Impact of Alcohol Health Messages in a Real-world Online Retail Setting

World Health Organization (WHO)

Status: Completed

Conditions: Sales; Risk Perception; Knowledge; Behaviour Change; Intentions; Message Perception; Emotional Response

Treatments: Behavioral: Health messages - pictograms; Behavioral: Health messages - existing Swedish legislation

Study type: Interventional

Funder types: Other

Identifiers

NCT07116447

2025-03328-01

Details and patient eligibility

About

The goal of this between-participants parallel randomized controlled trial conducted in the Systembolaget mobile application is to investigate the impact of exposure to health messages on cognition and behaviour.

The primary study objective is to examine whether repeated exposure to rotating health warning messages in a mobile app where customers can purchase alcoholic beverages influences the number of purchased units of alcohol over the studied period.

The secondary objectives are to examine whether repeated exposure to health warning messages in a mobile app influences the number of alcoholic and non-alcoholic products purchased over the studied period, knowledge of alcohol-related harms, alcohol-related risk perceptions, emotional response to the message, engagement with the messages, behavioural intentions and self-reported behaviour of the study participants.

Users of the app providing informed consent for participation in the study will be assigned either to an experimental group, where they will be exposed to rotating messages describing health risks associated with alcohol designed in line with the existing Swedish regulation, or to a control group that will be exposed to messages reflecting existing industry practice.

The intervention will last for ten weeks, during which the recruited participants' data on product purchases in the app will be collected through in-app analytics. Both the number of alcoholic units and number of products purchased per session will be assessed and compared at the session level between the two groups. At the end of the intervention, participants will complete a short survey examining their knowledge, risk perceptions, emotional response, engagement with the messages, intentions and behaviour.

Enrollment: 11,719 patients

Sex: All

Ages: 20+ years old

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

• minimum alcohol purchase age in Sweden (20+)
• have downloaded the Systembolaget app and have given permission to the app to track in-app analytics
• understand Swedish language

Exclusion criteria

• not of minimum alcohol purchase age in Sweden
• no permission to track in-app analytics
• no understanding of Swedish language

Trial design

Primary purpose: Prevention

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

---

11,719 participants in 2 patient groups

Intervention

Experimental group

Description:

Participants in the intervention group will be exposed to textual health warning messages currently mandated for use in printed alcohol advertisements under the Swedish Alcohol Ordinance (1994:2046). Messages will rotate, with each user exposed to a single message per session. The following eight messages will be included: Alcohol is addictive. Alcohol can cause damage to nerves and the brain. Alcohol can cause damage to the liver and pancreas. Alcohol can cause cerebral haemorrhage and cancer. Half of drivers who die in road traffic accidents involving just one vehicle are under the influence of alcohol. Half of all people who drown have alcohol in their blood. Alcohol consumption during pregnancy can damage the child. Children who are given alcohol at home drink to intoxication more frequently than other children.

Treatment:

Behavioral: Health messages - existing Swedish legislation

Control

Active Comparator group

Description:

The control group will consistently be exposed to health messages that are commonly present on existing alcohol labels and are aligned with voluntary commitments of alcohol producers, such as pictograms indicating no alcohol use during pregnancy and while driving. These pictograms will be displayed in black and white and in small sizes consistent with current practice, with a diameter of approximately 6 millimetres.

Treatment:

Behavioral: Health messages - pictograms