More Than Activity: The Effect of Sustained Engagement in Digital Alcohol Support Interventions for Regional and Remote Communities

IF 3.2 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of Rural Health Pub Date : 2026-08-08 DOI:10.1111/jrh.70192

Katinka van de Ven, Getenet Dessie, Kedir Y. Ahmed, Nicole Lee, Hazel Dalton, Julaine Allan, Subash Thapa

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Abstract

Purpose

This study examines differences between major city and regional and remote participants in engagement in a digital alcohol support intervention (Daybreak), risky drinking, and psychological distress and tests the mediating role of psychological distress.

Methods

This was a longitudinal, observational cohort study of Daybreak participants between January 2019 and December 2024 (N = 12,824). Outcomes were risky drinking and psychological distress. Ordered logistic regression examined associations between the outcomes and program engagement, and multilevel generalized structural equation modeling tested mediation by psychological distress.

Findings

At 6 months, risky drinking scores declined by 42% in major city participants and 57% in regional and remote participants. High engagement in reacting to posts reduced risky drinking in both metro (OR = 0.47, 95% CI 0.27–0.80) and regional and remote areas (OR = 0.42, 95% CI 0.18–0.99). High engagement in post sharing was associated with lower odds of high risky drinking only in major city participants (OR = 0.56, 95% CI 0.33–0.98). In regional areas, participants who aimed to quit drinking at registration had lower risky drinking (OR = 0.72, 95% CI 0.53–0.99), while longer program inactivity increased odds of psychological distress (OR = 1.95, 95% CI 1.13–3.38). Psychological distress mediated 56% of the association between post reactions and risky drinking in major city participants and 33% in regional and remote participants.

Conclusions

Distinct engagement pathways across regional and remote and major city settings suggest the need for more flexible digital program designs. Psychological distress, as a partial mediator, should be both a treatment target and a mechanism of change.

Abstract Image

查看原文本刊更多论文

不仅仅是活动：持续参与数字酒精支持干预措施对区域和偏远社区的影响。

目的：本研究考察了主要城市、地区和偏远地区参与者在参与数字酒精支持干预（Daybreak）、风险饮酒和心理困扰方面的差异，并测试了心理困扰的中介作用。方法：这是一项纵向观察队列研究，在2019年1月至2024年12月期间对Daybreak参与者进行研究（N = 12824）。结果是危险饮酒和心理困扰。有序逻辑回归检验了结果与项目参与之间的关系，多层次广义结构方程模型检验了心理困扰的中介作用。研究发现：6个月后，大城市参与者的危险饮酒得分下降了42%，地区和偏远参与者的危险饮酒得分下降了57%。在地铁（OR = 0.47, 95% CI 0.27-0.80）和区域和偏远地区（OR = 0.42, 95% CI 0.18-0.99），对帖子做出反应的高参与度降低了饮酒风险。在主要城市的参与者中，高度参与帖子分享与高风险饮酒的几率较低相关（OR = 0.56, 95% CI 0.33-0.98）。在地区，注册时戒酒的参与者饮酒风险较低（OR = 0.72, 95% CI 0.53-0.99），而长期不参加项目活动增加了心理困扰的几率（OR = 1.95, 95% CI 1.13-3.38）。在大城市参与者中，心理困扰介导了56%的后反应与危险饮酒之间的关联，而在地区和偏远地区参与者中，这一比例为33%。结论：不同地区、偏远地区和主要城市环境的不同参与途径表明，需要更灵活的数字程序设计。心理困扰作为部分中介，既应是治疗目标，也应是改变的机制。

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来源期刊

Journal of Rural Health 医学-公共卫生、环境卫生与职业卫生

CiteScore

7.60

自引率

6.10%

发文量

审稿时长

>12 weeks

期刊介绍： The Journal of Rural Health, a quarterly journal published by the NRHA, offers a variety of original research relevant and important to rural health. Some examples include evaluations, case studies, and analyses related to health status and behavior, as well as to health work force, policy and access issues. Quantitative, qualitative and mixed methods studies are welcome. Highest priority is given to manuscripts that reflect scholarly quality, demonstrate methodological rigor, and emphasize practical implications. The journal also publishes articles with an international rural health perspective, commentaries, book reviews and letters.