When less is more: How attentiveness impacts the efficacy of online personalized feedback interventions for college student alcohol use

Abstract

Background

Personalized feedback-based interventions for reducing high-risk alcohol use among college students vary in length and intensity. Comprehensive multicomponent personalized feedback interventions (PFIs) include more material and have greater intensity compared to briefer, single-component interventions such as personalized normative feedback (PNF). However, while PFIs may offer more comprehensive support, their lengthiness can potentially reduce attention and engagement with the intervention content, impacting their overall efficacy. This study examines how attentiveness—the degree to which participants engage with and process the intervention material—differs between single- and multicomponent interventions and how this variation moderates the efficacy of PFIs.

Methods

A secondary analysis of a longitudinal randomized clinical trial was conducted, involving 1137 undergraduates reporting past-month heavy episodic drinking (63% female; mean age = 20.1 years). Assessments occurred at baseline and 3, 6, and 12 months postintervention, with primary outcomes including drinks per week and negative alcohol-related consequences. Intervention conditions included (a) assessment-only control (AOC), (b) multicomponent PFI, and (c) single-component PNFs. Generalized linear mixed models were used to evaluate attentiveness as a moderator of treatment efficacy across multicomponent PFI, single-component PNFs, and AOC conditions.

Results

Analysis detected significantly higher attentiveness levels in single-component PNFs compared to the multicomponent PFI (b = 0.35, p < 0.001). A three-way interaction (Time × Condition × Attentiveness) indicated that the efficacy of multicomponent PFI versus AOC on drinks per week was only significant for those reporting moderate-to-high attentiveness levels, not for those with low attentiveness. When comparing multicomponent PFI to single-component PNF, multicomponent PFI outperformed single-component PNF only when attentiveness was high; conversely, when attentiveness was low, single-component PNF outperformed multicomponent PFI.

Conclusions

While the simplicity of PNF allows for easy implementation with minimal cognitive effort, multicomponent PFI demonstrates greater efficacy potential, particularly when comprehended thoroughly. Future research could explore strategies to enhance attentiveness with multicomponent PFI, such as sequential delivery across multiple sessions to optimize its benefits.