Alcohol Reduction Intervention Interview Guide

Abstract

The Alcohol Reduction Intervention Interview Guide (Oldham et al., 2024) is a structured qualitative measurement protocol designed to rigorously assess the multi-component acceptability of digital alcohol reduction interventions within clinical trial contexts. Developed as part of a large-scale randomized controlled trial (the iDEAS trial) comparing the digital behavioral intervention smartphone application Drink Less (Garnett et al., 2019) against the standard web-based comparator, the National Health Service (NHS) alcohol advice webpage, the interview guide operationalizes the Theoretical Framework of Acceptability (TFA) articulated by Sekhon et al. (2017). Comprising 18 primary open-ended interview items alongside standardized 5-star rating scales and structured exploratory probes, the instrument investigates the cognitive, affective, behavioral, and practical dimensions of user engagement. Specifically, the schedule interrogates seven core TFA constructs: affective attitude, burden, ethicality, intervention coherence, opportunity costs, perceived effectiveness, and self-efficacy, supplemented by evaluative probes into perceived personal relevance, trial-specific acceptability, and the motivational influence of research incentives. Qualitative administration typically ranges from 12 to 34 minutes per respondent. While classical psychometric parameters such as internal consistency coefficients (e.g., Cronbach’s alpha) and factor analyses are inapplicable to this qualitative interview guide, the instrument exhibits substantial qualitative rigor, content validity, and transferability. It provides an empirically grounded framework for evaluating behavioral change mechanisms, digital adherence barriers, and user-centered design principles in preventive medicine, public health, and addiction sciences.

Keywords

Theoretical Framework of Acceptability, Alcohol Reduction, Digital Health Interventions, Drink Less App, NHS Alcohol Advice, Process Evaluation, Qualitative Assessment, Behavioral Medicine, Telehealth, Mobile Health

Authors

The Alcohol Reduction Intervention Interview Guide was formulated and deployed by an interdisciplinary consortium of behavioral scientists, clinical psychologists, health economists, and addiction researchers affiliated with prominent academic and public health bodies across the United Kingdom and the United States:

• Melissa Oldham, PhD – Department of Behavioural Science and Health, University College London, London, United Kingdom (Email: [email protected]).
• Larisa-Maria Dina, MSc – University College London, London, United Kingdom (ORCID: 0000-0002-2530-2983).
• Gemma Loebenberg, MSc – University College London, London, United Kingdom (ORCID: 0000-0001-9927-2839).
• Olga Perski, PhD – Department of Behavioural Science and Health, University College London, London, United Kingdom; Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, United States.
• Jamie Brown, PhD – Department of Behavioural Science and Health, University College London, London, United Kingdom (ORCID: 0000-0002-2797-5428).
• Colin Angus, MSc – Sheffield Alcohol Research Group, School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom (ORCID: 0000-0003-0529-4135).
• Emma Beard, PhD – Department of Behavioural Science and Health, University College London, London, United Kingdom (ORCID: 0000-0001-8586-1261).
• Robyn Burton, PhD – Office for Health Improvement and Disparities, London, United Kingdom (ORCID: 0000-0003-1684-5238).
• Matt Field, PhD – Department of Psychology, University of Sheffield, Sheffield, United Kingdom (ORCID: 0000-0002-7790-5559).
• Felix Greaves, PhD – School of Public Health, Imperial College London, London, United Kingdom.
• Matthew Hickman, PhD – Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom (ORCID: 0000-0001-9864-459X).
• Eileen Kaner, PhD – Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom.
• Susan Michie, DPhil – Centre for Behaviour Change, University College London, London, United Kingdom.
• Marcus R. Munafò, PhD – School of Psychological Science, University of Bristol, Bristol, United Kingdom (ORCID: 0000-0002-4049-993X).
• Elena Pizzo, PhD – Department of Applied Health Research, University College London, London, United Kingdom.
• Claire Garnett, PhD – Department of Behavioural Science and Health, University College London, London, United Kingdom (ORCID: 0000-0002-6589-299X).

Purpose

The primary clinical and research purpose of the Alcohol Reduction Intervention Interview Guide is to capture rich, qualitative, phenomenological, and evaluative feedback regarding the acceptability of digital interventions designed to mitigate hazardous and harmful alcohol consumption. Unhealthy alcohol intake represents one of the foremost preventable contributors to global morbidity, chronic liver disease, cardiovascular pathology, neoplasia, and premature mortality. Although evidence-based psychological strategies (such as behavioral self-monitoring, action planning, normative feedback, and cognitive restructuring) are effective in mitigating alcohol misuse, their public health translation depends upon sustained end-user engagement, perceived utility, and intervention fidelity.

Within clinical trials of digital health technologies—specifically mobile health (mHealth) applications and web-based therapeutic portals—high rates of user attrition, low sustained adherence, and digital disengagement frequently undermine theoretical treatment outcomes. Quantitative metrics, such as app sessions, screen-view duration, or modular completion rates, indicate what participants do, but they fail to illuminate why individuals abandon, underutilize, or enthusiastically adopt specific components. The Alcohol Reduction Intervention Interview Guide was explicitly constructed to solve this explanatory deficit during the process evaluation phase of the iDEAS (Evaluating the Efficacy and Cost-effectiveness of Digital Interventions for Alcohol Reduction) trial.

By engaging respondents in structured dialogic inquiry, the interview schedule serves multiple complementary objectives:

• Deconstructing User Experience (UX): It delineates the micro-contexts of real-world use, distinguishing situational triggers that prompt users to launch an app or consult a webpage from contextual barriers that impede interaction (e.g., social gatherings, high-stress environments, or routine daily commuting).
• Evaluating Theoretical Mechanisms of Acceptability: It systemically probes the specific psychological mechanisms identified by the Theoretical Framework of Acceptability, such as emotional valence, cognitive workload, perceived behavioral efficacy, and perceived disruption to daily living.
• Disentangling Intervention from Trial Acceptability: A critical design innovation of this guide is its deliberate operational demarcation between the digital health tool itself (e.g., Drink Less or the NHS portal) and the surrounding clinical trial procedures (e.g., research compensation, lengthy longitudinal follow-up questionnaires, and researcher contact). This prevents researchers from confounding trial burden with intervention dissatisfaction.
• Informing Iterative Intervention Optimization: The resulting data provide granular, user-led recommendations that enable software engineers, behavioral architects, and health service providers to refine user interfaces, restructure intervention timing, calibrate behavioral nudges, and eliminate cognitive friction before broad public health implementation.

Psychological Construct

The central psychological construct operationalized by the interview guide is Intervention Acceptability. Historically, acceptability was treated as an ill-defined, single-item pragmatic metric (e.g., satisfaction ratings, retention rates, or intervention completion). However, modern behavioral psychometrics conceptualizes acceptability as a multifaceted, dynamic construct reflecting the extent to which people delivering or receiving a healthcare intervention consider it to be appropriate, based on anticipated or experienced cognitive and emotional responses.

Drawing directly from the Theoretical Framework of Acceptability, the guide assesses the construct through seven theoretical sub-dimensions alongside specialized clinical sub-domains:

1. Affective Attitude

This dimension examines how an individual feels emotionally about an intervention before, during, or after engagement. Rather than evaluating cold utility, it captures the emotional valence—such as pleasure, frustration, anxiety, reassurance, or boredom—elicited by the interface, notifications, and tone of the intervention. In the guide, this is operationalized via questions interrogating how much the user liked or disliked the digital tool.

2. Burden and Cognitive Load

Burden measures the perceived amount of cognitive, temporal, physical, or logistical effort required to initiate and sustain participation in the intervention. Highly burdensome interventions demand onerous data entry, convoluted navigation, or unrealistic time commitments, directly precipitating behavioral dropout. The guide specifically evaluates whether tracking alcohol intake or reading educational materials was perceived as overly time-consuming or mentally taxing.

3. Ethicality and Social Fit

Ethicality captures the degree to which an intervention aligns with an individual’s core personal value system, moral identity, cultural background, and perceived equity. Within the context of substance misuse, this construct touches heavily on potential feelings of stigmatization, judgment, privacy preservation, and inclusivity. The guide assesses ethicality by probing whether respondents believe the digital intervention is universally accessible and appropriate for anyone across the socio-demographic spectrum.

4. Intervention Coherence

Intervention coherence reflects the user’s mental model of how the intervention operates and the clarity of its underlying mechanism of action. If a user cannot comprehend how logging daily units or viewing educational statistics leads to reductions in cravings or consumption, adherence precipitously declines. The interview schedule operationalizes this construct by querying whether participants clearly understood how the tool worked and what goals it aimed to accomplish.

5. Opportunity Costs

This behavioral-economic dimension evaluates what values, benefits, or activities an individual must forfeit to engage with the digital intervention. Opportunity costs encompass tangible elements (such as time spent away from work or family) and psychological elements (such as giving up social leisure routines). The guide investigates whether continuous logging or interaction interfered with other valued daily activities or interpersonal relationships.

6. Perceived Effectiveness

Perceived effectiveness denotes the user’s subjective belief that the intervention has produced, or is capable of producing, the intended therapeutic outcome—namely, moderation or cessation of alcohol intake. This construct involves subjective assessments of behavior change, reduced urge frequency, enhanced craving management, and heightened self-monitoring fidelity.

7. Self-Efficacy

Grounded in Bandura’s social cognitive principles, self-efficacy within this framework denotes the user’s confidence in their own capability to navigate, master, and routinely implement the intervention’s recommendations, features, and self-regulatory tools. The guide measures whether users felt empowered and technologically competent when utilizing the digital intervention.

8. Perceived Personal Relevance

Extending beyond standard TFA dimensions, the guide evaluates perceived personal relevance—the extent to which users perceive content to be tailored, personalized, and culturally compatible with their specific drinking patterns, motivations, and life circumstances, rather than perceived as generic or impersonal.

Theoretical Framework

The architectural foundation of the Alcohol Reduction Intervention Interview Guide is anchored in modern health psychology and behavioral science frameworks, most notably the Theoretical Framework of Acceptability (TFA) formulated by Sekhon, Cartwright, and Francis (2017).

Historically, healthcare literature routinely conflated acceptability with related but distinct constructs, such as treatment satisfaction, intervention feasibility, adherence, and intervention uptake. Sekhon and colleagues addressed this theoretical ambiguity by synthesizing literature across medical, psychological, and behavioral domains, defining acceptability through a rigorous, multi-construct perspective: “a multi-faceted construct that reflects the extent to which people delivering or receiving a healthcare intervention consider it to be appropriate, based on anticipated or experienced cognitive and emotional responses to the intervention.”

The TFA posits that acceptability must be conceptualized across three temporal epochs:

• Prospective Acceptability: Anticipated reactions prior to engaging with an intervention.
• Concurrent Acceptability: Real-time cognitive and affective evaluations while interacting with the active components of the intervention.
• Retrospective Acceptability: Post-intervention evaluation once the intervention period has concluded.

The Alcohol Reduction Intervention Interview Guide focuses primarily on retrospective acceptability, administered at longitudinal trial exit points (e.g., 6 months post-enrollment), while also prompting participants to recall their prospective motivations for enrolling in the trial. Furthermore, the design of the interventions evaluated by this guide—particularly the Drink Less smartphone platform—is explicitly derived from the Behaviour Change Wheel (BCW) and the COM-B Model (Capability, Opportunity, Motivation, and Behaviour) developed by Michie et al. (2011), along with the standardized Behaviour Change Technique Taxonomy v1 (BCTTv1) (Michie et al., 2013).

Within this theoretical convergence, acceptability operates as a central psychological moderator. An intervention may integrate theoretically verified behavior change techniques (e.g., goal setting, self-monitoring, normative feedback), but if it triggers negative affective attitudes, imposes excessive cognitive burden, or clashes with user self-efficacy, engagement drops, decoupling the user from the active theoretical ingredients. The interview guide systematically opens this “black box” of complex intervention evaluation, operationalizing each TFA dimension into conversational probes that bridge empirical qualitative data with theoretical mechanisms.

Validity

Because the Alcohol Reduction Intervention Interview Guide is a qualitative interview schedule rather than a psychometric self-report scale designed for numerical aggregation, its measurement properties are assessed through qualitative validity, content validation, and epistemic trustworthiness rather than classical test theory (CTT) metrics.

Content and Face Validity

The guide demonstrates exceptionally high content validity. Its items were not generated ad hoc; rather, they were engineered through systematic mapping against the established theoretical constructs of the Theoretical Framework of Acceptability (Sekhon et al., 2017). Expert behavioral scientists, clinical psychologists, and health economists from University College London and partner institutions reviewed, iterated, and pre-tested the prompt sequences to ensure that each target domain (e.g., burden, ethicality, coherence) was accurately represented by accessible, non-leading, and non-stigmatizing language.

Construct and Criterion Credibility

In qualitative psychometrics, construct credibility and validity correspond to Lincoln and Guba’s foundational criteria for qualitative trustworthiness: credibility, transferability, dependability, and confirmability.

• Credibility (Internal Validity): Oldham et al. (2024) established credibility through prolonged engagement with trial participants, purposive maximum-variation sampling (capturing varied genders, age brackets, baseline drinking severity levels, and socio-economic backgrounds), and rigorous audio-recording and verbatim transcription of all interview data. Independent dual-coding frameworks were applied to evaluate transcript content against the TFA domains, confirming that the questions systematically elicited the intended psychological constructs without leading the interviewees.
• Transferability (External Validity): While qualitative findings are contextually situated within adult drinkers in the UK, the structural architecture of the guide is directly transferable. The questions are formulated with interchangeable modular tokens (e.g., [Drink Less app / NHS Alcohol advice webpage]), permitting direct adaptation to other digital public health domains, such as smoking cessation, weight management, and chronic disease self-management.
• Dependability and Confirmability: Dependability was ensured through an exhaustive audit trail that documented interview protocol revisions, operational codebooks, and reflexivity practices. Qualitative researchers regularly engaged in reflexive debriefing to prevent interviewer bias from shaping participant responses, particularly regarding affective attitudes toward the digital resources.

Reliability

In classical psychometric testing, reliability is conventionally expressed through statistical coefficients of internal consistency (e.g., Cronbach’s alpha, McDonald’s omega) or temporal stability (test-retest correlations). For qualitative interview guides, such mathematical calculations are neither theoretically appropriate nor methodologically indicated. Instead, the reliability of the Alcohol Reduction Intervention Interview Guide is evaluated through procedural reliability, inter-coder dependability, and standardized interview protocol fidelity.

Standardization and Administrative Consistency

The instrument incorporates strict conversational instructions, standardized question phrasing, and predefined hierarchical probes. The clear demarcation between intervention-specific inquiries and clinical-trial-specific queries minimizes interviewer-induced measurement error. Every participant is systematically exposed to the identical sequence of core TFA domains, ensuring that variations in qualitative transcripts reflect genuine differences in participant experience rather than idiosyncratic deviations in interviewer administration.

Inter-Coder Agreement and Analytical Rigor

In the primary study by Oldham et al. (2024), analytic reliability was demonstrated through rigorous thematic framework analysis:

• A subset of interview transcripts was independently coded by multiple qualitative analysts using a codebook deductively organized by the TFA constructs and inductively open to novel emergent themes.
• Discrepancies in thematic indexing, conceptual categorization, and operational boundary definitions were systematically discussed and reconciled through team consensus meetings.
• This high level of inter-coder consensus provides empirical assurance that the interview guide consistently elicits categorical responses that can be systematically replicated across independent behavioral health evaluators.

Factor Analysis

Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) are psychometric methods designed to uncover latent dimensional structures within continuous or ordinal multi-item psychometric batteries. Because the Alcohol Reduction Intervention Interview Guide utilizes open-ended conversational exchanges designed for qualitative thematic and framework analysis, factor analysis was not conducted and is statistically inapplicable.

However, the conceptual architecture of the interview schedule mirrors a multi-factor structural model. The theoretical alignment between the interview prompts and the underlying latent constructs can be formally conceptualized as follows:

• Factor 1: Affective Valence & Acceptability (Operationalized by Items 4, 4a, 5, 15, and 15a; capturing global star ratings and affective attitudes).
• Factor 2: Utility & Effectiveness (Operationalized by Items 6 and 7; evaluating perceived personal relevance and subjective drinking reduction).
• Factor 3: Feasibility & Cognitive Cost (Operationalized by Items 8, 9, and 11; capturing temporal burden, functional friction, and opportunity costs).
• Factor 4: System Usability & Self-Efficacy (Operationalized by Items 10, 12, and 13; evaluating perceived equity/ethicality, user confidence, and intervention coherence).
• Factor 5: Research Artifacts & Trial Engagement (Operationalized by Items 1, 14, 16, and 16a; isolating procedural trial factors and financial incentive effects).

Researchers interested in quantifying these dimensions for structural equation modeling (SEM) frequently adapt these qualitative items into formal Likert-based TFA survey scales, where CFA routinely confirms the seven-factor independence of Sekhon et al.’s framework.

Instrument / Measurement Tool

The Alcohol Reduction Intervention Interview Guide is structured as a semi-structured qualitative interview schedule incorporating open-ended exploratory questions, diagnostic follow-up probes, and anchored 5-star ordinal rating items. The complete structural parameters of the measurement tool are detailed below:

• Instrument Name: Alcohol Reduction Intervention Interview Guide
• Authors: Melissa Oldham, Larisa-Maria Dina, Gemma Loebenberg, Olga Perski, Jamie Brown, Colin Angus, Emma Beard, Robyn Burton, Matt Field, Felix Greaves, Matthew Hickman, Eileen Kaner, Susan Michie, Marcus R. Munafò, Elena Pizzo, and Claire Garnett
• Year: 2024
• Administration Format: One-on-one semi-structured qualitative interview (administered via teleconference, telephone, or in-person audio-recorded settings).
• Target Population: Adult drinkers (aged 18 years and older) participating in digital intervention trials or behavioral healthcare programs.
• Administration Time: Between 12 and 34 minutes per respondent (mean duration approximately 20–25 minutes).
• Structure of Items:
  • Part 1: Digital Support Acceptability: 14 primary items exploring intervention use contexts, TFA constructs (affective attitude, personal relevance, effectiveness, burden, coherence, ethicality, opportunity costs, self-efficacy), an anchored 5-star global acceptability rating, and an open debriefing prompt.
  • Part 2: Trial Participation Acceptability: 4 primary items evaluating experience of trial enrollment, follow-up survey burden, a 5-star trial acceptability rating, and the motivational influence of study incentives.
• Scoring and Data Interpretation:
  • Qualitative Data: Audio-recorded, transcribed verbatim, and analyzed using Framework Analysis or Thematic Analysis mapped to the Theoretical Framework of Acceptability matrix.
  • Ordinal Rating Items (Global Acceptability): Rated on a discrete 1 to 5 Star Scale where 1 = “One Star” (Lowest Acceptability) and 5 = “Five Stars” (Highest Acceptability), complemented by qualitative justifications (“And can you tell me why?”).

Permissions & Fee and Test Year

The Alcohol Reduction Intervention Interview Guide was officially published in 2024 as an integral component of the process evaluation protocol within the iDEAS randomized controlled trial (Oldham et al., Journal of Medical Internet Research, 2024; 26:e42319).

Licensing and Accessibility: The source article, interview guide, and associated evaluative materials are published under an open-access Creative Commons Attribution License (CC BY 4.0). As such, the tool is fully available for clinical, educational, and empirical academic research free of charge. Researchers and healthcare practitioners are permitted to reproduce, modify, adapt, and administer the interview guide, provided appropriate academic attribution is granted to the original authors (Oldham et al., 2024) and the primary publication is cited.

Correspondence and Contact: Inquiries regarding the original implementation of the guide or the iDEAS trial methodology should be directed to the corresponding author, Dr. Melissa Oldham, Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London, WC1E 7HB, United Kingdom (Email: [email protected]).

References

• Garnett, C., Crane, D., West, R., Brown, J., & Michie, S. (2019). The development of Drink Less: An alcohol reduction smartphone app for excessive drinkers. Translational Behavioral Medicine, 9(2), 296–305. https://doi.org/10.1093/tbm/iby043
• Michie, S., Richardson, M., Johnston, M., Abraham, C., Francis, J., Hardeman, W., Eccles, M. P., Cane, J., & Wood, C. E. (2013). The Behavior Change Technique Taxonomy (v1) of 93 hierarchically clustered techniques: Building an international consensus for the reporting of behavior change interventions. Annals of Behavioral Medicine, 46(1), 81–95. https://doi.org/10.1007/s12160-013-9486-6
• Michie, S., van Stralen, M. M., & West, R. (2011). The behaviour change wheel: A new method for characterising and designing behaviour change interventions. Implementation Science, 6, Article 42. https://doi.org/10.1186/1748-5908-6-42
• National Health Service. (2022). Alcohol advice. NHS. https://www.nhs.uk/live-well/alcohol-advice/
• Oldham, M., Dina, L.-M., Loebenberg, G., Perski, O., Brown, J., Angus, C., Beard, E., Burton, R., Field, M., Greaves, F., Hickman, M., Kaner, E., Michie, S., Munafò, M. R., Pizzo, E., & Garnett, C. (2024). Evaluating the acceptability of the Drink Less app and the National Health Service alcohol advice web page: Qualitative interview process evaluation. Journal of Medical Internet Research, 26, Article e42319. https://doi.org/10.2196/42319
• Sekhon, M., Cartwright, M., & Francis, J. J. (2017). Acceptability of healthcare interventions: An overview of reviews and development of a theoretical framework. BMC Health Services Research, 17, Article 88. https://doi.org/10.1186/s12913-017-2031-8

13. Items of the Scale (Questionnaire)