Date: 06 December 2018
Dr Julia Sinclair is a professor of addiction psychiatry at the University of Southampton. Her primary focus is research in patients with alcohol use disorders. She investigates how biological, psychological and social mechanisms impact individuals and looks at the impact on clinical outcomes of prevention, engagement and response to treatment.
Dr Ellen Copson is an associate professor of medical oncology at the University of Southampton. Ellen combines her clinical breast cancer practice with clinical research. She is particularly interested in host factors which influence the response to systemic treatments for early breast cancer. She also acts as clinical adviser for a number of studies investigating the relationship between breast cancer and nutrition, and for several early breast cancer survivorship studies.
"As breast cancer numbers rise, prevention and awareness is becoming paramount in helping women all over the world manage their own risk factors and reduce impact upon health services. The World Health Organisation (WHO) believes that sufficient knowledge of risk factors and prevention is enough to avoid between 30-50% of cancers across the globe. We wanted to focus our attention on increasing awareness among women of alcohol as a risk factor in breast cancer and get them to consider the impact their consumption might be having on their long-term health prospects. Through our initial research it was clear that most women were unaware that alcohol is the second most modifiable factor in breast cancer and were equally unaware of the level of alcohol they consumed on a weekly basis. It was clear to us that we weren’t maximising our opportunity to communicate these messages with women and health workers, missing vital contact points within the screening programme and symptomatic clinics."
ABREAST OF HEALTH
"The Abreast of Health intervention was created out of this need to communicate these messages effectively to women, and health workers with knowledge gaps, in a way that would be easy for them to consume and free from judgement. The common view among women who we surveyed was that they did drink, but not at a level they considered to be problematic so there was a barrier already in place to change the way they looked at their consumption pattern.
"A lot of the women involved assumed it was binge-drinking that was a risk factor, not smaller consumption over a longer period of time. Through seed funding from BUPA and Cancer Research UK we developed a web-based app that women could access via a tablet while they were in symptomatic breast clinic waiting areas. Alongside asking questions about how much alcohol they consume, and delivering them with a personalised assessment of how many units they are drinking per week, it also tells them their risk level, information on the links between alcohol consumption and breast cancer and a guide on how many calories it adds up to by comparing it to food items.
"Over 1,300 women have taken part in the study since 2017 and our research suggests that it is having an impact on the way women consume messages around their health. Of the 214 who tested the app prototype:
• 77% women approached in clinics agreed to participate
• 95% participants submitted data and received personalised feedback
• 50% spent over 6 minutes reading additional information pages
• Overall, participants rated the intervention 4.4 out of 5
A DIFFERENT APPROACH
"One of the most fascinating things about this intervention is that it focuses on people skills and fine-tuning messages to deliver health information, rather than involving any medical intervention at all. We noticed subtle differences in what people would and wouldn’t click on, just by changing a few words here and there and changing imagery. Essentially, what we’re trying to affect is self-reflection upon habits and a gradual shift towards modifying these behaviours around alcohol consumption in women, without a dictatorial or pushy approach.
"We know that around 1 in 8 people will make a change to their behaviour based on these sorts of ‘brief’ interventions, so the next stage for us with this study is to pilot the intervention and follow up the women who took part and find out if the intervention nudged them towards
reducing the level of alcohol they drink.
"The study will continue to change graphics and words to determine the level of impact that they have on participation levels and we’ll also be randomising the intervention with the alcohol part of the survey removed so that we can see clearly what the effective components are. At the moment the study is only in Southampton at the breast screening and breast clinic, but we hope that it will soon be trialled in Manchester as part of the next phase.
"Ultimately, what we want to achieve is to reduce the number of breast cancer cases where alcohol is a contributing factor. But we also want to empower women to have control over their risk factors and be able to see what is best for themselves. We want them to have a clear and informed picture from a trusted source, without the need for conflicting advice when they have to consult multiple sources."
Abreast of Health is funded by the Medical Research Council, sponsored by University Hospital Southampton NHS Foundation Trust and delivered with the support of the NIHR.
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