Revista Adolescência e Saúde

Revista Oficial do Núcleo de Estudos da Saúde do Adolescente / UERJ

NESA Publicação oficial
ISSN: 2177-5281 (Online)

Vol. 15 nº 2 - Apr/Jun - 2018

Original Article Imprimir 

Páginas 49 a 55


"How much do you drink?": A mobile application for empowerment and increase awareness in young users of alcohol

¿Cuánto usted bebe?": Una aplicación móvil para empoderamiento y concientización de jóvenes usuarios de alcohol

"Quanto você bebe?": Um aplicativo mobile para empoderamento e conscientização de jovens usuários de álcool

Autores: Ihan Souza Cavalcante1; Cynthia de Freitas Melo2; Tauily Claussen D'Escragnolle Taunay3; José Eurico de Vasconcelos Filho4

1. Graduation in Psychology by Fortaleza University (UNIFOR). Master´s Degree in Psychology by the Postgraduate Program in Psychology - at UNIFOR. Fortaleza, CE, Brazil
2. Doctor in Psychology by the Rio Grande do Norte Federal University (UFRN). Natal, RN, Brazil. Professor of the Postgraduate Program in Psychology of the Fortaleza University (UNIFOR). Fortaleza, CE, Brazil
3. Doctor in Medical Sciences by the Ceará Federal University (UFC). Professor of Psychology at the Fortaleza University (UNIFOR). Fortaleza, CE, Brazil
4. Doctor in Computer Sciences (IHC) by the Pontifícal Catholic University of Rio de Janeiro (PUC-Rio). Rio de Janeiro, RJ, Brazil. Professor of the Postgraduate Program in Technology and Innovation in Nursing at UNIFOR. Fortaleza, CE, Brazil

Cynthia de Freitas Melo
Universidade de Fortaleza
Av. Washington Soares, nº 1321, Sala N13, Bairro Edson Queiroz
Fortaleza, CE, Brasil. CEP: 60811-905
(cf.melo@yahoo.com.br)

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Keywords: Adolescent, alcoholics, technology.
Palabra Clave: Adolescente, alcoholismo, tecnología.
Descritores: Adolescente, alcoolismo, tecnologia.

Abstract:
OBJECTIVE: Studies on the epidemiology of alcohol in Brazil indicate that its consumption has increasingly taken place in younger age groups, suggesting the need to review control, prevention and treatment approaches. To do so, the most diverse types of approaches are required to reach alcohol users, which can be done with new technology features, in the case of the present work, through the mHealth technology. Therefore, the present study aims to create a mobile application that facilitates this own look at the level of alcohol consumption of the users of the tool.
METHODS: The technological concept was made through weekly meetings with a multidisciplinary team composed of professionals and graduates from Psychology, Social Service and Computer Science, based on participatory interaction design , raising important and fundamental points to approach with alcohol users.
RESULTS: It was observed that it was possible to build a concrete and applicable tool which is in the final stage of testing.
CONCLUSION: The mobile application, in its beta version, demonstrates main features for self-awareness of alcohol consumption, which extends to the different intensities of use, facilitating both prevention and identification of problems already installed.

Resumen:
OBJETIVO: Los estudios sobre la epidemiología del alcohol en Brasil indican que su consumo se ha realizado en grupos de edad cada vez más jóvenes, sugiriendo la necesidad de revisar las medidas de control, prevención y tratamiento. Para ello, son necesarios los más diversos tipos de enfoques para el alcance de los usuarios de alcohol, que pueden ser hechos con nuevos recursos de la tecnología, en el caso del presente trabajo, por medio de una tecnología mHealth. Por lo tanto, el presente estudio tiene como objetivo crear una aplicación para dispositivos móviles que empoderen al usuario en cuanto al nivel personal de consumo de alcohol, las implicaciones y riesgos asociados, así como permitirle, al consumidor, el crear metas de reducción de consumo.
MÉTODOS: La concepción de la tecnología se dio a través de reuniones semanales con un equipo multidisciplinario compuesta por alumnos e investigadores de Psicología, Servicio Social y Ciencias de la Computación, pauteadas en el diseño de interacción participativo, levantando puntos importantes y fundamentales para abordarlo con consumidores de alcohol.
RESULTADOS: Se observa que fue posible construir una herramienta concreta y aplicable que se encuentra en fase final de prueba.
CONCLUSIÓN: La aplicación diseñada, en su versión beta, presenta funcionalidades para auto-concientización del consumo de alcohol, que se extiende a las diversas intensidades de uso, facilitando tanto la prevención, como la identificación de problemas ya instalados.

Resumo:
OBJETIVO: Estudos sobre a epidemiologia do álcool no Brasil indicam que seu consumo tem se realizado em faixas etárias cada vez mais jovens, sugerindo a necessidade de revisão das medidas de controle, prevenção e tratamento. Para tanto, são necessários os mais diversos tipos de abordagens para o alcance dos usuários de álcool, que podem ser feitas com novos recursos da tecnologia, no caso do presente trabalho, por meio de uma tecnologia mHealth. Portanto, o presente estudo objetiva criar um aplicativo para dispositivos móveis que empodere o usuário quanto ao nível pessoal de consumo do álcool, as implicações e riscos associados, bem como permite o usuário a criar metas de redução de consumo.
MÉTODOS: A concepção da tecnologia se deu por meio de reuniões semanais com uma equipe multidisciplinar composta por alunos e pesquisadores de Psicologia, Serviço Social e Ciências da Computação, pautadas no design de interação Participativo, levantando pontos importantes e fundamentais para abordagem com usuários de álcool.
RESULTADOS: Observa-se que foi possível construir uma ferramenta concreta e aplicável que encontra-se em fase final de teste.
CONCLUSÃO: O aplicativo concebido, em sua versão beta, apresenta funcionalidades para autoconscientização do consumo de álcool, que se estende nas diversas intensidades de uso, facilitando tanto a prevenção, como a identificação de problemas já instalados.

INTRODUCTION

In most countries, including Brazil, the use of psychoactive substances is a very common feature, having many cultural, biological, psychological and social variables that simultaneously influence their consumption as1. Among many substances, alcoholic beverages stand out because they are always present on most social occasions, where 80% of people consume it, and of these 10% are alcoholics (a term now used instead of alcoholic worshiper, because it is less stigmatizing and more appropriate to address this dependent public)2.

Many users start drinking alcohol in low doses, mainly because of its euphoric action and the ability to decrease inhibitions, which facilitates social interaction. Doses that tend to be increasing due to the need for progressively larger amounts of the substance (tolerance), and in more severe cases, withdrawal syndrome3. There is, therefore, a variety of patterns of frequency and intensity of alcohol use, such as: experimental, occasional, regular, abusive, harmful and dependent use4. It should be noted, however, that the World Health Organization (WHO) establishes that there is no consumption of psychoactive substances without harm to those who consume it5.

To better reflect on the problem of alcoholism in the population, the economic and social costs of alcoholism are highlighted worldwide. Alcohol use is associated with 25 to 50% of traffic accidents with fatalities, in addition to being associated with unemployment, crime, health problems and premature deaths6. Therefore, the perspective of research and interventions in education, prevention and health promotion with young people, especially adolescents, is also emerging.

Alcohol use in adolescence and the importance of appropriate approaches

One potentially at-risk group is young people. It is understood that pre-adolescence and adolescence are stages of experimentation of various behaviors, from the stimulus and offer of opportunities. A fundamental process for the construction of their own identity, their image and social role. Thus, the adolescent comes in contact with new activities that need to be accepted in the social group, such as initiating the use of psychoactive substances, in most cases, making use of alcoholic beverage7.

It is recognized that, especially among young people, patients' adherence to a treatment program or recognition of prevention tools are conditioned by their motivation and understanding of what they consume, their effects and risks to their health8. Motivation and educational work can be performed through the Motivational Interview and Psychoeducation, which can be propagated through easy-to-join tools among young people and adolescents, such as mobile applications.

Motivational Interview has a number of techniques and principles that can increase patient motivation and adherence to treatment, helping to establish a link between the patient, the therapist and the other participants. The methodology also helps the patient feel free to talk about alcohol and realize that it will be understood without being confronted9-10. Thus, reinforcing the "readiness for change", we have different stages organized by Prochaska and DiClemente: pre-contemplation, contemplation, preparation, action and maintenance11.

Psychoeducation is reinforced by the importance of teaching the user and his / her family members about the problems related to the use of substances, their treatment and difficulties associated with a sine qua non condition for the treatment process. It also reinforces the importance of learning methods to monitor certain types of behavior, the severity of the behavior and its symptoms. Psychoeducational interventions facilitate acceptance and cooperation in coping with difficulties12.

These interventions can be more accessible, with greater spread and adherence, when combined with mobile communication devices (smartphones, tablets), through the creation of a smartphone application. Mobile computing understood as mobile health, according to WHO, is medical practice with support for mobile devices such as smartphones, patient monitoring devices and other wireless devices. To meet this practice, this type of technology presents the proposal of improvement and extension of the quality of programs for a greater reach of services and strengthening of health information systems. Its use also presents advantages such as saving time, better data exchange, reducing the loss of information that is stored in the device, and collecting information from patients in their settings without the need for displacement13.

In view of the above, the present study aims to present a mobile application developed with the objective of collaborating with the self-perception of the alcohol user on their level of alcohol consumption.


SEARCH METHOD

The present study deals with the development of a mobile application through a comparative analysis of the registered data of consumption that serves as a tool to identify the level of consumption among alcohol users and self-awareness of the risks associated with the respective levels of consumption, access to psychoeducational information on alcohol and analysis of economic costs.

The idea arose from the verification of two growing poles in society. On the one hand, the spread of increased alcohol use, especially among young people. On the other hand, the expansion of the daily use of technologies, such as the use of mobile communication devices (smartphones, tablets, etc.), the popularization of Internet utilities and the increase of accessibility to all social classes. It is understood that, through these new technologies, complementary alternatives and differentiated approaches can be created to reach this young user of alcohol, who can arouse interest through the proposal of granting the user the power to self-evaluate in a playful way and interactive.

Through the analysis of the proposed methodology, requirements were identified for the creation of a mobile application, built through the alliance of multidisciplinary efforts of Psychology, Computer Science and Engineering, Social Service, Visual Audio and New Media within the scope of the Application Nucleus Information Technology (NATI).

The research procedures begin with a bibliographic study and interviews conducted by the Psychology and Social Work team with a sample of participants directly involved (multidisciplinary team) and indirectly (patients from specialized clinics or public units) in the context of the problem. After this survey the requirements for the application were identified:


 An alcohol consumption pattern tracking tool;

 A tool for contemplation (working on ambivalence) about alcohol consumption;

 A tool for recording and feedback of alcohol consumption and its financial expense;

 A tool with educational information about alcohol.


With this, the creation of the application was made for Android platform. It is based on its functionalities the Initial Analysis with a scale of identification of alcohol use, the record of alcohol consumption, Decisional Balance, Psychoeducation and quiz.

Once the functional needs of the application have been established, a specific profile of the target audience has been established, to which the design of the application will be directed in order to encourage user's adherence to the tool proposed here. As the bibliographical survey indicated that the studies indicate a higher prevalence of alcohol consumption from the age of 1416, the target population was established in the 15- to 25-year-old age group, both sexes, educated, with active social life, use smartphones and don´t have a diagnosis of alcohol dependence, considering that it is a tool for reflection on possible abusive behavior.

After the identification stage of requirements, the establishment of requirements and the survey of the target audience, the team discussions about the focus on the usability of the application began, that is, what would be the nomenclature of its functionalities and how they could be information to the public with the aforementioned profile.


RESULTS

Based on preliminary meetings and weekly discussions, the application was created and the testing phase started. Its interface and interaction design have been designed based on persuasive design so that they are interactive and attractive to young people and adults. In this way, the developed mobile application has five main functionalities: 1) "Drink Gauge" that meets the need of a brief screening for the identification of alcohol use by the AUDIT scale; 2) "Beverage Counter" that wants to record the drinks consumed, the quantity of the same and the recording of financial expenses; 3) "I drink because ..." has the purpose of reevaluating drinking behavior through a survey of the pros and cons of consumption; 4) "On alcohol" that will give psychoeducational information, and; 5) "Quiz" that also intends to bring psychoeducational information although it is interactively with questions and answers (see Figure 1).


Figure 1. Sketch the images of some application features.



Features of the "Drink Gauge"

The "Drink Gauge" is the first and crucial functionality of the application, because it contains the scale in which it can classify what type of user it identifies, when answering a measuring instrument, AUDIT, where the following commands will appear:


1. Respond to the questionnaire: Upon entering the "Drink Gauge" functionality, the user will be presented with one question at a time from the AUDIT scale, where they will answer the questions through a selection of predetermined answers, which in the whole are counted in ten questions1.

2. Usage classification suggestion: The application will classify the adolescent according to the type of alcohol user that matches it, that is, according to the score achieved; the application will say that there is a suggestion between occasional, regular, abusive or dependent.

3. Learn more: The application will provide data and information on what the user-specific classification means.


Function of the "Beverage Counter"

The Drink Counter provides the user with a record of the drinks that were consumed, adapted according to the standard dose of the type of beverage consumed, the amount consumed, the amount of money spent and the date that occurred.


1. Drink Log: Upon entering the "Drink Meter" feature, the application will display images with names and the default dose for each drink, based on milliliters (ml) and percentage alcohol concentration of the drink.

2. Quantity consumed: after choosing what was consumed, the user will record the quantity of each one or the only one that he chose.

3. Total spent: in this the user will record how much he spent with what was consumed.

4. Comparison: At the end of the month the application will compare the amount of money it spent with alcohol consumption and how much it receives per month, considering that the user has put their data in relation to their income at the beginning of the registration.


"I drink because ..." features

"I drink because ..." is a feature based on Decisional Balance, a tool used in the Motivational Interview to explore ambivalent feelings about behavior by exploring the pros and cons of it.


1. Choice of the advantages and disadvantages of drinking: at first the user will be asked to choose a number of advantages and then disadvantages over the consumption of alcohol that are in the application database.

2. Choice of the advantages and disadvantages of NOT drinking: in this second moment it works the same way, although the advantages and disadvantages choices are made about not consuming the alcohol.

3. Scale sample: When the advantages and disadvantages are finished, the application will show the image of a scale indicating the side on which it has the most weight, whether it is the side of the advantage or the disadvantage of drinking and in another image the weight of the scale: advantage and disadvantage of not drinking.


This functionality can be understood as an important motivational intervention to solve the ambivalence with the structured visualization of the advantages and disadvantages, contrasting with arguments related to the exposure and protection factors of consumption. It is also important to update the decision scale at different times of treatment, collaborating with evidence for cognitive restructuring of the patient11.

About "Alcohol" Features


1. In "About Alcohol", psychoeducational information is presented that provides insights into the complexity and the personal, social, economic and public health impacts that alcohol can cause. Information: In this functionality you will be warn by many information that can support awareness of alcohol use, or gain knowledge to pass on to friends. This information consists of subjects related to diagnosis, history of alcohol, laws on consumption, socioeconomic impacts, mental health, etc.

2. According to Wright, Basco and Thase14, Cognitive-Behavioral Therapy (CBT) is based on the idea that patients can learn skills to modify cognitions, so psychoeducation presents its efficacy during the therapy process for to instrumentalize patients with the knowledge that will help reduce the risk of relapse.


Functionality of the "Quiz"

This functionality has the same objective as the previous one, "About Alcohol", as it contains psychoeducational information for the development of awareness and knowledge about alcohol. However, its approach is different because it brings information as a game of questions and answers, linked to curiosities or myths about alcohol, bringing a playful tone to the application.


1. Truth or myth: Here the application will give the information and the user will answer if it is true or myth.

2. Curiosities: Already in this, the application will give information that are usually linked to popular beliefs and will give the user choices to answer, subsequently giving the right answer on the information.



FINAL CONSIDERATIONS

Due to the low number of preventive measures, the importance of a mobile application with self-usable resources is facilitated, facilitating the self-identification and bringing to the users more responsibility towards their attitudes, through the provision of sufficient subsidies to realize their current consumption and possible associated risks, without being critical or confrontational. Thus, users can benefit from premature observation of their behavior, which isn´t commonly perceived by young people in our society who has social values about alcohol.

Thus, it is considered that the more preventive measures exist, the more effective it will be in the awareness and re-education of alcohol use, understanding that the etiology of the chemical dependence itself is quite varied. As a limitation of the tool, it is identified the absence of the health professional who could use the application's functionalities as intervention and establishment of the therapeutic link, since the application will not replace the treatment, suggestions or interventions made by professionals who work in this area.

The trajectory traced to the development of this tool nourishes ideas for the extension of its utilities, serving as a great incentive to research at the national level, both to understand the use of alcohol by users of this tool, seeking the association of socioeconomic variables with the abusive or dependent on alcohol. This can also imbue feelings about alcohol consumption, as well as don´t do it, understand the provision of the amount of financial investment for the use of alcohol and promote awareness of the possible health risks that abusive consumption may entail among adolescents and young adults in Brazilian society.


REFERENCES

1. Migott AMB. Dependência Química: Problema biológico ou social? Cad Saúde Pública 2014; 24:710-13.

2. Abreu CC, Malvasi PA. Aspectos transculturais, sociais e ritualísticos da dependência química. In: Diehl A, Cordeiro DC, Laranjeira R. Dependência Química: Prevenção, Tratamento e Políticas Públicas. Porto Alegre: Artmed. 2011. p. 67-82.

3. Brasil, Secretaria Nacional de Políticas sobre Drogas. Prevenção do Uso de Drogas: Capacitação para Conselheiros e Lideranças Comunitárias / Ministério da Justiça, Secretaria Nacional de Políticas sobre Drogas. 2013. (ed. 5). Brasília: SENAD.

4. Brasil, Secretaria Nacional de Políticas sobre Drogas. Fé na Prevenção: prevenção do uso de drogas por instituições religiosas e movimentos afins. 2014. (ed. 3). Brasília: SENAD.

5. Genebra, World Health Organization. Classificação de transtornos mentais e de comportamento da CID-10: descrições e diretrizes diagnósticas. Porto Alegre: Artmed. 1993.

6. Moreira LB, Fuchs FD, Moraes RS, Bredemeier M, Cardozo S., Fuchs SC, Victoria CG. Alcoholic beverage consumption and associated factors in Porto Alegre, a Southern Brazilian city: a population-based survey. J Stud Alcohol 1996. 57 (3), 253-59.

7. Cavalcante MB, Alves MD, Barroso MG. Adolescência, álcool e drogas: uma revisão na perspectiva da promoção da saúde. Esc Anna Nery Rev Enferm 2008: 12(3): 555-59.

8. Bessa MA. O adolescente usuário de crack. In: Ribeiro M, Laranjeira R. O tratamento do usuário de crack. Porto Alegre; Artmed 2012. p. 619-630.

9. Jungerman FS, Laranjeira R. Entrevista motivacional: Bases teóricas e práticas. 2014. Acesso em 22 de abril de 2016. Disponível em <http://www.uniad.org.br/desenvolvimento/images/stories/publicacoes/science/Entrevista%20motivacional.pdf>.

10. Jaeger A, Oliveira MS, Freire SD. Entrevista motivacional em grupo com alcoolistas. Temas em Psicologia 2014; 16(1), 097-106.

11. Sales C, Figlie NB. Entrevista Motivacional. In: Diehl A, Cordeiro DC, Laranjeira R. Dependência Química: Prevenção, Tratamento e Políticas Públicas. Porto Alegre: Artmed. 2011. p. 67-82.

12. Freire SD Implicações Práticas no Tratamento Psicoterápico da Dependência Química. In: Andretta I, Oliveira MS. Manual Prático de Terapia Cognitivo-Comportamental. São Paulo: Casa do Psicólogo. 2012. p. 389-402.

13. Zeni C, Borsato EP, Pinto JSP, Malafaia O. Panorama do uso de computação móvel com conexão wireless. In: IX Congresso Brasileiro de Informática em Saúde, 2004.

14. Wright JH, Basco MR, Thase ME. Aprendendo a terapia cognitivo-comportamental. Porto Alegre: Artmed. 2008. p. 59-73.
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