Heavy alcohol consumption often leads to multiple negative consequences, such as physical [1
], mental [5
], social [7
] and economic problems [8
]. It is one of the most important risk factors for chronic diseases, like cardiovascular diseases and cancer [7
], and mortality [12
]. Unhealthy alcohol consumption, defined as the tendency to drink more than two (females) or three (males) standard drinks per day [13
], is widely prevalent [16
]. In 2007, around 14.0% of Dutch men and 10.5% of Dutch women failed to comply with the country's alcohol guidelines [19
]. Other drinking patterns, like binge drinking, also seem to have an impact on various health-related problems and are widely common as well, especially among youngsters and young adults [12
]. The high prevalence of unhealthy drinkers indicates the need for interventions to encourage people to reduce their alcohol intake.
Research has shown that computer tailored interventions, in which information is adapted to the characteristics and needs of the individual in order to give more personal and relevant advice [21
], are a promising tool to stimulate behavior change as well as to maintain healthy behaviors and to prevent relapse. Computer-tailored programs show key benefits in comparison with non-tailored materials, e.g. they contain less unnecessary and more attractive and more relevant information [22
], they are cost-effective [24
], they seem to be more effective in behavioral change [25
], and the tailored messages are more often read, saved, printed out, remembered and discussed with others [21
Computer-tailored interventions are frequently based on theories [e.g. [29
]. One potential framework for the development of such an intervention is the Transtheoretical Model (TTM) [31
]. The TTM distinguishes five stages of change: precontemplation
; and maintenance
. The TTM describes the likelihood that people in different stages may require different intervention strategies in order to move onto a further stage [33
]. This means that the tailored feedback messages should be tailored to the stage of change of the individuals in order to motivate them to adopt or maintain healthy behaviors. Despite several criticisms [35
], various studies found that certain factors may be more relevant in certain stages than others [41
]. According to De Vries and Backbier [43
], people in different motivational stages differ in terms of attitude, social influence and self-efficacy, as presented in Figure. The pattern has been confirmed for smoking cessation by other studies [41
], but not yet for alcohol consumption.
Figure illustrates that changing attitudes is a crucial first step in a behavioral change process. When comparing people in the different stages of change, precontemplators are assumed to perceive more pros than cons of the “unhealthy” behavior. In the contemplation stage, the pros and cons are more in balance whereas in the action stage people experience more cons than pros. This crossover is a typical phenomenon that distinguishes precontemplators from contemplators and preparers [45
]. With regard to social influence, the impact of this factor increases gradually across the behavioral change process. Precontemplators and contemplators are assumed, however, not to differ in levels of self-efficacy. They do, though, have lower levels of self-efficacy than people in the preparation and action stage. This principle, referred to as the Ø–pattern by De Vries and Backbier [43
], can also be used to guide the development of stage-matched interventions [41
]. The first goal of this paper is to study whether a similar pattern can also be observed for the intention to reduce alcohol intake in Dutch adults.
Another important issue concerning computer tailoring is whether tailored programs are appreciated as much by respondents in all stages of change. On the one hand, one may argue that the stage-matched feature of these types of interventions may lead to as much appreciation from respondents in precontemplation as those in preparation, because optimally respondents of a tailored approach receive no redundant or irrelevant information. Yet, because respondents in precontemplation are not yet ready to think about changing their behavior, it is therefore likely that – despite the tailored approach – respondents will be less favorable in terms of their evaluations than those in preparation. The second goal of this paper is therefore to assess potential differences in appreciation between respondents in different stages.
This study assesses the factors associated with intention to adhere to Dutch alcohol consumption guidelines based on the TTM. The first goal of our study is to compare adults of the general population in different stages of change with regard to the following psychosocial predictors of drinking: (1) attitude; (2) social influence; and (3) self-efficacy. The second goal of this study is to investigate if the appreciation of the computer-tailored alcohol program is related to the motivational stage of a person. Our aim is to identify the potential relevance of possible stage-matched interventions regarding Dutch alcohol consumption guidelines.