5 rays night out a new iphone app targeting alcohol use in young people executive summary web

Ray’s Night Out A new iPhone app targeting alcohol use in young people

Associate Professor Leanne Hides Professor David J Kavanagh Dr Oksana Zelenko Associate Professor Dian Tjondronegoro Stoyan R Stoyanov Dr Wendell Cockshaw

October 2015 Young and Well CRC Unit 17, 71 Victoria Crescent Abbotsford VIC 3067 Australia youngandwellcrc.org.au

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Ray’s Night Out A new iPhone app targeting alcohol use in young people

Associate Professor Leanne Hides QUT Institute of Health and Biomedical Innovation

Professor David J Kavanagh QUT Institute of Health and Biomedical Innovation

Dr Oksana Zelenko QUT School of Design, Creative Industries Faculty

Associate Professor Dian Tjondronegoro QUT Science and Engineering Faculty

Stoyan R Stoyanov QUT Institute of Health and Biomedical Innovation

Dr Wendell Cockshaw QUT Institute of Health and Biomedical Innovation

Institute of Health and Biomedical Innovation (IHBI), School of Psychology and Counselling, Queensland University of Technology (QUT), Brisbane, Australia Creative Industries (CI), Queensland University of Technology (QUT), Brisbane, Australia Science and Engineering Faculty (SEF), Queensland University of Technology (QUT), Brisbane, Australia

ISBN: 978-0-9925966-9-9 Suggested citation: Hides, L., Kavanagh, DJ., Zelenko, O., Tjondronegoro, D., Stoyanov, SR., & Cockshaw, W. (2015) Ray’s Night Out: A new iPhone app targeting alcohol use in young people.

Copies of this guide can be downloaded from the Young and Well CRC website youngandwellcrc.org.au This work is copyright. Apart from any use as permitted under the Copyright Act 1968, no part may be reproduced by any process without prior written permission from the Young and Well CRC. Requests and enquiries concerning reproduction and rights should be addressed to the Chief Executive Officer, Young and Well CRC, 17/ 71 Victoria Crescent, Abbotsford VIC 3067, Australia.

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Acknowledgements The eTools for Wellbeing project is a partnership between the Queensland University of Technology and the Young and Well Cooperative Research Centre.

The eTools for Wellbeing Research Team wishes to acknowledge the generous support and collaborative efforts of all supporting partners.

We especially would like to acknowledge the important contributions from the young people who took the time to engage in all aspects of conceptualisation, implementation and evaluation of the project.

The eTools for Wellbeing Research Team wishes to acknowledge the contributions of Dr Lake-Hui Quek, Brendan Pearce, Desmond Koh, Steven Edge, Kristen Tulloch, Kate McLisky, and the assistance and collaborative efforts of all supporting partners in this project.

Associate Professor Leanne Hides is supported by an Australian Research Council Future Fellowship.

Young and Well Cooperative Research Centre The Young and Well Cooperative Research Centre is an Australian-based, international research centre that unites young people with researchers, practitioners, innovators and policymakers from over 70 partner organisations. Together, we explore the role of technology in young people’s lives, and how it can be used to improve the mental health and wellbeing of young people aged 12 to 25. The Young and Well CRC is established under the Australian Government’s Cooperative Research Centres Program. youngandwellcrc.org.au

Queensland University of Technology (QUT) QUT is a top Australian university with global connections and an applied emphasis in courses and research best suited to the needs of industry and the community. QUT has a reputation for quality undergraduate and postgraduate courses and has 42,000 students, including 6000 from overseas. Courses are in high demand and its graduate employment rate is well above the national average for Australian universities. The Young and Well CRC is QUT’s 10th CRC, and is a partnership between the Faculties of Health, Science and Engineering, Business and Creative Industries at QUT. qut.edu.au

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Executive summary BACKGROUND Excessive drinking is endemic in young people. Risky single occasion drinking (RSOD; > 4 drinks in < 6 hours) more than doubles the risk of injury in those aged 15 to 25 years, yet many do not view their alcohol use as problematic. Innovative, youth-friendly and highly accessible ways of delivering preventative health messages are required. The potential role of smartphone applications (apps) in reducing RSOD in young people is yet to be determined. Ray’s Night Out is a new iPhone app for promoting harm minimisation and controlled drinking strategies in young people aged 16 to 25.

OBJECTIVE To describe the design, development, prototype testing and evaluation of the effectiveness of the Ray’s Night Out app.

METHODS Study 1 Two participatory design workshops (PDWs) were employed with five young people aged 18 to 25 years to develop the app’s concept and design. An iterative design process was implemented by a team of experts to synthesise young people’s ideas with evidence-based strategies for reducing the harms associated with RSOD. Young people’s feedback was sought throughout the design and development process.

Study 2 A second round of PDWs were conducted to test the quality, utility and acceptability of the Ray’s Night Out prototype. Nine participants aged 19 to 23 years who had engaged in at least one RSOD episode in the past month tested the app and provided qualitative feedback on its acceptability and usability. Quantitative feedback on the app’s engagement, functionality, aesthetics and information quality was also obtained using the Mobile App Rating Scale for App Users (MARS-AU). The app was refined based on this feedback and further testing followed.

Study 3 A randomised controlled trial comparing immediate versus one-month-delayed access to the app was conducted to evaluate its quality and efficacy. One hundred and ninety seven (197) participants aged between 16 and 25 years who had engaged in RSOD in the past month participated in the trial. The impact of the app on alcohol-related knowledge (primary outcome), alcohol use in the past month and alcohol-related harms measured on the Rutgers Alcohol Problem Index (RAPI) was examined. Data was collected at one, two, three and six months follow-up. User-perceived app quality was calculated using the MARS-AU and a number of app-specific questions after one month of app use.

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RESULTS Study 1 The overarching themes and features of the app were identified during the PDWs and implemented during the iterative design and development process. Features included an interactive avatar, use of the terms ‘good vibes’ and ‘stupid line’ to describe key concepts within the app, and the need to vary drinking goals according to the type of night out.

Study 2 Ratings on the MARS-AU scale suggested that the Ray’s Night Out prototype had good to excellent levels of functionality and visual appeal, a good level of information quality, and an acceptable level of engagement. Participants agreed that the app had high levels of youth appeal, and would prompt users to think about their alcohol use limits. Qualitative feedback provided several suggestions for improving the app, including the addition of an informative tutorial overlay and pub-style alcohol trivia to increase users’ alcohol-related knowledge and highlight the consequences of RSOD. Study 3 App quality was assessed on the MARS-AU scale after one month of app-use: • The app received a mean MARS-AU rating of 3.8 (SD=0.5) on the five-point rating scale, with good (four-star) levels of functionality, visual aesthetics and information quality and acceptable levels of engagement.

• The app was successful in triggering further consideration of drinking: o 68% agreed it made them think about their drinking o 77% said it motivated them to think about their drinking goals for a night out o 37% said it may influence them to drink less o 31% said it motivated them to change their drinking • Quantitative feedback also indicated the app provided support for alcohol control: o 46% said the app helped them identify their ‘stupid line' for drinking o 80% said it gave helpful hints on safer drinking o 77% said it made them think about how their drinking goal may vary according to the type of night out they were planning The efficacy of Ray’s Night Out was assessed at one month follow up only. Young alcohol users in the immediate app access group had significantly higher alcohol knowledge scores at one month follow up, than those in the delayed access group. No other between-group differences on alcohol use or related harm were found.

The impact of Ray’s Night Out on alcohol use and related problems was assessed in both groups at two, three and six months follow-up, compared to baseline. Significant reductions in the average number of typical and maximum drinks consumed on one occasion were found in both the immediate and delayed access groups at two and six months follow-up.

Reductions in the number and frequency of alcohol-related problems (RAPI) were found at two, three and six months follow up, relative to baseline. The proportion of young people with no alcohol related problems increased from 24.9% at baseline to 39.7%, 39.0% and 48.1% at two, three and six months follow up respectively. A significant reduction in the severity of harmful alcohol use assessed using the Alcohol Use Disorders Identification Test (AUDIT) was also found between baseline and six months follow up.

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CONCLUSIONS Ray’s Night Out was developed using a user-centred approach and iterative design and development process. Results suggest that Ray’s Night Out provides a non-stigmatising and easily accessible approach for increasing young people’s alcohol-related knowledge and awareness of drinking limits. The app had high levels of acceptability among young people, who also rated the app highly for its visual aesthetics, functionality and information quality.

While the app increased participants’ knowledge of alcohol use, further testing is required to determine if the reductions in alcohol use and related problems found over time were due to app use alone. Clinicians, teachers, practitioners or parents can use Ray’s Night Out to help increase young people’s knowledge and awareness of alcohol use limits in an engaging and youth-friendly way. An updated version of Ray’s Night Out is available for download from the Australian Apple App store.

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