The Effectiveness of a Web-Based Self-Help Program to Reduce Alcohol Use Among Adults With Drinking Patterns Considered Harmful, Hazardous, or Suggestive of Dependence in Four Low- and Middle-Income Countries: Randomized Controlled Trial
Abstract
Background
Given the scarcity of alcohol prevention and use disorder treatments in many low- and middle-income countries (LMICs), the World Health Organization has launched an eHealth portal that includes the web-based self-help program “Alcohol e-Health.”
Objective
This study aimed to test the effectiveness of the Alcohol e-Health program in a randomized controlled trial.
Methods
This was a two-arm, individually randomized, and controlled trial across four LMICs comparing the self-help program and psychoeducation and internet access as a usual waiting list. Participants were broadly recruited from community samples in Belarus, Brazil, India, and Mexico from January 2016 through January 2019. The primary outcome measure was a change in the Alcohol Use Disorders Identification Test (AUDIT) score with a time frame of 6 months between baseline and follow-up. Secondary outcomes included self-reported numbers of standard units of alcohol over the previous week and cessation of harmful (risky) or hazardous alcohol use (AUDIT score <8).
Results
For this study, the researchers recruited 1400 predominantly male (n=982, 70.1%) at least harmful (risky) or hazardous alcohol users. The mean age was 37.6 years (SD 10.5). The participants were recruited from Brazil (n=587), Mexico (n=509), India (n=212), and Belarus (n=92). Overall, a complete case analysis identified higher AUDIT changes in the intervention group (B=−4.18, 95% CI −5.42 to −2.93, P<.001, d=0.56) that were mirrored by changes in weekly standard units of alcohol (B=−9.34, 95% CI −15.90 to −2.77, P=.005, d=0.28) and cessation rates for harmful (risky) or hazardous alcohol use (χ21=14.56, N=561, P<.001). The supplementary intention-to-treat analyses largely confirmed these initial results.
Conclusions
The expansion of the Alcohol e-Health program to other LMICs with underdeveloped alcohol prevention and treatment systems for alcohol use disorders should be considered after successful replication of the present results.
