Discovering what young adults want in electronic interventions aimed at reducing alcohol-related consequences

Abstract

Background:

Despite intervention efforts, negative alcohol-related consequences continue to impact young adults. Most alcohol interventions focus on reducing alcohol consumption; however, previous research indicates that focusing solely on alcohol use may not decrease consequences. Additionally, many alcohol interventions have diminishing engagement, and few are designed with young adults involved in the development process. Drawing on user-centered design, this study sought to understand young adult perceptions, preferences, and needs for electronic interventions specifically aimed at reducing alcohol consequences.

Methods:

Using semi-structured qualitative interviews, 21 young adult drinkers (ages 18–24; 57.1% female) shared their opinions regarding the need for electronic interventions (i.e., mobile or web-delivered) to reduce alcohol consequences as well as their preferences for content, features, and ways to increase engagement. Interviews were coded and analyzed using a multi-step thematic analysis approach.

Results:

As part of our discovery phase of intervention development, content coding revealed four main themes. Participants perceived several benefits of interventions focused on alcohol consequences, such as promoting mindful alcohol use and reducing alcohol-related harms. Participants also discussed perceived limitations of such programs, including believing consequences from drinking are unavoidable, necessary for learning, and associated with peer pressure. Preferences for features included real-time tracking, personalized feedback, and psychoeducation along with preferences for design including non-judgmental framing, interactive content, and a user-friendly platform.

Conclusions:

Engaging end users early in the development process is a valuable approach to increase intervention relevancy with the target population. This can also inform intervention content and design to maximize engagement and satisfaction (e.g., framing, features, and interactivity) while also reducing barriers identified early on (e.g., peer pressure).

INTRODUCTION

Alcohol use is prevalent among young adults (YAs; Substance Abuse and Mental Health Services Administration [SAMHSA], 2023) and misuse can lead to adverse consequences across a variety of domains (e.g., relationships, mental health, and physical health; Krieger et al., 2018; Lee et al., 2011; Patrick et al., 2020; Tembo et al., 2017). Heavy episodic drinking (i.e., having 4+/5+ drinks for women/men within a 2-h period) is common in this age group and has been associated with a range of negative consequences such as physical altercations, sexual assault, driving while intoxicated, and hangovers (Centers for Disease Control and Prevention, 2022; Merrill et al., 2023; Waterman et al., 2019). Moreover, a recent national survey in the United States found that the percentage of people who had an alcohol use disorder was highest among YAs (16.4% or 5.7 million people) and has increased over the years (SAMHSA, 2023). Given this prevalence and impact, efforts to address alcohol use and consequences in young adulthood are urgently needed.

Numerous interventions have been developed to address alcohol use in YAs (Hutton et al., 2020; Larimer et al., 2022; Murphy et al., 2022). While many have been efficacious in reducing alcohol use (Tanner-Smith & Lipsey, 2015), changes in alcohol consequences have been less consistent (Cronce & Larimer, 2011; Cunningham et al., 2024). Alcohol use is only one of several contributing factors of alcohol consequences (Mallett et al., 2011, 2013) and different etiological pathways have been identified for use and consequences (Mezquita et al., 2014; Neal & Carey, 2007). Harm reduction approaches aim to enhance alcohol awareness and mitigate the risk of consequences rather than solely concentrating on abstinence or decreasing consumption itself (Larimer et al., 2012; Marlatt & Witkiewitz, 2002). Research indicates existing harm reduction interventions for YAs are effective in reducing consequences (Charlet & Heinz, 2017; Larimer et al., 2012), suggesting this approach would continue to be a valuable strategy for YAs and can be further enhanced.

Alcohol interventions, when delivered in-person, are constrained by several barriers, including high costs, inadequately trained staff, and limited access to those who might need it (Hilliard et al., 2014). Electronic alcohol interventions (i.e., mobile or web-delivered) can overcome many of these barriers and extend reach to a larger and more diverse audience (e.g., YAs not in college). Indeed, Internet use in YAs is widespread with roughly 99% reporting access to the Internet (Pew Research Center, 2021a) and 96% owning a smartphone (Pew Research Center, 2021b). Moreover, the flexibility of electronic platforms can allow for communication of health education and monitoring behavior in real time while also maintaining privacy. As a result, electronic delivery of alcohol interventions can provide greater comfort for disclosing drinking patterns and reduce stigma around getting help (Finn et al., 2023; Hutton et al., 2020; Wallhed Finn et al., 2014).

Despite the convenience of electronic delivery (Dedert et al., 2015; Donoghue et al., 2014; Hutton et al., 2020; Sohi et al., 2023), studies have found “end users” (i.e., those using the intervention) show a pattern of diminished engagement over time (Kazemi et al., 2017) and this often results in lower effectiveness of interventions (Molina-Recio et al., 2020; Ramos et al., 2021). Thus, refining interventions to enhance user engagement is of critical importance. User-centered design represents a promising avenue for improving electronic interventions and influencing YAs’ subsequent drinking outcomes (Carreiro et al., 2020; McCurdie et al., 2012). Often paired with qualitative methods, this approach aims to identify end users’ specific preferences and needs—in their own words—to inform the development of products (International Standards Organization, 2018). Collaborating with the “target” or intended audience as part of intervention development can allow us to create more relevant, engaging, and efficacious interventions for YAs (Molina-Recio et al., 2020).

While a few published studies have qualitatively reported on YA preferences for electronic interventions to reduce alcohol consumption (Block et al., 2013; Milward et al., 2016; Schouten et al., 2023), there is a dearth of qualitative research focused on those that might address alcohol consequences. There are a large number of publicly available apps supporting alcohol reduction with many incorporating behavior change techniques such as blood alcohol content (BAC) calculators, alcohol education and monitoring, and normative feedback (Hoeppner et al., 2017; Michie et al., 2012). However, YAs prefer interventions that go beyond solely providing alcohol-related information, instead tailoring content within the context of personal goals, psychosocial variables (e.g., reasons for change) and mood changes, or providing social support (Gaume et al., 2021; Schouten et al., 2023). Previous studies also emphasize the need to develop relevant and meaningful applications for end-users, as interventions that are not personally tailored often lack significance and overlook individual differences, potentially compromising engagement (Milward et al., 2016, 2017). One route to potentially overcoming these deficits lies in the use of a “discovery phase” as part of intervention development. In user-centered design, the discovery phase is often used to gather information to understand the scope of the problem and potential solutions prior to defining the approach or product (Rosala, 2020). This enables researchers to build empathy for the target population (Blayney et al., 2022) and identify features and functionalities to promote learning and engagement, placing YA preferences at the center of intervention development.

Drawing on user-centered design, the present study used qualitative methods as part of a discovery phase for the future development of an electronic intervention focused on alcohol consequences. The aims of the current study were to (1) explore YAs thoughts on electronic interventions (i.e., mobile or web-delivered) focused on reducing alcohol consequences and (2) identify user preferences for content, features, and delivery of such an intervention. Directions for future research incorporating user-centered design into intervention development will also be discussed.

METHOD

Participants and procedures

YAs who drink alcohol (N = 21) were recruited to participate in a study focused on understanding YAs negative drinking experiences. Participants were purposively sampled based on age (18–20 vs. 21–24) and student status (i.e., college vs. non-college attending) to allow for the exploration of experiences of the target phenomenon and demographically varied cases. YAs were recruited from social media (i.e., Facebook and Instagram) as well as a private repository of YAs who consented to be contacted for future research opportunities after completing involvement or screening out of other studies in the research center where the current study was conducted. Potential participants completed an online contact form expressing interest in the study, after which they were scheduled for a Zoom call with trained research staff to verify their identity and answer screening questions. Eligibility criteria were (a) 18–24 years old, (b) reporting heavy episodic drinking at least once in the past month, (c) reporting at least two negative alcohol consequences in the past month, and (d) living in the Seattle Metropolitan area. Eligible participants were then scheduled for a 1.5-h individual Zoom interview and provided information on the next steps. Interviews were conducted until thematic saturation was achieved after 21 interviews; that is, when new interviews produced little or no new useful codes or themes relative to the study objectives (Fusch & Ness, 2015; Guest et al., 2006).

Prior to the Zoom session, participants were sent a link to the consent form and a short survey to collect information on demographics, alcohol use, and alcohol consequences. Upon logging in, participants provided verbal consent to participate. Interviews were semi-structured and conducted by the last author. Participants were first asked to discuss times when “something happened that wasn’t particularly good, maybe something that you wish did not happen” while drinking and the events or decisions that led up to the experience. Aligned with this study’s aims, participants were then asked about their opinions and preferences for interventions focused on reducing alcohol consequences, which is the focus of our qualitative analysis. Interviews were audio recorded and participants were compensated $50 for their time. All procedures were approved by the university’s Institutional Review Board.

The sample was 57.1% assigned female at birth and 52.4% identified as women (4.8% gender minoritized). Participants were, on average, 21.23 years old (SD = 1.75). Regarding race/ethnicity, 47.6% (n = 10) identified as White Non-Hispanic, 28.6% (n = 6) Asian/Asian American Non-Hispanic, and 23.8% (n = 5) Multiracial Non-Hispanic. Over 1/3 (38.1%, n = 8) were not currently enrolled in college. On average, in the past month, participants drank 3.29 days per week (SD = 1.82; Range = 0–7) and consumed 9.71 drinks (SD = 5.93; Range = 0–22) in a typical week. While all participants reported heavy episodic drinking at least once in the past month, some participants reported not typically drinking (i.e., 0 drinks per typical week) in the past month. The average number of alcohol consequences in the past month was 11.24 (SD = 9.62; Range = 3–36).

Interview questions

Interview questions were designed to address the two primary aims of the current study. The first question asked, “What do you think, or how would you feel about a website or mobile application that was designed to help people have less “bad things”, or things they wish didn’t happen from occurring when they decide to drink?” The openness of this question was purposeful, as the main aim was to explore YAs’ perceptions of these types of interventions. The second question asked, “For someone like you, what do you think this website or mobile application would need to have for you to use and enjoy it?” Participants were asked probing questions to gather further details when necessary (see Appendix S1).

Analysis plan

Interviews were transcribed and verified against the audio file for accuracy. A mixed inductive and deductive thematic analysis was used to analyze the interviews using the Microsoft Teams software. The coding team consisted of the first, second, and last author. Following processes recommended by Nowell et al. (2017) and Bingham (2023), the coding team began reading a subset of interviews independently to familiarize themselves with the data and developed a priori topic codes aligned with the study’s research questions. Following this phase of deductive coding, the team independently read all interviews in-depth and refined codes within and across each topical category and generated new codes that represented emerging ideas in the data using an open coding approach. The coding team reviewed the open coding and sorted all potentially relevant coded extracts into higher-level categories that reflected emergent themes and subthemes. Themes and subthemes were refined and finalized until group consensus was reached. Consistent with recommendations to not quantify small-sample qualitative data (Pratt, 2009), the research team focused on organizing and describing rather than quantifying.

RESULTS

Aim 1: Young adult opinions on interventions to reduce alcohol consequences

For the first aim, we explored the target population’s thoughts and opinions about the need for electronic interventions focused on alcohol consequences. From this, two themes were identified (Table 1): (1) perceived benefits and (2) perceived limitations.

TABLE 1.

Overview of main findings, grouped by theme.

Broad themes	Description	Subthemes	Description
Perceived benefits of electronic interventions	Opinions of participants regarding the ways that an electronic intervention could reduce consequences of alcohol consumption		Electronic interventions can help facilitate engagement in behaviors that promote awareness of their alcohol consumption and reduce negative consequences of alcohol, including illness and risky behaviors
Perceived limitations of electronic interventions	Opinions of participants regarding the limits of electronic interventions as a means to reduce alcohol consequences	Alcohol consequences are unavoidable	The belief that interventions do not work to reduce alcohol consumption as negative drinking experiences are necessary for learning and alcohol habits are difficult to regulate
		Peer pressure promotes drinking in social settings	It will be difficult for end users to use an electronic intervention while in social settings, as these settings contain many sources of peer pressure and other external distractions
		Apathy and antagonism towards interventions is a barrier to use	Electronic interventions are unlikely to encourage end users to make changes to their alcohol use
Requested features (see Table 2)	Potential features of an electronic intervention that participants would find useful and appealing	Planning and personalization	Means to reflect on past drinking events and plan future drinking events
		Core features	Essential components to optimize the effectiveness and functionality of alcohol electronic intervention
		Other features	Other considerations, including safety alerts, limiting access to certain phone functionality while drinking, and education and other resources
Preferences for structure and design	Opinions of participants regarding an intervention’s design and functionality	Non-judgmental tone	Interventions should be mindful of language and tone to avoid criticizing alcohol use and engagement in risky behaviors
		Interactive and personalized	The ability to tailor the electronic intervention to one’s goals by selecting the features that one finds the most helpful
		Community and social support	A social component to the intervention to allow means to connect directly or indirectly with peers
		Simplistic design and user friendly	An electronic intervention that is simple and easy to navigate, especially while drinking

Theme 1: Perceived benefits of electronic interventions

Electronic interventions could promote mindful drinking and reduce consequences

Participants discussed the utility of interventions to better understand their drinking behaviors by helping to analyze their habits. As one participant suggested, this may be particularly appealing for YAs who are trying to change or reduce their drinking:

Honestly I would probably try it, especially ‘cause like I’m in that place where I’m trying to like work on that [cutting down drinking] a little bit more.

(Participant [P]3, 22 y/o Woman [W])

Electronic interventions were seen as a way to mitigate the negative effects of alcohol, particularly the physical repercussions of heavy drinking. For example, having tools for measuring alcohol use and intoxication, such as drink counters and information on blood alcohol concentration (BAC), could promote awareness of consequences they do not enjoy and help them reduce or prevent these consequences from happening:

Yeah, that [an application] would actually be really helpful. That’s [getting sick/vomiting] the one thing I still try and avoid all the time. Cause I’m like ‘I’m not sure if this would make me sick’ …

(P1, 22 y/o W)

If someone you know knows that they’re the type to get angry and violent when they drink, you know they want to stop that behavior, they want to reduce it. You know, they’ll probably be more motivated to try things out.

(P9, 22 y/o Man [M])

Participants also discussed interventions as a tool for learning ways to engage in more mindful drinking. For YAs, this meant knowing the alcohol content of drinks and learning their “limits”. Including goal setting prior to drinking was described, which, in combination with a BAC estimate, was seen as important information on how to pace drinking:

…to make a goal for yourself I guess for like how you’re like, ‘OK, this is how I want to feel by the end of the night,’ ‘like I don’t wanna feel sick tomorrow like I want to be able to drive or whatever,’ and then the like kinda app or whatever it be like ‘OK well in order to do that you shouldn’t drink more than this amount,’ like kind of like a way to calculate it.

(P2, 22 y/o W)

Theme 2: Perceived limitations of electronic interventions

Alcohol consequences are unavoidable

Some YAs believed consequences of alcohol consumption are unavoidable, and interventions would not have a significant impact on the frequency or quantity of YAs alcohol use. These perspectives centered around beliefs that negative experiences are necessary and that drinking habits are either uncontrollable or difficult to regulate. Those who were pessimistic felt negative experiences (e.g., throwing up and hangovers) were key to developing an acceptable relationship with drinking and it was through repeated exposure to consequences that awareness and development of the limits emerged:

… all of the problems that I’ve ever had with drinking have been pressured in sophomore year. I really didn’t know my limits and, like, how much I should, like, trust myself to have, I guess. And I didn’t really know when to stop. I guess you could say like, as a senior now and like having that- all of these experiences, I feel like now I know when to stop.

(P6, 21 y/o W)

In contrast, other YAs believed alcohol intoxication hinders the ability to plan and change behavior in the moment. As a result, decision making that could result in consequences was seen as unavoidable when intoxicated:

But you know, I feel like just like when you’re drunk, regardless of the tools you have, everything just goes out the window.

(P7, 21 y/o W)

People who want to do stupid things when they’re drunk are going to do stupid things when they’re drunk like—like harmful decision making is going to happen, regardless.

(P8, 22 y/o W)

Peer pressure promotes drinking in social settings

There was also a perception that social components, such as peer pressure and an atmosphere promoting drinking, would overpower or negate the influence of interventions. First, stimuli or distractions in social contexts were thought to prevent users from using or checking electronic interventions as intended in the moment:

I think that [an electronic intervention] sounds like a good idea, but I just don’t know how people would use it while under the influence, because they probably wouldn’t be paying attention to it. Unless they were like really conscious about it or were trying to, like I feel it wouldn’t be very useful in party settings, but maybe like when they’re trying to control like drinking alone or something.

(P5, 18 y/o W)

Second, peer pressure specific to certain YA groups, such as Greek life, was also of concern as a common perception from these groups is that “it is cool to drink a lot” and there may be indirect pressure to fit in. Belonging to these groups was thought to encourage heavy drinking and could reduce both engagement and efficacy of electronic interventions. This may be due to peer pressure within institutions and organizations, as these YAs spoke on how this peer pressure often stemmed from the beliefs and traditions of fraternities or sororities. Therefore, interventions would have difficulty competing with the expectations of these social drinking communities:

I feel like college kids, and like especially college students in the Greek system are kind of…like a lot of people do choose to join ‘cause they want to party. And so I think that they already have that mindset and because of that. That’s probably going to be hard to change the outcomes.

(P6, 21 y/o W)

Lastly, even with tools and goals about drinking in mind, there is still direct pressure to drink. Pressure from peers may be more influential on behavior than BAC or drinking limit alerts:

the big problem is that people just wanna drink to get drunk a lot and so I don’t really know if they would actually want to refer to something. Especially with the peer pressure issue… that- people just like ‘oh, I’ll just do what other people tell me to do and I’ll ignore like what I actually want or what I should be doing.’

(P4, 24 y/o W)

Apathy and antagonism towards interventions is a barrier to use

A few participants communicated that electronic interventions would not be effective at influencing behavior no matter how material was presented or the functions available. In contrast to other limitations, these YAs did believe that alcohol consumption could be managed, but that interacting with an electronic intervention may be too troublesome. Having to adhere to the demands of the application, such as inputting data before and after drinking events, could dissuade YAs from trying it:

When you’re drunk, I mean already hard to kind of operate your phone… I don’t know people my age… we don’t really wanna be bothered with like fiddling around with an app. […] if I had to like fiddle around with something before I started drinking or after I’m starting to drink, um I probably wouldn’t use that. I mean, it just sounds like an added stress in my life.

(P9, 22 y/o M)

Additionally, any attempt to regulate behavior may cause individuals to act against the advice while drinking:

For me personally, I’m a very stubborn person, so if my phone was telling me, like-like ‘don’t do this,’ […] if it felt like my phone was trying to police me, I wouldn’t listen to it.

(P8, 22 y/o W)

Moreover, as another YA described, sufficient informational resources already exist and those who drink heavily are doing so with some awareness of the consequences. Therefore, there are concerns that an electronic intervention may not add benefit to YAs’ drinking experiences:

I just feel like the people who do drink—they just—like I feel like for the most part, people are already aware of the like consequences surrounding it. And despite that, they still continue to drink, so I’m not sure how much more help like resources would be to them.

(P10, 19 y/o W)

Aim 2: Young adult preferences for electronic interventions

For the second aim, we explored YAs preferences for content, features, and ways to interact with electronic interventions to reduce alcohol consequences. From this, two themes emerged: (1) requested features and (2) preferences for design.

Theme 3: Requested features

Although some participants could verbalize the features they would like to see, others found it challenging to determine what would be helpful without accessing a testable electronic intervention. Despite this, several features were discussed, including planning and personalization, core features, and other “wish list” items (see Table 2, including quotes referred to below in text).

TABLE 2.

Requested operational features for electronic applications with illustrative quotes.

	Description	Quotes
Planning and personalization
Goal setting	Ability to create personalized alcohol goals to avoid negative alcohol-related consequences	A: “…kind of feature in the app or website where like it could be like, ‘how many hours are you gonna be in this event? How many drinks do you plan on having?’ just to kind of like, not as like a hard and fast rule, but to be like just to kind of get your mind thinking about that and like putting that in” (P2, 22 y/o W)
		B: “…to make a goal for yourself I guess for like how you’re like, ‘OK, this is how I want to feel by the end of the night,’ ‘like I don’t wanna feel sick tomorrow like I want to be able to drive or whatever,’ and then the like kinda app or whatever it be like ‘OK well in order to do that you shouldn’t drink more than this amount,’ like kind of like a way to calculate it” (P2, 22 y/o W)
		C: “I think that [a goal setting tool] would be helpful actually like kind of putting aside like a little slot, or time or whatever, or some reminder. […] it has to be integrated with like your daily life, not just like it by itself; […] but if it’s like more of like a calendar interactive thing that I think will be actually be useful I think that’s when I would use it rather than just it by itself. It has to be like something I already use like my calendar notes and stuff” (P4, 24 y/o W)
Tracking drinking	Tracking mood, behavior, and drinking experiences over time to identify patterns and social influences of alcohol use	D: “…press like a start button and then at the end of the night you’re you know, very likely, probably not going to stop it but. Um maybe something where it’s like it pings you like the morning after and it’s like hey’s can you just like log how you felt like what your night was like? […]You know where there’s like a diary aspect of it too. I feel like people are very into journaling these days, so that could help” (P17, 22 y/o M)
		E: “…you put your little entry in 7:00 PM um, I feel good but I’m like nervous you know and maybe write yourself like a three. It was like a three to five rating and then it’s like 10:00 PM like oh, oh something really bad happened and then it’s like I’m wasted. I feel bad the next day and so then you can like look at that and that really helped me get like cause and effect together” (P12, 22 y/o W)
		F: “In my head it would be something that like maybe learns from each different time that you drink, so it would be like ‘I went on this night. It was and I went to this location and I drink this much. This is what I felt throughout the time’” (P17, 22 y/o M)
		G: “… like where did you go? Who are you with? How many people were you with? Like? Did you feel like you drink all at once or later?” (P17, 22 y/o M)
Core features
Blood alcohol concentration (BAC) calculator	An interactive feature to calculate and track BAC with personalized information and real-time updates, including projected alcohol effects	H: “So yeah, height, weight, how much you’ve eaten, how much you drank, how much time is elapsed and then, a shifting baseline that would adapt based off of your experiences, and then how it would relate to that specific person, so it would be like a personal calculator that learns from you” (P18, 18 y/o M)
		I: “And then like it’d be cool if it said, like what the different BACs like did to you, ‘cause I’ve looked that up before and like I didn’t realize like the risk of throwing up starts at like a certain BAC” (P1, 22 y/o W)
		J: “The only thing though that would be kind of difficult, is like I said, calculating the BAC something I had a little bit of a hard time with for the survey is like knowing how many like how many drinks like ‘cause I said I don’t really measure so it’s more of an estimating thing” (P12, 22 y/o, W)
Drink tracker (quantity)	A system where users could tap a button to input their drinks, along with a function to track water intake	K: “…just like alcohol drinks, in general. Just like this drink has like this amount of con—like this alcohol content. And like so like this would be like worth like this amount of shots, kind of deal or something. Just so maybe that might help people like keep track of how much they’re drinking if they choose to do so” (P10, 19 y/o W)
Alcohol-related spending habits	Tracking alcohol-related expenses to inform future spending habits	L: “…comparing price points like this is what you’re going to buy or this is what you bought, and for that same amount of money, you could have bought blank. Like you could have gotten this nice jacket or you know, some roller skates!” (P15, 22 y/o Genderqueer)
Other features
Safety alerts	Safety alerts integrated into drink trackers and BAC calculators to discourage risky behaviors	M: “it would be really fun if there was like an infographic showing like ‘yo, don’t drive’ or ‘yo you should probably stop right now’” (P16, 23 y/o M)
Limiting phone functionality	Feature to limit phone functionality while drinking for better decision-making with technology use	N: “Maybe even limiting screen time would be a helpful thing if it had access to like limiting text messaging, or like if it could turn off certain people before you start drinking […] I generally think like tracking intake and like blocking phone functionality would maybe…like stop the digital side of destructive decisions” (P8, 22 y/o W)
Education and other resources	A central hub of accessible educational material on alcohol use, including broad information, comparisons to peers, and guidance for avoiding consequences and engaging in alcohol safety	See Table 3

Planning and personalization

Participants described wanting tools to not only reflect on past drinking experiences, but also help plan future ones. Key to this request was taking a personalized approach.

Goal setting.

Setting personalized goals to stick to a predetermined alcohol amount (Quote 2A) would help avoid unwanted alcohol-related consequences by helping YAs consider what they want to experience while drinking (Quote 2B). Rather than a new and separate app for goal setting, a feature that could be integrated into existing apps and systems (e.g., calendar and notes app) would increase convenience of use (Quote 2C).

Tracking drinking.

Tracking behaviors, moods, and experiences over time while drinking would be a meaningful experience for YAs. Similar to a drink tracker, information about one’s drinking event could be inputted into a dairy or journal feature (Quote 2D). Ideally, YAs would be able to track fluctuations in their mood while simultaneously tracking alcohol consumption. This would enable them to better understand if and how drinking influences their mood and, conversely, how their mood influences their drinking habits (Quote 2E). This form of personalized feedback could allow users to learn valuable information on their emotional states, notice trends in their own drinking patterns, and learn from past experiences (Quote 2F). Information on drinking patterns should also include salient environmental and social factors that influence or can be influenced by alcohol use such as location, environment, and peer groups (Quote 2G).

Core features

BAC calculator.

Inclusion of a BAC calculator garnered considerable enthusiasm from participants. YAs envisioned an interactive calculator to include personalized information (e.g., birth sex, weight, food intake, and number of drinks) and allow users to see changes in BAC throughout one’s drinking session in real time (Quote 2H). According to YAs, there is utility of showing projected alcohol effects at different BACs; for example, the severity of physiological effects (loss of coordination and getting sick) after three standard drinks for each user. This could equip individuals with foreknowledge of alcohol’s effects, enabling end users to better plan their evening and avoid unwanted consequences (Quote 2I).

There was, however, some skepticism regarding the feasibility of tracking one’s BAC during drinking events. YAs discussed that it can be hard to measure drinks, both in amount of alcohol per drink and total number of standard drinks consumed (Quote 2J). If this were to be implemented, BAC trackers should take into consideration ease and convenience of use and training module(s) on how to accurately track drinks.

Real-time tracking.

Several YAs felt that drink diaries and trackers were essential and necessary features. Many visualized tapping a button whenever they finished a drink with potentially additional functions to also track water intake. Tracking drinks could help individuals monitor their alcohol consumption throughout a drinking occasion and see their patterns of drinking across time (Quote 2K).

Alcohol-related spending habits.

Similar to tracking alcohol use, tracking how much money is spent on alcohol and alcohol-related purchases can help YAs make informed decisions on future spending habits. This feature could inform end users of alternative, desirable items they could buy in place of the money they spent on alcohol (Quote 2L).

Other features

In addition to the two themes discussed above, several additional features should be considered for electronic interventions. Safety alerts or infographics could be integrated into a drink tracker/BAC calculator to discourage driving while intoxicated and other risky behaviors (Quote 2M). Additionally, an electronic intervention could limit phone functionality and access to apps while drinking. For YAs, this meant limiting screen time, preventing the sending of text messages to certain individuals, or accessing bank information. Limiting access to features may facilitate better decision-making with technology while drinking (Quote 2N).

Education and other resources.

As demonstrated in Table 3, a central and accessible hub of educational material on topics related to alcohol use, drinking behaviors, and local and national resources may also be helpful for YAs. This includes having access to broad information about alcohol, including negative effects associated with use and alcohol interactions with medications or other substances (Quotes 3A–D). It may also be beneficial for YAs to know how they compare to other YAs, effects of peer pressure, and signs of risky alcohol use (Quotes 3F–G). Moreover, many were in favor of an intervention that provided general recommendations and guidance for avoiding unwanted consequences, initiating conversations with others to combat peer pressure, and tips for engaging in alcohol safety (Quotes 3H–J). For example, this could include suggestions on how to have “tricky” discussions with friends about their drinking habits, setting boundaries with others, and expressing concern for others safety and well-being (Quote 3J).

TABLE 3.

Participant preferences for education and resources with illustrative quotes.

	Quotes
General alcohol information
Negative effects associated with alcohol use	A: “Or just like kind of educating people about like the broad, broadly negative effects of the alcohol, maybe ‘cause I feel like it’s just so ingrained, especially in like college” (P11, 21 y/o W)
Alcohol interactions with medications	B: “You know maybe they’re not supposed to drink if they have a certain condition, or they took a certain medication… I mean you know someone’s medication schedule was like a consistent thing and it was like uploaded on some kind of app and oh you took this medication tonight. Remember, like you’re not supposed to drink after you take this one” (P9, 22 y/o M)
Risks and side effects of mixing substances	C: “Maybe more education on like mixing different substances like I think that’s really important ‘cause I know like if you mix certain things and like there’s risk of like death and like a heightened risk of death” (P1, 22 y/o W)
Effects of alcohol on mental health and psychiatric disorders	D: “Oh, I had a like bad day, something that if you use like oh blank bipolar and you click on that and then it’s like oh here’s like how this is with alcohol. And then like you read more about like the relationship between like what you are and like alcohol might be interesting” (P12, 22 y/o W)
Drinking habits and rates of alcohol abuse among young adults	E: “Maybe just like information just regarding young adults, in general, about like their drinking habits, I guess” (P10, 19 y/o W) F: “I think maybe the rate of alcoholism [and] info about drunk driving” (P10, 19 y/o W)
Signs of risky alcohol use (e.g., binge drinking)	G: “…binge drinking for sure ‘cause I think like I’ve seen it happen to other people at parties like they just keep going and they don’t stop. And it’s kind of like really worrisome. So I think recognizing the signs of binge drinking in like your friends or yourself, or if you’re out partying somewhere like recognizing it in strangers almost” (P13, 21 y/o W)
Effects of peer pressure	H: “…it would talk about peer pressure I guess and like um, take that into account” (P5, 18 y/o W)
Recommendations and resources
Tips for avoiding unwanted consequences and reducing alcohol consumption	I: “I think it’s important to focus on the negatives, but if you’re going to like highlight a negative, it should be maybe like then followed by a solution. so it’s like instead of—I don’t know—drinking X amount like try doing this and switching it up to water for the last two drinks” (P14, 23 y/o M)
Guidance for safe drinking	J: “You just got to educate people. I think like from the get-go about like what is like you know how to keep yourself safe and like avoid the people who are bad…” (P7, 21 y/o W) K: “Like maybe like the pre-drinking like building up to the drinking like OK like what, maybe a checklist like what can I do tonight to make sure that I’m going to be safe can be helpful” (P7, 21 y/o W)
Learning to initiate tough conversations with friends and setting boundaries while drinking	L: “Like knowing how to talk to your friends about what you’re comfortable with and what you’re not comfortable with is like a big discussion that you need to have with them. […] talking to your friends about their drinking habits is a tricky subject that I think a lot of people don’t know how to navigate” (P13, 21 y/o W)
Information on local and national alcohol rehabilitation centers	M: “…locally used or like national or international used app like local resources. […] or like if you’re in distress and you need some rehabilitation here are some local centers that we found near you” (P15, 22 y/o Genderqueer)

Theme 4: Preferences for structure and design

Central to participants’ concerns were intervention design and functionality. Four primary needs were expressed including (1) non-judgmental tone, (2) interactive and personalized, (3) community and social support, and (4) simplistic design and user-friendly interface.

Non-judgmental tone

There was a strong desire from many YAs for an electronic intervention that was encouraging and non-judgmental. A judgmental tone was characterized as language that either glamorizes negativity regarding alcohol use or is overly prescriptive in drinking recommendations (e.g., encouraging abstinence from alcohol). This, in turn, could discourage end users from using the intervention or taking the advice it offers. Thus, language that recognizes the desires of the target population is preferred:

[Rather than] ‘don’t drink’ but like ‘how to be careful while you are drinking’ sort of website. I think that is important ‘cause I feel like college kids are going to drink regardless.

(P6, 21 y/o W)

Accordingly, information provided should be useful to end users and presented in a constructive manner:

Not being told what to do and just get—just being given the information very fairly like subjectively.

(P10, 19 y/o W)

Interactive and personalized

A successful app would need to be personalized and tailored to individual users. This could take the form of creating a unique profile, entering personal information (e.g., height and weight) to receive personalized feedback, and interacting with features that are important and relevant to them:

It would have had like a relatable app that doesn’t make it feel like there’s like a lot much older adult like writing it or talking to me.

(P5, 18 y/o W)

As one participant noted, it is important for developers to recognize the heterogeneity among YAs and understand how unique lived experiences and differing identities may influence alcohol use and decisions regarding alcohol:

I definitely think it’s important because everybody is coming from a different place and they have different reasons to partake in alcohol and so really trying to take those into consideration…

(P16, 23 y/o M)

Furthermore, limitations with current interventions should be considered to design new and relatable content that goes beyond what interventions are currently offering by contextualizing drinking events so that users can include personal and relevant information rather than generic information:

The flaw with like current websites and stuff that try to like track your drinking is that they really overgeneralize it to everyone. Nothing is very specific and there’s just kind of this over-focus on like, how many like beers did you have and like how much wine did you have … Like everything just feels like very like surface level and I think it would be better if it asks more like ‘where, you know, where did you go?’ ‘Did you enjoy this place?’

(P17, 22 y/o M)

Community and social support

Another subtheme discussed by YAs was creating a supportive community of YAs wanting to reduce the consequences of alcohol. Some believed that it would be helpful to build a community with peers or connect with experts to discuss and share their experiences with alcohol:

Yeah, like somewhere where people we can like talk to other people about your things. […] think of like experts talk about the things that young adults go through when they’re drinking and stuff like that.

(P13, 21 y/o W)

However, a community and social support network received mixed support. A social network component in an intervention could encourage or glorify intoxication or negative experiences, potentially discouraging individuals from engaging with the intervention:

The only thing that I would worry about for an app like that would be like glamorization of negativity, which is something that definitely like bothers me, but I know it’s something that like exists with everything. Whether it’s like mental health or drinking like even addiction problems are really glamorized in certain groups and then you have people who might be encouraging negativity for a social media-based thing.

(P12, 22 y/o W)

Simplistic design and user-friendly interface

Another central concern raised was ease and convenience of use. Electronic interventions for YA drinking should be intuitive and simplistic. It was also important to have a design that would be easy to navigate while drinking or out at a party to promote usability throughout the drinking event:

Maybe be easy to access cause like you know when you’re drinking, it’s kind of hard to use your phone. You know easy to like, navigate cause like again when you’re drunk. It’s hard to navigate like anything, so have it be user-friendly for someone who’s intoxicated.

(P7, 21 y/o W)

In addition, a universal search tool in the app would boost the accessibility of information:

…not be like visually assaulting I guess, which is a hard thing to do… Again, it could just be something that like you. There’s like a search bar and you just type in something and like whatever is nearest to that will show up.

(P17, 22 y/o M)

Furthermore, having smaller, “digestible” bits of information rather than larger, detailed chunks that would be time-consuming to read and process would be beneficial for increasing the useability of the intervention:

I mean I think having good little like rules of thumb or I don’t want to say like catchphrases or like taglines you know. I think you know the easier to digest as quick as possible I think is like become pretty standard.

(P14, 23 y/o M)

In sum, the overarching sentiment is to have an intervention design that would keep end users interested and engaged while minimizing the effort required to access tools.

DISCUSSION

The current study represents a formative step within the discovery phase of user-centered design to understand and increase empathy around YA drinking experiences. This phase had two primary objectives: (1) to gain insight into how YAs perceive electronic interventions focused on reducing negative alcohol consequences and (2) to identify specific features YAs would consider beneficial in such interventions. Broadly, our findings show that YAs had positive reactions to developing interventions of this kind, though important barriers were also identified to address early in the development process. Together, these findings provide researchers and developers with considerations for future intervention efforts.

Barriers

A notable barrier was that some YAs perceived consequences as unavoidable either because they were seen as necessary to learn drinking limits, or because alcohol habits were perceived as incapable of being regulated. This is consistent with well-documented variance among YA evaluations of alcohol-related consequences (Merrill et al., 2018). These varied YA evaluations of consequences may be representative of where YAs fall along a continuum of readiness to change drinking behaviors (Prochaska & Velicer, 1997; Schroé et al., 2022) and could be conceptualized as ambivalence which is a longstanding focus of alcohol prevention efforts from a motivational interviewing approach (Miller & Rollnick, 2002). Research has found that the more personalized the information is in the intervention, the more YAs are willing to explore their ambivalence and approach changing alcohol-related behaviors (Borsari & Carey, 2005). This may lead to better intervention outcomes, as YAs indicating a desire to change drinking behaviors show significantly greater reductions in drinking quantity compared to those that don’t (Schulte et al., 2022).

Approach

YAs expressed interest in electronic interventions to reduce alcohol consequences that are non-judgmental, intuitive, and customizable. Importantly, YAs do not want to be told “not to drink” or feel criticized for drinking, even if their drinking has led to negative events in their life. This is consistent with many existing brief interventions for alcohol use that use harm-reduction and motivational interviewing approaches to foster collaborative and empathetic exploration options of change (DiClemente et al., 2017; Whiteside et al., 2010). Interventions that follow the spirit of these approaches should be perceived as non-judgmental, however, feedback should be elicited from the YA end users to verify that language is non-judgmental from their perspective, and it may be best to specifically ask for ratings of judgmental tone.

Features

Many YAs requested an interactive, personalized drink tracker and BAC calculator to see real-time changes in their estimated BAC. Notably, electronic tools providing BAC estimates are already widely disseminated (Lau-Barraco et al., 2018; Miller et al., 2013; Riper et al., 2009). However, although YAs described the utility of momentary BAC calculators as an interactive informational monitoring link to prevent unwanted consequences, this may be at odds with longstanding research demonstrating BAC estimates may encourage alcohol consumption (Gajecki et al., 2014; Weaver et al., 2013).

YAs also generated preferences for electronic interventions that incorporate mindful awareness and intentional goal setting for alcohol use. While goal setting is a longstanding and well-disseminated tool for YA alcohol use (Cox & Klinger, 2011; Epton et al., 2017), incorporating nonjudgmental mindful awareness is a promising component of electronic interventions for YA alcohol use (Arnaud et al., 2020), focusing on key pathways hypothesized to drive alcohol-related consequences such as attentional control and emotion regulation (Dvorak et al., 2014; Mellentin et al., 2021). While a randomized controlled trial among college students did not find an association between the use of a mindfulness application and alcohol use (Huberty et al., 2019), alcohol use was a secondary outcome and research suggests mindfulness interventions are effective when focused on a specific behavior (Karremans & Papies, 2017). Research is needed to assess the efficacy of providing mindfulness strategies focused on contexts surrounding alcohol-related consequences and potentially even strategies that can be used while drinking.

YAs also discussed the strengths and weaknesses of social engagement, acknowledging the potential drawbacks of peer pressure while also recognizing the advantages of social networks in fostering connection and community. Consistent with research that individual drinking interventions can have a small improvement in drinking habits in their social network (Hallgren et al., 2021) and documented YA preferences for electronic interventions that engage the community to increase support and motivation (Milward et al., 2016), some YAs perceived social components of an electronic intervention could build a community encouraging healthy drinking habits. Conversely, consistent with findings that alcohol-related content across peers’ social media predicts increased alcohol use (Nesi et al., 2017), other YAs recognized social components may inadvertently increase risky drinking behaviors. Indeed, a recent randomized controlled trial demonstrated that a text message intervention promoting peer outreach among YAs significantly increased peer support and reduced peer pressure to drink but had mixed acceptability and effects on drinking outcomes (Suffoletto et al., 2024), underscoring the complexity of peer support intervention approaches on YA drinking.

Implications for research and practice

Overall, our participants indicated that a tailorable, personalized, and customizable electronic intervention is a good match for this age group and may increase the popularity of the intervention (Hoeppner et al., 2017). Consistent with Gaume et al. (2021), findings from this study suggest that interventions could be more effective by centralizing motivational interviewing techniques to emphasize relational factors and maintain a non-judgmental stance, support exploration and self-efficacy, and elicit change talk and commitment to change, particularly for YAs experiencing ambivalence. Electronic interventions should assess readiness to change attitudes and perceived ability to make changes and provide customizable and optional features to reinforce personal choice.

Designs that require minimal data entry, especially during drinking events are preferred and developers could consider collecting data either passively (e.g., geolocation and through wearables) or actively (e.g., brief text notifications) with options to opt into more user-intensive and interactive features, again reinforcing personal choice and personalization. YAs advocated for the inclusion of behavior change techniques such as BAC calculators, personalized feedback, goal-setting, and normative feedback. They also provided a variety of possible add-on features including opt- in availability of (1) safety alerts based on BAC to prevent unwanted consequences in real time, (2) limiting phone screen time and use while drinking, and (3) pairing drink tracking with tracking fluctuations in their behaviors, moods, experiences, location, environment, peer groups, and finances. Developers should also consider providing a hub of educational material presented in a way that is brief and “digestible,” and includes a universal search tool to allow YAs to access information that is relevant to them. Finally, additional research is warranted to reconcile discrepancies in user-feedback and existing empirical evidence for social and community support and BAC calculators by recognizing end users as crucial partners in developing and implementing interventions, while concurrently adhering to clinical recommendations.

Limitations

In interpreting the findings of this study, it is important to acknowledge limitations. First, due to the broad nature of the interview questions, a comprehensive understanding of how individuals who did not generate one of the themes or subthemes may perceive them is unknown. Additionally, the sample was restricted to the Seattle metropolitan area and results may only generalize to YAs living in comparable cities. While the authors agreed that saturation was reached, indicating a point when comprehensive insight of YA opinions and preferences had been achieved, interviews were conducted with a relatively homogeneous sample limiting the ability to determine potential nuances with respect to diverse racial, ethnic, and gender identities. Future research should purposefully sample racial/ethnic and gender minorities to identify differences and ensure their voices are included in intervention development processes.

CONCLUSION

This study provided a formative step in developing empathy and seeking an understanding of what heavy-drinking YAs want out of electronic interventions focused on reducing alcohol-related consequences. Overall, YAs had positive responses to such interventions, however, researchers must consider reservations regarding the perceived utility of experiencing consequences to learn one’s limits, the usability of features while drinking, and other things in social drinking contexts that also impact behavior. Additionally, several of the preferred features YAs listed are features currently available in apps or websites including drink trackers and BAC estimators. Future research should also assess implementation gaps for these features that are already widely disseminated. Furthermore, investigation of what would motivate end users to access the intervention (e.g., advertisements, friend referrals, and using with a therapist) and the process of choice selection will be an important consideration in future stages of development.

DATA AVAILABILITY STATEMENT

Research data are not shared.