely concerned with technical functions such as lack of a back button and general design: Aim now to build a version of FACT that can be used with younger/probably underage drinkers.

What is required to create FACT-Junior A study day/workshop will be held in Feb/March 2018 at which pupils 14-16 will be invited from local schools/colleges. Aim of workshop: To gain insight into some research that takes place at Universities: Focus Group to gain insight into what young people feel should be included in FACT- Junior: Do the students think it is a good idea. Will need to be game-based: Current version is aimed at adults What will tempt them to use it?

What is required to create FACT-Junior? Issues to think about: How do we introduce materials concerning alcohol consumption and calories? Is the traffic light system the best way to provide what is essentially information/education to younger people? Issues such as developing self-efficacy and confidence are likely to be key for this group. How do we do this within an App. Feedback from the potential users will be essential. To date much of the information we have is about function of the app to make it user friendly to adults. Thanks for listening.