A Gamified, Social Media Inspired Personalized Normative Feedback Alcohol Intervention for Sexual Minority Women
Condition: Alcohol Drinking; Alcohol Abuse; Alcohol; Harmful Use
MeSH terms: Alcoholism; Alcohol Drinking
Study type: Interventional

Summary: 
      Sexual minority women in the United States are more likely to drink alcohol, engage in heavy
      drinking, and experience alcohol-related problems than are heterosexual women. Yet, to date,
      no evidence-based intervention or prevention efforts have been developed to reduce alcohol
      consumption among female sexual minority community members. The proposed research seeks to
      narrow the disparity in alcohol intervention research by examining an innovative gamified
      personalized normative feedback (PNF) intervention to reduce drinking among sexual minority
      women found to frequent social media sites and overestimate norms related to peers' general
      alcohol use and drinking to cope with sexual minority stigma. The newly developed GANDR
      (Gamified Alcohol Norm Discovery and Readjustment) PNF format takes the well-established core
      components of a PNF alcohol intervention and delivers these components within an inviting,
      social media inspired, culturally-tailored online competition. This incognito intervention
      format is designed to be more appealing, engaging, believable, positively received, and thus
      effective than standard web-based PNF. The version developed for sexual minority women
      delivers PNF on alcohol use and stigma-coping behaviors within the context of an online game
      about sexual minority female stereotypes. Following two introductory rounds of play by a
      large cohort of sexual minority women, a sub-sample of 500 sexual minority female drinkers
      will be invited to participate in an evaluation study. Study participants will be randomized
      to receive 1 of 3 unique sequences of feedback (i.e., Alcohol & Stigma-Coping, Alcohol &
      Control, or Control topics only) during 2 intervention rounds taking place over a 6-month
      period. The randomized feedback sequences and multiple rounds of play will allow the research
      team to evaluate whether PNF on alcohol use reduces sexual minority women's alcohol
      consumption and negative consequences relative to PNF on control topics (AIM 2: H1), examine
      whether providing PNF on stigma-coping behaviors in addition to alcohol use further reduces
      alcohol use and consequences beyond alcohol PNF alone (AIM 2: H2), and identify mediators and
      moderators of intervention effectiveness (AIM 3).
    

Detailed description: 
      This incognito alcohol intervention is culturally tailored to appeal to heavy social media
      using sexual minority women residing in the US and ranging in age from 21 to 55 years.
      Personalized normative feedback on sexual identity and age specific descriptive drinking and
      stigma-coping norms are delivered to players within the context of an online competition
      designed to challenge sexual minority women stereotypes and increase visibility. To increase
      the believability of the normative statistics, players create a social media-inspired profile
      at registration which includes an optional photo, brief bio, links to social media accounts,
      and other basic information. Registered players are able to browse the profiles of others and
      actual norms for all topics are transparently generated by the responses of players taking
      part in the competition. To increase motivation and engagement, each monthly round of the
      competition features a point-based reward system, a leader board, and a cash prize that is
      awarded to the top scorer who demonstrates the greatest accuracy in perceptions of peers. To
      decrease defensive reactions and increase appeal, feedback topics are ostensibly selected by
      chance in the game with treatment PNF on alcohol use and stigma-coping behaviors delivered
      alongside feedback on control topics of high interest to community members (e.g., style,
      relationships, sex, etc.). Appeal and credibility are also gained through sponsorship and
      promotion of the competition by several collaborating community organizations trusted as
      sources for health and social information by sexual minority women.

      One round of the game is played each month over a 8 month period. Players are encouraged to
      browse player profiles before each round and it is made clear that the goal is to grow one's
      score by submitting accurate guesses and strategic bets on the responses of other players in
      one's age and sexual identity group. Each round includes questions about 2 to 3 topics
      ostensibly selected by a slot machine like spinner. For each topic, players make guesses
      about the behaviors and experiences of other players in their age and sexual identity group,
      choose amounts of points to bet on these guesses being true of the group, and then contribute
      to actual group norms by answering parallel questions. Each round is "open" for 30 days. Once
      closed, players are sent a text message containing a private link at which they can see
      detailed results (PNF) for the round, view the leaderboard and cash prize winner, and play
      the next round.

      Packaging this intervention as a fun, identity-relevant competition for sexual minority women
      rather than a transparent alcohol intervention study allows feasibility and efficacy to be
      evaluated simultaneously, with a high degree of ecological validity. First, 1200 sexual
      minority women will be recruited to take part in the online competition. No
      participation-based incentives will be offered to players beyond the opportunity to compete
      for a variable cash prize each round. Then, following two initial rounds of play, a
      sub-sample of 500 drinkers will be invited to take part in an incentivized evaluation study
      after answering alcohol use questions in Round 3. Upon consenting to participate in the
      evaluation study, participants will be randomized to receive 1 of 3 unique sequences of
      feedback (i.e., Alcohol & Stigma-Coping, Alcohol & Control, or Control only) during
      intervention Rounds 3 and 4. Short-term reductions in alcohol use will be assessed in Round 6
      of the competition where players will be prompted to guess, bet on, and answer alcohol use
      and control topic questions for a second time (i.e., Replay Bonus Round; 2 month follow-up).
      Following all rounds of the competition, a short survey will assess the alcohol use and
      negative consequences of Evaluation Study participants a final time (4 month follow-up).

      Feasibility analysis will examine engagement with the online competition platform and
      sustainability of play in the absence of traditional study participation incentives among
      players not involved in the Evaluation Study. Efficacy analysis will focus on study
      participants randomly assigned to 1 of the 3 feedback conditions in order to: 1) evaluate
      whether PNF on alcohol use reduces sexual minority women's alcohol consumption and negative
      consequences relative to PNF on control topics; 2) examine whether providing PNF on
      stigma-coping behaviors in addition to alcohol use further reduces alcohol use and
      consequences beyond alcohol PNF; and, 3) identify mediators and moderators of intervention
      effectiveness.
    

Intervention name(s): Personalized Normative Feedback
Intervention type(s): Behavioral
Intervention description(s): Personalized Normative Feedback (PNF) is a popular social norms-based intervention strategy which presents individuals with a personalized, individual report designed to correct misperceived peer norms using a graphical display. Bar charts compare actual alcohol use statistics for the peer group to A) participants' estimates of peer drinking and, B) their own self-reported drinking.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: The web app is programmed to invite an eligible sub-sample of participants from the larger population to take part in an evaluation study during the competition's 3rd monthly round. Those who consent to participate are automatically randomized by Qualtrics Research Suite to receive 1 of 3 unique sequences of feedback (i.e., Alcohol & Stigma-Coping, Alcohol & Control, or Control topics only) during 2 intervention rounds taking place during a 6-month period.
Masking: Double (Participant, Investigator)
Primary purpose: Prevention
Keywords: Social Norms; Personalized Normative Feedback; Sexual Minority Women