title: The investigation of a transdiagnostic online intervention on alcohol consumption, binge eating, and gambling behaviour
Creators: name: Humphreys, Gabrielle
Publisher: name: University of Liverpool Repository
Year: 2024

description: The acceptability, suitability, and efficacy of online interventions for health-related behaviour change is debated. eHealth interventions can reduce extensive healthcare waitlists, providing instant access for individuals in need, whilst also lessening the workload demand for healthcare professionals. Users can access services at any time and location with complete anonymity, removing further barriers to help seeking. Despite this potential, many individuals report concern over navigating these platforms and the lack of support provided throughout – a valid worry when discussing complex topics like mental health and compulsive behaviours. Professionals tend to voice concerns over practical elements of delivery, such as technical issues, changed routine, and data confidentiality. Equally, the lack of evidence-based design in some interventions is a major point of concern, with many businesses opting for a less rigorous, and therefore cheaper, development stage. This poses ethical issues over users expending effort and money on potentially ineffective and unsupported structures. 

This PhD investigated the acceptance of an evidence-based online and transdiagnostic intervention, informed by the Behaviour Change Wheel (Chapter 3) and a systematic review on existing and effective online tools (Chapter 2). The developed intervention spanned five weeks and consisted of learning exercises, set tasks and online feedback from psychologists. This aimed to target either gambling, alcohol consumption or binge eating behaviours, selected due to their similarities in compulsivity and social attitudes. This framework was designed for OhMyMood LtD, an existing Dutch eHealth company who funded this research. In this thesis, the developed intervention was examined through a pilot study by both healthcare professionals and existing OhMyMood users (Chapter 4). Predictors of this intervention acceptance were also studied thoroughly, with one study conducted focussing on the impact of eHealth literacy and technology use (Chapter 6), and another study examining the influence of behaviour severity on this same acceptance (Chapter 7). Finally, attrition rates were also examined in users of an existing OhMyMood intervention for general psychological well-being with the aim to identify those at risk of leaving the course early (Chapter 4). 

This thesis holds useful implications for the development of future interventions, highlighting the importance of a rigorous and evidence-based design process with many testing stages. Younger males were identified as being most at-risk of intervention drop out, something healthcare professionals should be aware of when providing support. Equally, support should be provided to improve both technology skills and eHealth literacy – two factors found to improve acceptance rates. Despite scepticism on their appropriateness, acceptance was also found to increase with one’s gambling severity, highlighting that perhaps these online platforms are best applied to online-based behaviour – an area for future research. Importantly, this acceptance was also improved with a younger age, suggesting online interventions have a place in the future of healthcare.