Background: Alcohol misuse is associated with a number of health risks and harms that may be particularly detrimental to adolescents. Existing interventions for which there is evidence of effectiveness are time and cost intensive. Brief interventions or classroom delivered programmes are often ineffective, possibly due to their basis in rational models of behaviour. Young people’s risk taking behaviour may be better understood from a dual process perspective, which assumes two routes to behaviour; one rational and planned, the other a faster, reactive and spontaneous route. The Prototype Willingness Model (PWM) assumes that for adolescents, reactive behaviour is a result of the contemplation of ‘prototypes’ or widely held social images about the type of person who engages in a risk behaviour. Evaluation of these prototypes influences ‘willingness’ or an openness to the opportunity to engage a specific behaviour through a process of social comparison. Aim: The PWM has been applied to numerous risk behaviours and populations but there is less research in relation to its application to teenage drinking in a UK context. Thus, the overall aim of the thesis was to develop an intervention targeting constructs in the social reaction pathway in the PWM in order to explore its application to understanding and preventing alcohol misuse in young people. Method: This project used mixed methods and had a multiphase design with separate stages. A framework to guide development of a theory based intervention was proposed. This seven step framework built on existing guidance from Intervention Mapping and the Medical Research Council. The findings from each step are set out below. Findings: Step One: Evidence from a literature review suggested that the social reaction pathway in the PWM may be an appropriate theoretical basis for an intervention to reduce alcohol misuse in young people. Much of the evidence base comes from the USA or from studies that use college students. Step Two: Four focus groups were carried out with 27 11-13 and 16-17 year olds and analysed using deductive thematic analysis. The findings from this study show that young people in this sample were able to clearly describe the characteristics of social images (i.e. prototypes) in relation to alcohol. Step Three: The results of an online questionnaire completed by 182 young people supported the application of the PWM in an alcohol misuse intervention aimed at UK adolescents. The results indicated the intervention should use behaviour change techniques (BCTs) that target prototype perceptions with a focus on characteristics related to sociability. Step Four: The intervention was developed drawing the findings of steps one to three. Four BCTs reflecting the processes in the PWM were incorporated into an intervention in the format of an online quiz. Step Five: Fifteen expert participants gave feedback on the planned intervention in a Delphi study that took place in two questionnaire rounds. Findings suggested support for the content and mode of delivery and suggestions were made for improvements to the intervention. Step Six: Results of a questionnaire completed by 102 teachers and parents, and 16 think aloud interviews with young people found favourable responses to the format and content of the intervention. Feedback suggested that further development may be needed in terms of challenging coolness and peer pressure and in how plans to avoid drinking might be enacted. Step Seven: The findings were integrated and five intervention development priorities were identified from the studies with experts, teachers, parents and young people. In addition, nine overarching meta-themes were identified across all studies, which are discussed in light of their implications for interventions and future research. Conclusion: Drawing on these findings, a plan for intervention based on the social reaction pathway of the PWM, named the Alcohol Smart Quiz (ASQ) is presented. Strengths and weaknesses of the ASQ and the guiding framework used to develop it are discussed. The project highlighted the benefits of taking a clearly stated mixed methods approach, and shows the importance of early qualitative work in exploring theoretical constructs in intervention design.
Permanent link to this resource: https://doi.org/10.24384/ynde-7h36
Davies, Emma L.
Supervisors: Foxcroft, David ; Martin, Jilly
Faculty of Health and Life SciencesDepartment of Psychology, Social Work and Public Health
Year: 2013
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