Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2021 Aug 27;23(8):e21686.
doi: 10.2196/21686.

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

Michael P Schaub  1 , Marcela Tiburcio  2 , Nora Martínez-Vélez  2 , Atul Ambekar  3 , Roshan Bhad  3 , Andreas Wenger  1 , Christian Baumgartner  1 , Dzianis Padruchny  4 , Sergey Osipchik  4 , Vladimir Poznyak  5 , Dag Rekve  5 , Fabricio Landi Moraes  6 , André Luiz Monezi Andrade  7 , Maria Lucia Oliveira Souza-Formigoni  6 ; WHO E-Health Project On Alcohol And Health Investigators Group  5
Collaborators, Affiliations
Randomized Controlled Trial

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

Michael P Schaub et al. J Med Internet Res. .

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: We 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 a psychoeducation and internet access as 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 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 drinks over the previous week and cessation of harmful or hazardous drinking (AUDIT score <8).

Results: For this study, we recruited 1400 predominantly male (n=982, 70.1%) at least harmful or hazardous alcohol drinkers. 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, 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 drinks (B=-9.34, 95% CI -15.90 to -2.77, P=.005, d=0.28) and cessation rates for harmful or hazardous drinking (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.

Trial registration: ISRCTN ISRCTN14037475; https://www.isrctn.com/ISRCTN14037475.

International registered report identifier (irrid): RR2-10.1111/add.14034.

Keywords: World Health Organization; alcohol; internet; public health; self-help.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
CONSORT-EHEALTH flowchart: overview of participant flow. CCA: complete case analysis; ITT: intention to treat.
See this image and copyright information in PMC

References

    1. Allen L, Williams J, Townsend N, Mikkelsen B, Roberts N, Foster C, Wickramasinghe K. Socioeconomic status and non-communicable disease behavioural risk factors in low-income and lower-middle-income countries: a systematic review. The Lancet Global Health. 2017 Mar;5(3):e277–e289. doi: 10.1016/S2214-109X(17)30058-X. https://linkinghub.elsevier.com/retrieve/pii/S2214-109X(17)30058-X S2214-109X(17)30058-X - DOI - PMC - PubMed
    1. Smyth A, Teo KK, Rangarajan S, O'Donnell M, Zhang X, Rana P, Leong DP, Dagenais G, Seron P, Rosengren A, Schutte AE, Lopez-Jaramillo P, Oguz A, Chifamba J, Diaz R, Lear S, Avezum A, Kumar R, Mohan V, Szuba A, Wei L, Yang W, Jian B, McKee M, Yusuf S. Alcohol consumption and cardiovascular disease, cancer, injury, admission to hospital, and mortality: a prospective cohort study. The Lancet. 2015 Nov 14;386(10007):1945–1954. doi: 10.1016/S0140-6736(15)00235-4.S0140-6736(15)00235-4 - DOI - PubMed
    1. Global status report on alcohol and health. World Health Organization. 2018. [2021-08-04]. https://apps.who.int/iris/bitstream/handle/10665/274603/9789241565639-en... .
    1. Wang PS, Angermeyer M, Borges G, Bruffaerts R, Tat Chiu W, DE Girolamo G, Fayyad J, Gureje O, Haro JM, Huang Y, Kessler RC, Kovess V, Levinson D, Nakane Y, Oakley Brown MA, Ormel JH, Posada-Villa J, Aguilar-Gaxiola S, Alonso J, Lee S, Heeringa S, Pennell BE, Chatterji S, Ustün TB. Delay and failure in treatment seeking after first onset of mental disorders in the World Health Organization's World Mental Health Survey Initiative. World Psychiatry. 2007 Oct;6(3):177–85. https://onlinelibrary.wiley.com/resolve/openurl?genre=article&sid=nlm:pu... - PMC - PubMed
    1. Benegal V, Chand PK, Obot IS. Packages of care for alcohol use disorders in low- and middle-income countries. PLoS Med. 2009 Oct;6(10):e1000170. doi: 10.1371/journal.pmed.1000170. https://dx.plos.org/10.1371/journal.pmed.1000170 - DOI - DOI - PMC - PubMed

Publication types