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Tjondronegoro, Dian, Drennan, Judy, Kavanagh, David, Zhao, Elaine Jing,White, Angela, Previte, Josephine, Connor, Jason, & Fry, Marie-Louise(2015)Designing a mobile social tool that moderates drinking.IEEE Pervasive Computing, 14(3), pp. 62-69.
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https://doi.org/10.1109/MPRV.2015.62
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Designing an Engaging Mobile Social Tool for Moderating
Drinking
Journal: IEEE Pervasive Computing
Manuscript ID: PC-2014-01-0002.R1
Manuscript Type: Regular
Date Submitted by the Author: n/a
Complete List of Authors: Tjondronegoro, Dian; Queensland University of Technology, Zhao, Elaine Jing; University of New South Wales, School of Arts and Media White, Angela; University of Queensland, Fry, Marie-Louise; Queensland University of Technology, Previte, Josephine; University of Queensland, Drennan, Judy; Queensland University of Technology,
Connor, Jason; University of Queensland, Kavanagh, David; Queensland University of Technology,
Keywords:
C.3.h Ubiquitous computing < C.3 Special-Purpose and Application-Based Systems < C Computer Systems Organization, D.2.14.a User interfaces < D.2.14 Human Factors in Software Design < D.2 Software Engineering < D Software/Software Engineering
Abstract:
Binge drinking is an important health issue worldwide, resulting in a range of health and social harms. The portability and connectivity of mobile technology can be used to encourage the practice of monitoring and mediating alcohol use. Social networking services, if used among peer-support networks to promote responsible drinking, could be effective in moderating alcohol consumption. This paper presents the design of a novel
mobile social networking tool to facilitate responsible drinking, and a qualitative analysis of focus groups to evaluate the proposed tool. The focus group results confirm the usability of the design and potential usefulness of the proposed functionalities. A follow-up interview with field trial participants confirm that tool is easy to use for intervening excessive alcohol consumption by encouraging drink counting and facilitating peer-supports for moderate alcohol consumption during drinking session.
IEEE Pervasive Computing
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Designing an Engaging Mobile Social Tool for Moderating Drinking
Dian Tjondronegoro, Information Systems School, Science and Engineering Faculty, Queensland University of Technology, Australia. [email protected] Elaine Jing Zhao, School of Arts and Media, Faculty of Arts and Social Sciences, University of New South Wales, Australia. [email protected] Angela M. White, Centre for Youth Substance Abuse Research, The University of Queensland, Australia. [email protected] Marie-Louise Fry, Griffith Business School, Department of Marketing, Queensland Australia. [email protected] Josephine Previte, UQ Business School, The University of Queensland, Australia. [email protected] Judy Drennan, School of Advertising, Marketing and Public Relations, QUT Business School, Queensland University of Technology, Australia. [email protected] Jason P Connor, 1. Centre for Youth Substance Abuse Research, The University of Queensland, [email protected] David J. Kavanagh, Institute of Health and Biomedical Innovation, Queensland University of Technology, Australia. [email protected]
Abstract
Binge drinking is an important health issue worldwide, resulting in a range of health and
social harms. The portability and connectivity of mobile technology can be used to
encourage the practice of monitoring and mediating alcohol use. Social networking
services, if used among peer-support networks to promote responsible drinking, could be
effective in moderating alcohol consumption. This paper presents the design of a novel
mobile social networking tool to facilitate responsible drinking, and a qualitative analysis
of focus groups to evaluate the proposed tool. The focus group results confirm the
usability of the design and potential usefulness of the proposed functionalities. A follow-
up interview with field trial participants confirm that tool is easy to use for intervening
excessive alcohol consumption by encouraging drink counting and facilitating peer-
supports for moderate alcohol consumption during drinking session.
Keywords: mobile social application, design, focus group, qualitative analysis, alcohol
1. Introduction
Binge drinking by young adults is an increasing problem resulting in a range of health
and social harms (Chikritzhs, et al, 2002). In most of developed countries, drinking is
considered as an integral component to socializing, celebrating important events and the
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transition and establishment of adulthood. For example in Australia, by the age of 18,
approximately 50% of males and females were drinking at risky levels, but the majority
of this group perceived themselves as ‘social drinkers’ and did not consider their
consumption pattern to be problematic (Australian Medical Association, 2009). In the
US, approximately 90% of the alcohol consumption in under 21-year-olds is in the form
of binge drinks (Office of Juvenile Justice and Delinquency Prevention, 2005). In Europe,
Denmark has the highest number of binge drinking, with 60% of 15–16-year-olds
reporting participating in this behavior, compared to 54% in the UK which is the fourth
highest (Grube, 2005).
Only a few young people seek assistance for high-risk drinking (Cunningham, 2011).
Common reasons for not seeking treatment include stigma, embarrassment, and a desire
to handle problems on their own (Cunningham, 2001). Governments and health
authorities have attempted to transition young adults towards drinking less via legislation,
increased taxes on ‘ready mix’ drinks and advertising campaigns. However, these
strategies have had only a limited impact on community-wide levels of drinking by young
people (Kisely, et al, 2013).
For an intervention strategy to be effective at the time and place it occurs, it needs to take
the context of consumption into consideration (National Preventative Health Taskforce
Alcohol Working Group, 2009; Norman, 1998). To date there has been little research on
the use of mobile technologies to promote low-risk drinking. Research on internet-based
alcohol interventions for young people has typically focused on the provision of
information and normative feedback, which has small but significant effects, at least in
the short term (White, 2010). However, they are not designed for use in the drinking
situation itself, which suggests that there may be opportunities to do much more with a
mobile phone app since it is typically used in the drinking session.
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The convenience, portability and connectivity of mobile technology have resulted in a
high proportion of young people using mobile phones (Roy Morgan Research Single
Source, 2012). As such, this technology has the potential to be harnessed to facilitate
moderate drinking in that target group. Most of existing mobile applications that are
effective in engaging and retaining users incorporate social networking and peer-support
functionalities. In particular, online communities facilitating peer-to-peer support have
significant potential to directly promote health and behavior change (Cunningham, 2008).
However, most apps to reduce alcohol consumption typically employ single-user
interactions (e.g. drink counter). This project fills this gap by developing a novel alcohol-
related mobile app that leverages the positive benefits of peer support (by employing a
‘trusted circle of friends’) to mediate and reduce high-risk drinking.
This paper presents the design of mobile social networking tool to facilitate responsible
drinking during drinking sessions. The proposed mobile tool focuses on facilitating peer
support to ensure safety, whilst simultaneously promoting moderate drinking during a
social event. A qualitative analysis of three focus groups with young women aged 18 to
24 is discussed, to determine if the proposed design were seen as attractive, engaging, and
as having potential utility. We also provide results from an interview with two
representative users who have participated in the field trial. The choice of focusing on
young women as our first main target group is based on findings that young women look
out for each other on social occasions to avoid potential harm to any group members
(Crespigny, 1999). While women typically do not drink as heavily as men, those that do
consume alcohol at risky levels have equal or more problems than men from their
drinking (U.S Department of Health and Human Services, 2008). Women are known to
be more vulnerable than men to the physical harms of alcohol and are at risk of sexual
assault when they are intoxicated in public places (Lindsay, 2005). Anderson et al (2014)
report young women’s who binge drink are more likely to continue risky drinking
patterns when pregnant and are more likely to continue risky drinking than reduce
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drinking. Moreover, frequent binge drinking in late adolescent influences levels of
depression in 22-27 year old women (Powers, 2013).
2. Design of the Mobile Tool
Cohn et al.’s (2011) inventory assessment reported that in 2011 approximately 767 out of
350,000 mobile tools (apps) in iTunes focused on alcohol use. Of those, 545 apps (71%)
were identified as facilitating alcohol use, with 222 apps (29%) identified as intervening
(i.e. aimed at reducing alcohol use).
Figure 1. Classification of Alcohol Related Apps
As Figure 1 illustrates, facilitating alcohol mobile tools typically include:
• Information on where and what to drink;
• Drinking games for people to find excuse to drink and overcome awkwardness in
social events, such as trivia games;
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• Tools to order and track drinks, and photo booth to capture drink sessions, and
events in general;
• Social event management.
Whereas, intervening alcohol mobile tools provide:
• Health and well being messages such as weight management;
• Intoxication warnings (blood alcohol concentration, drunk face emulation);
• Sobriety tests (coordination controls);
• Financial management (tracking spending);
• Social marketing (to give warnings and advice).
The proposed mobile social tool is novel as it aims to combine both (intervening and
facilitating) approaches by supporting functionalities and features used before, during,
and after a drink session:
1) Facilitating a peer-support for moderate alcohol consumption
Formation of a peer support group prior to the event and a quick-dial feature elicited
assistance with alcohol control and safety
2) Intervening excessive alcohol consumption.
An event timeline and drink counter can potentially promote awareness of alcohol use,
while sharing with peers was intended to engage social pressure for alcohol control.
The following section details the functionality of the mobile app.
2.1. Facilitating a peer-support network before event
The peer support functionality encourages users to identify, schedule, and plan a social
event that could involve the consumption of alcohol. They do this by creating an event
and inviting friends to attend. Once an event has been created and confirmed, it appears
on the organizer’s list of upcoming events, and the invited friends receive a push
notification, and a new event in their event list.
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Figure 2 depicts the start of a night out interfaces, whereby the event name, venue, date,
time and invited friends are inserted by users, enabling creation of a personal profile and
record of relevant information (e.g. favorite places, drinks, emergency contacts and
address). Friends can be added from the friend list, or “bumping” phones together. When
an event is started, a timeline for the event is established.
(a) (b) (c)
(d) (e) (f) Figure 2. Starting Event Interfaces: Insert all event details (a); Snap an event photo (b) Add a friend via bump or friends list (c); Viewing Event Details (d); Confirming
or rejecting invitations (e); Status of friends attendance (f)
2.2. Intervening excessive alcohol consumption
Figure 3 displays the interfaces used during an event. The Timeline interface for the
event is activated as the event starts and deactivated when the organizer ends the event.
Past event timelines remain available for later reviews. The timeline UI design is adapted
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from social networking tools, such as Facebook and Path, as a means to provide a
chronological account of events. The timeline forms the main communication platform
for a particular event. It represents the social environment, and encouraging activities
(e.g. taking and sharing photos) other than the consumption of alcohol. The user’s main
interaction with timeline is sharing their activities with the peers and promotes a sense of
looking out for everyone’s safety and monitoring behavior during a drinking session. This
includes: Post status on timeline, similar to group chatting functionality, including
indicating I’m home” status on timeline (ensuring safety). The timeline also provides a
reflective tool on the user’s drinking and the drinking of their friends.
(a) (b) (c)
(d) (e) (f)
Figure 3. During Event: Timeline (a); User Primary Interaction with Timeline (b);
Quick Dial (c); Photo booth (d); Drink Table (e); Drink menu (f)
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Event timeline and peer sharing functionalities are aligned with the intervention strategy
to influence the context of consumption. Instead of monitoring consumption, the mobile
tool focuses on the social costs of high alcohol consumption, such as losing credibility by
appearing out of control in front of their peers, known as the theory of planned behavior
(Norman, 1998; Norman, 2006). As part of the timeline, the Photo Booth function
encourages users to capture photos and share to their peers via the timeline, and the
additional feature of customized frames and stickers can add the fun element. A
necessary condition for reductions in dysfunctional behavior is that the person is aware of
the behavior. Reviewing photos can help to remind users how they behave during a
drinking session.
For monitoring and moderating drinking, the Drink table interface can be easily accessed
from the timeline view. First, they need to “order” or specify a drink by tapping ‘+’
button. A list of drink categories will appear as a simple Drink Menu. Once a drink is
selected from the list, choice of drink will be put up on the hanging board. Users can tap
and hold the table to add the drink. This is intuitive design as we use the analogy that the
user is actually tapping on the table to get more drinks of the same kind, until they order a
new one. The immediate visual feedback of how many glass or bottles counted on the
table will help users to track their alcohol consumption. Each time a drink is added on the
table, the timeline will broadcast (to the peers) the name of the person who just added a
drink to allow peer-supported self-monitoring of moderate drinking intention.
3. Focus Groups
In the design phase of the responsible drinking mobile app, three focus groups were
conducted with young women in August 2012 to gather their views about the proposed
mobile social tool design. Focus group facilitators encouraged participants to discuss
their experiences with smart phone technologies and alcohol consumption, as well as
their views on technology to support healthy lifestyle goals,. Participants viewed a set of
in-progress / draft app to stimulate discussion as to the potential of the app in managing
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alcohol consumption Discussion themes focused on examining tool functionalities for
supporting before- and during- a night out event where alcohol was likely to be
consumed. All participants gave informed consent to the study. Each participant was
compensated with a gift voucher valued at 20AUD. focus groups were audio-recorded
with two facilitators guiding discussions and taking notes. Interview data were analyzed
using constant comparison method as outlined by Strauss and Corbin (1998). Comparison
method is particularly useful when there are multiple focus groups within the same study
as it allows researchers to assess saturation in general and across-group saturation in
particular.
3.1. Participant Details
In total, fourteen young women aged between 18-24 years old participated in three focus
groups. All participants were university students. All participants, except one, were smart
phone users and engage with apps for information, entertainment and utility frequently.
Nine participants self-identified themselves as binge drinkers or frequent drinkers, with
three being moderate drinkers and two being non-drinkers. For moderate and non-
drinkers the choice to drink responsibly was due to health, fitness and study commitments
and further supports recent research examining responsible drinking motivations (Herring
et al., 2012; Fry, 2011, Anderson et al., 2011; Piancentini & Banister, 2009). The sample
distribution is appropriate for our purpose, as the app is designed to engage any young
people that go out to a drink session (e.g. for social events), even for non-drinkers.
3.2. Feedback on Tool Design and Features
Organizing an event
Participants liked the fact that the app allows them to view all events, to reflect on the
past events as a memory and to organize future events. The participants agree that the
information during planning of the event, i.e. organizer, participants, time and location is
useful. As each user can see everyone’s responses to the event invites, participants
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perceived it similar to Facebook messages, and reported frustrating experiences with
Facebook messages in setting up events, as many people would not reply to invitations.
Eight participants preferred keeping the communication within a confined social circle.
Impact on final design: we have ensured the peer network formation is kept within a
confined social circle. Friends need to be added manually and no import from existing
network like Facebook. Bump technology is used to make it easier to add new friends.
Timeline
All participants perceived the timeline as a useful feature, which facilitated coordination
during a night out if they became separated from friends, needed help or were running
late. All participants liked being able to keep exchanges private and within their social
group, who they considered would not judge them. They also liked app-based
communication within the small circle, as they confessed most things they would put on
the timeline would be things they could not say out loud (e.g., about “meeting a hot
guy”). Six participants prefer not to share the entire night out on Facebook, to avoid the
information being exposed to people they did not want to know about the night (e.g.
parents or bosses). They would like to have the option to choose whether they wanted to
share something or not. Some suggested a feature of requiring “group permission” to post
the conversation or timeline to Facebook after the event. The ‘I’m home’ button attracted
attention from most participants, who liked the idea. The button saved them calling or
messaging each other to make sure everyone was safe and sound at home.
Impact on final design: we ensured that the timeline posts could only be viewed by the
confined circle of friends, and could not be shared to public social networks.
Quick Dial
For the Quick Dial feature, all participants voted for ‘cab’ as the first priority in the
available numbers. Emergencies numbers like police or ambulance needed to be double
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confirmed, or the buttons kept apart to avoid miss-dial. Eight participants agreed that it
was useful to include train or night bus timetables, and loved the idea of putting close
friends and newly met friends on Quick Dial. When asked whether they would ever call
their friends’ parents when out drinking, none said they would do so, unless the situation
were very serious. In those cases, they would call police or hospitals first and would only
call parents when they arrived at police station or hospital.
Impact on final design: the quick dial mainly features the emergency contacts, such as
police and ambulance. While it was useful to add public transport timetable, we kept it
out of the current scope, as the information integration would require further redesign of
the quick dial interface (too much information will make it too cluttered). The option to
add other “emergency contacts” is left entirely to an individual if they wish to provide,
and not required or probed.
Photo booths and gallery
All participants liked taking photos when going out and perceived photos as an important
part of identity and memory building. One mentioned it’s ‘like a scrapbook on the mobile
phone’. Others nodded in agreement. They liked the fact that “past event timelines”
remained available for review. Participants mentioned being tagged in a ‘bad’ photo as a
bad experience. They usually requested that those photos be removed via private
messages: they saw this as another reason for containing information within a confined
group.
Impact on final design: the timeline gallery of photos are retained so that the closed peer-
network would be able to review and support each other to learn from their past behavior
during a drinking session.
Monitoring drinking
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When asked whether they would use the function of logging drinks during the night out,
ten participants initially gave negative answers. They saw it bothersome or distracting on
a good night out, especially when dancing or talking. As the discussions went on, safety
concerns emerged as a major motivation for logging drinks (e.g. when they were driving).
Another motivation was the opportunity to reflect on their drinking behavior.
Four participants mentioned that recalling the number of drinks consumed on the
previous night was a regular discussion amongst friends when they got up next morning.
Five participants said that knowledge about their blackout points would help planning for
future drinking occasions based on how much they could handle. They generally did not
know how much they drank because they often got refills, and did not have standard
drinks. More interest and willingness to log their drinks was expressed if it could be done
faster and more easily, for example, by using bumping technology. Information that
would help them to choose drinks included price, alcohol content, and calories.
Participants agreed it would be useful to have the calories consumed converted to
physical exercise required to burn those calories, so that they had a clearer idea of the
meaning of the calories.
Impact on final design: we have retained the drink counting mechanism, which was
uniquely designed compared to existing apps, so that it can be tested during a field trial.
We did not use additional information such as cost and calories even though they could
work as deterrents, as these types of information use is not within the scope of this study.
Our focus was on supporting peer-network that looks out for each other.
4. Interview of Field Trial Participants
A follow up interview was conducted on 8 May 2014 to learn from a peer-group of two
participants who have used the completed mobile tool during field trials (i.e. actual
drinking sessions) from December 2013 to April 2014. Based on the interaction logs, they
have used the tool during two drinking sessions.
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When asked about “what worked”, both respondents agreed they really liked that the
timeline feature is like Facebook event, as they can add and edit photos during an event.
This confirms the usefulness of photo booths and gallery functionality. When asked about
counting drinks functionality, one respondent said, “counting drinks wasn’t a big issue
because I only had a couple when we went out”, while the other highlighted, “I’m a little
bit more particular about how much I’m having because I don’t want a hangover the next
day so I feel like I’m already mentally doing what the app is doing.” However, both of
them agreed that sharing their drinks in the timeline make them more conscious. When
asked about the motivation for counting drinks, economic reason was the key, i.e. amount
of money is more important than amount of alcohol, as both respondents are aware of her
own limit (e.g. one said, “I don’t go above 5 otherwise I’m too silly”).
On the use case scenario of using timeline to send anonymous message to say that a
friend is drinking too much, one respondent said she liked that idea as she drives a lot (for
her friend). Respondents also like the QuickDial as “it easier to contact (their friends) if
you do loose them or need to get in touch”, and both agreed of the safety aspect because
it is about girls looking after each other.
When asked about “What do you think the barriers or the motivators would be while
you’re drinking to use it?” A respondent said “Forgetting to pick (the phone) up”, another
said “forgetting to (count) every time you have a drink...like mentally thinking that you
need to count it when you haven’t done in the past”. When asked if they would be
comfortable using the phone during a drinking session, both respondents said “Yeah,
normally the phone’s out.And if I knew that I was having a night out where I didn’t have
to restrict the number of drinks if I was driving, then I would be more likely to use it. “
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These findings demonstrate that the tool is accepted and easy to use for intervening
excessive alcohol consumption by encouraging drink counting and facilitating peer-
supports for moderate alcohol consumption during drinking session.
3. Discussion
Based on the discussion with focus group participants, current smart phone experiences
show that friends’ or partners’ adoption is a major motivator to use certain apps. Other
motivators include novelty, convenience and free access to the app. Incorporation of
bumping technology in setting up events or logging drinks, and being able to add from a
list of favorite drinks or create events based on ‘favorite places’ and a ‘friends list ‘may
therefore increase the chances of an app’s adoption.
Leveraging social dynamics in the app design is consistent with young women’s
behavior, and there has already been some success in enlisting friends’ support in
achieving moderate drinking goals. While the aim is to facilitate moderate drinking,
mobile app designers need to consider social dynamics before, during and after drinking
events. Features such as the ‘timeline’, ‘I’m home’ button, ‘photo sharing and gallery’,
and ‘quick dial’ not only facilitate the coordination before, during and after the event, but
also help participants to create a shared memory. Customizable contacts on ‘quick dial’
also appeal to young women’s strong sense of maintaining their social groups.
While using the mobile to update their status or post photos during the night out was seen
as interrupting the experience, the wish to review the event was a motivator. Norms of
responsible behavior on social media and concerns over privacy appeared to drive a
preference to keep communication within a confined social circle. ‘Check-in’ was
reported to be frequently used by young women, and geo-location may therefore provide
a motivation to use the app.
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Using the mobile app for drink counting was perceived as bothersome or distracting, but
safety concerns and the opportunity to later reflect on their drinking behavior (and in
particular, to know when they were at risk of blackout) may increase the likelihood of
alcohol monitoring. Translating drinks into meaningful indicators such as calories would
add appeal to users. Adding push notifications to reduce the need to check the mobile
frequently and enabling users to deliver moderate drinking reminders to their peers may
lessen negative perceptions while enhancing the app’s perceived utility.
While participants reported that drink monitoring would be more attractive if it was
linked to drink driving limits. Estimations of Blood Alcohol Content (BAC) are subject
to substantial individual variation (e.g. based on body size and composition and liver
function) and on foods that are consumed. They also require accurate assessments of
drink size and ethanol content. Since underestimations of BAC have potential to place
users at significant risk (e.g. of accidents or drink-driving offenses), we consider that the
inclusion of this feature may cause the app to have serious negative consequences.
Suggestions for More Features
The focus groups gave suggestions for useful features for future developments.
Information and pickup organizations - twelve participants mentioned they would like to
communicate with each other and share information before the event, and were glad to
know they could do it as soon as they set up the event. One mentioned it would be good
to know who would be driving and their routes before they went out. This would help
them organize pickups.
Alcohol calculation linked to calorie counting and drive drinking limit - Two participants
would like to have the drinking calculation linked to their driving limits (e.g. how long
should I wait to drive home after a big night out). One participant would like to see the
counting feature extended to calorie counting during an ‘eating spree’ after drinking.
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Push notifications - participants proposed adding push notifications to avoid the need to
check the mobile constantly. One said she would like to have something like a Facebook
‘poke’ button as a way to allow friends to remind her when she is drinking too much or
for her to provide similar reminders to them. She said that this could also be a useful
reminder when someone was not aware of their behavior when drinking.
The interview with field trial participants highlighted that it is not so much about what
did not work in the app, it is about how to encourage people to download and use it to
curb their behavior (actively use on the go). They suggested to make the tool like
Facebook “add-on” i.e. the event can be organized and advertised via Facebook event,
but as soon as they check in, it is all seamlessly only become private on the phone. In
addition: adding photos of group, grouping of friends are useful for event organization.
Setting up pre-drinks had been suggested as part of ritual for setting the event. They also
suggested counting calories and give messages after certain amount of drinks. For
example, “ if … I’ve had 5 drinks and it came up with a message ‘you’re totally wasted’
I’d be like ‘really!’ That would be funny to me if my phone was telling me at what stage
of drinking I was at. Another suggestion was to add a button for “move to another
venue”, instead of just “I’m home” especially if the functionality has a location
awareness so if a person was in big groups and someone has gone to another pub (but
they did not notify anyone) at least they would know whether their friend(s) have gone to
another location.
4. Conclusion and Future Work
This paper proposes a novel design for a mobile social tool that supports facilitating a
peer-support for moderate alcohol consumption. The focus groups confirmed the
potential usefulness of organizing event, event timeline, quick dial for facilitating peer
group interactions, while the drink counting and photo booth could help to curb their
drinking behavior (reviewing their drinking session). The suggestions were used for fine-
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tuning the design of the tool. The field study participants have confirmed the usability
and acceptability of the functionalities. Future research directions include updating the
design based on the suggested features and conducting a longer-term study with more
participants to use the mobile tool in the natural environment to test its feasibility and
utility in practice. We also will implement some of the suggested features such as adding
calories information, as it was highlighted in both focus groups and follow-up interview.
Acknowledgement
This research is funded by Australian Research Council Discovery grant (DP110102848).
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