Background: Engagement with digital behavior change interventions (DBCIs) is considered a prerequisite for intervention efficacy. However, in many trials on DBCIs, participants use the intervention either only little or not at all. Objective: To analyze engagement with a web-based intervention to reduce harmful drinking, we explored (1) whether engagement with a web-based alcohol intervention is related to drinking outcomes, (2) which user characteristics are associated with measures of engagement, and (3) whether reported outcomes are associated with data captured by voluntary intervention questionnaires. Methods: We analyzed data of the intervention arm of a randomized controlled trial on a DBCI to reduce risky alcohol consumption. Data were collected at baseline (T0), after 90 days (T1), and at the end of the 180-day usage period (T2). Engagement with the intervention was measured via system usage data as well as self-reported usage. Drinking behavior was measured as average daily alcohol consumption as well as the number of binge drinking days. User characteristics included demographics, baseline drinking behavior, readiness to change, alcohol-related outcome expectancies, and alcohol abstinence self-efficacy. Following a bivariate approach, we performed two-tailed Welch’s t tests and Wilcoxon signed rank/Mann-Whitney U tests or calculated correlation coefficients. Results: The data of 306 users were analyzed. Time spent engaging with the intervention as measured by system usage did not match self-reported usage. Higher self-reported usage was associated with higher reductions in average daily alcohol consumption (T1: ρ=0.39, P<.001; T2: ρ=0.29, P=.015) and in binge drinking days (T1: ρ=0.62, P<.001; T2: ρ=0.3, P=.006). Higher usage was reported from users who were single (T1: P<.001; T2: P<.001), users without children (T1: P<.001; T2: P<.001), users who did not start or finish secondary education (T1: P<.001; T2: P<.001), users without academic education (T1: P<.001; T2: P<.001), and those who worked (T1: P=.001; T2: P=.004). Relationships between self-reported usage and clinical or psychological baseline characteristics were complex. For system usage, the findings were mixed. Reductions in drinking captured by intervention questionnaires were associated with reported outcomes. Conclusions: Though self-reported usage could be consistently linked to better outcomes and multiple user characteristics, our findings add to the overall inconclusive evidence that can be found throughout the literature. Our findings indicate potential benefits of self-reports as measures of engagement and intervention questionnaires as a basis for tailoring of intervention content. Future studies should adopt a theory-driven approach to engagement research utilizing psychometrically sound self-report questionnaires and include short ecological momentary assessments within the DBCIs. Trial Registration: German Clinical Trials Register DRKS00006104; https://tinyurl.com/y22oc5jo

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中文翻译：

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参与基于网络的干预措施以减少有害饮酒：随机对照试验的二次分析

背景：参与数字行为改变干预措施（DBCI）被视为干预效果的前提条件。但是，在许多关于DBCI的试验中，参与者很少或根本不使用干预措施。目的：为了分析通过网络干预减少有害饮酒的参与度，我们探讨了（1）通过网络饮酒干预度与饮酒结果是否相关，（2）哪些用户特征与参与度相关，以及（3）报告的结果是否与自愿干预问卷收集的数据相关。方法：我们分析了一项关于DBCI的随机对照试验的干预组的数据，以减少危险的酒精消耗。在基线（T0），90天（T1）之后和180天使用期限（T2）结束时收集数据。通过系统使用情况数据以及自我报告的使用情况来测量对干预的参与程度。饮酒行为以平均每日饮酒量以及暴饮酒天数来衡量。用户特征包括人口统计学，基线饮酒行为，准备改变，与酒精有关的结局预期和戒酒自我效能感。采用双变量方法后，我们进行了两尾Welch t检验和Wilcoxon有符号秩/ Mann-Whitney U检验或计算出的相关系数。结果：分析了306位用户的数据。根据系统使用情况衡量，参与干预所花费的时间与自我报告的使用情况不匹配。较高的自我报告使用量与平均每日饮酒量的较高减少相关（T1：ρ= 0.39，P <.001; T2：ρ= 0.29，P =。015）和暴饮暴食日（T1：ρ= 0.62，P <.001; T2：ρ= 0.3，P = .006）。据报告，单身用户（T1：P <.001; T2：P <.001），没有孩子的用户（T1：P <.001; T2：P <.001），未启动或未使用的用户的使用率更高。完成中学教育（T1：P <.001; T2：P <.001），没有学历的用户（T1：P <.001; T2：P <.001）和工作的人（T1：P = .001） ； T2：P = .004）。自我报告的用法与临床或心理基线特征之间的关系很复杂。对于系统使用，发现是混合的。干预问卷所记录的饮酒量减少与所报告的结果相关。结论：尽管自我报告的使用方式可以始终与更好的结果和多种用户特征相关联，我们的发现增加了整个文献中尚无定论的整体证据。我们的研究结果表明，自我报告作为参与度的量度和干预问卷的潜在益处，是量身定制干预内容的基础。未来的研究应采用理论驱动的方法，利用心理上合理的自我报告调查表进行参与研究，并在DBCI中包括简短的生态瞬时评估。试验注册：德国临床试验注册DRKS00006104；https://tinyurl.com/y22oc5jo 未来的研究应采用理论驱动的方法，利用心理上合理的自我报告调查表进行参与研究，并在DBCI中包括简短的生态瞬时评估。试验注册：德国临床试验注册DRKS00006104；https://tinyurl.com/y22oc5jo 未来的研究应采用理论驱动的方法，利用心理上合理的自我报告调查表进行参与研究，并在DBCI中进行简短的生态瞬时评估。试验注册：德国临床试验注册DRKS00006104；https://tinyurl.com/y22oc5jo

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