Behavioural Nudging of Alcohol Consumption Behaviour in Online Shopping Environments

Alcohol consumption has significantly changed in the United Kingdom in the post-pandemic environment. Where on-license consumption had stopped during lockdowns due to pub, club, and restaurant closures, off-license consumption increased. The methods of sourcing alcohol changed to utilize online sources as well as traditional brick and mortar shops. This brings a significant change to the alcohol landscape as online shopping behaviors constitute a different range of consumer product exploration and decision making processes. The target population of the study is those using online shopping to complete their grocery shopping, which according to current market data is middle-aged individuals in middle to high income households.
Preliminary work will utilize the 6SQuiD framework to select behavioral change theories (BCTs) to be used in the experimental phase of the project. The behavioral change theories will be selected from a list of behavioral change theories that are being utilized in the larger field of alcohol cessation research, predominantly in the mobile application space. Ten will be selected for further exploration. The experimental phase of the project utilizes a simulated digital shopping platform environments to implement behavior change theories prior to "in the wild" application. This simulated shopping environment has been tested in other alcohol studies and works to establish the forms in which behavior change theories are incorporated. The "in the wild" exploration is motivated by current approaches in human computer interaction (HCI) research which focuses on how users react to technology around them as opposed to person-based approaches. These experiments rely heavily on qualitative outputs from users in a think-aloud format as well as quantitative outputs such as alcohol content of beverages purchased. This is to discover effective behavior change theories in reducing alcohol purchasing behavior in online shopping settings. These behavior change theories will be tested individually before being combined to see affect size impacts. The findings would yield the individual behavior change theories with the greatest affect sizes as well as potential combinations with large affect sizes. There is potential for affect sizes to not be additive, but this is an area which will be explored in part due to existing alcohol consumption cessation applications using combinations of behavioral change theories.
As a result of the series of experiments and associated studies, an experimental protocol for testing behavior change theories and their combinations in an online setting will be developed. This will be built on top of existing frameworks such as 6SQuiD.
Secondary impacts to the researched population will include promoting and educating the target population about the health implications of moderate to high alcohol consumption and the health benefits of consumption reduction. The target is to reduce the purchasing of high alcohol content beverages in off license settings and nudging towards lower consumption rates by way of incorporating no/low alcohol options. The final output would be not only the individual behavioral change theories and their combinations with the largest affect sizes, but also a framework for a personalized, preventative alcohol consumption intervention at the point of purchase for those utilizing online purchase points. This framework could be utilized in a number of ways inside and outside the digital health space. In the digital space it can impact the website architecture of online shopping platforms. In the health space, there could be changes in which alcohol related health warnings are supplied to consumers (including place, frequency, and method). In the policy space there could be changes to requirements around interactions in the online shopping space to verify ages and limiting amount of alcohol supplied to consumers, mirroring existing policies in place at physical shop locations.

Impact on Health and Care
The CDT primarily addresses the most pressing needs of nations such as the UK - namely the growth of expenditure on long term health conditions. These conditions (e.g. diabetes, depression, arthritis) cost the NHS over £70Bn a year (~70% of its budget). As our populations continue to age these illnesses threaten the nation's health and its finances.

Digital technologies transforming our world - from transport to relationships, from entertainment to finance - and there is consensus that digital solutions will have a huge role to play in health and care. Through the CDT's emphasis on multidisciplinarity, teamwork, design and responsible innovation, it will produce future leaders positioned to seize that opportunity.

Impact on the Economy
The UK has Europe's 2nd largest medical technology industry and a hugely strong track record in health, technology and societal research. It is very well-placed to develop digital health and care solutions that meet the needs of society through the creation of new businesses.

Achieving economic impact is more than a matter of technology. The CDT has therefore been designed to ensure that its graduates are team players with deep understanding of health and social care systems, good design and the social context within which a new technology is introduced.

Many multinationals have been keen to engage the CDT (e.g. Microsoft, AstraZeneca, Lilly, Biogen, Arm, Huawei ) and part of the Director's role will be to position the UK as a destination for inwards investment in Digital Health. CDT partners collectively employ nearly 1,000,000 people worldwide and are easily in a position to create thousands of jobs in the UK.

The connection to CDT research will strongly benefit UK enterprises such as System C and Babylon, along with smaller companies such as Ayuda Heuristics and Evolyst.

Impact on the Public
When new technologies are proposed to collect and analyse highly personal health data, and are potentially involved in life or death decisions, it is vital that the public are given a voice. The team's experience is that listening to the public makes research better, however involving a full spectrum of the community in research also has benefits to those communities; it can be empowering, it can support the personal development of individuals within communities who may have little awareness of higher education and it can catalyse community groups to come together around key health and care issues.

Policy Makers
From the team's conversations with the senior leadership of the NHS, local leaders of health and social care transformation (see letters from NHS and Bristol City Council) and national reports, it is very apparent that digital solutions are seen as vital to the delivery of health and care. The research of the CDT can inform policy makers about the likely impact of new technology on future services.

Partner organisation Care & Repair will disseminate research findings around independent living and have a track record of translating academic research into changes in practice and policy.

Carers UK represent the role of informal carers, such as family members, in health and social care. They have a strong voice in policy development in the UK and are well-placed to disseminate the CDTs research to policy makers.

STEM Education
It has been shown that outreach for school age children around STEM topics can improve engagement in STEM topics at school. However female entry into STEM at University level remains dramatically lower than males; the reverse being true for health and life sciences. The CDT outreach leverages this fact to focus STEM outreach activities on digital health and care, which can encourage young women into computer science and impact on the next generation of women in higher education.

For academic impact see "Academic Beneficiaries" section.