The effect of question order on outcomes in the core outcome set for brief alcohol interventions among online help-seekers: Protocol for a factorial randomized trial

Marcus Bendtsen*, Claire Garnett, Paul Toner, Gillian W. Shorter

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)
21 Downloads (Pure)


Background: A core outcome set (COS) for trials and evaluations of the effectiveness and efficacy of alcohol brief interventions (ABIs) has recently been established through international consensus to address the variability of outcomes evaluated.
Objective: This is a protocol for studies to assess if there are order effects among the questions included in the COS.
Methods: The 10 items of the COS are organized into 4 clusters. A factorial design will be used with 24 arms, where each arm represents 1 order of the 4 clusters. Individuals searching online for help will be asked to complete a questionnaire, and consenting participants will be randomized to 1 of the 24 arms (double-blind with equal allocation). Participants will be included if they are 18 years or older. The primary analyses will (1) estimate how the order of the clusters of outcomes affects how participants respond and (2) investigate patterns of abandonment of the questionnaire.
Results: Data collection is expected to commence in November 2020. A Bayesian group sequential design will be used with interim analyses planned for every 50 participants completing the questionnaire. Data collection will end no more than 24 months after commencement, and the results are expected to be published no later than December 2023.
Conclusions: Homogenizing the outcomes evaluated in studies of ABIs is important to support synthesis, and the COS is an important step toward this goal. Determining whether there may be issues with the COS question order may improve confidence in using it and speed up its dissemination in the research community. We encourage others to adopt the protocol as a study within their trial as they adopt the ORBITAL (Outcome Reporting in Brief Intervention Trials: Alcohol) COS to build a worldwide repository and provide materials to support such analysis
Original languageEnglish
Article numbere24175
Pages (from-to)e24175
Number of pages8
JournalJMIR Research Protocols
Issue number11
Publication statusPublished - 26 Nov 2020

Bibliographical note

Funding Information:
This project is funded by the Lifestyle Intervention Implementation Research group at Linköping University, for which MB is the research group leader.

Publisher Copyright:
© Marcus Bendtsen, Claire Garnett, Paul Toner, Gillian W Shorter.

Copyright 2020 Elsevier B.V., All rights reserved.


  • Alcohol
  • Brief alcohol intervention
  • Effectiveness
  • Efficacy
  • Factorial trial
  • Online intervention
  • Order effects
  • Outcomes
  • Protocol
  • Question order bias
  • Randomized trial

ASJC Scopus subject areas

  • Medicine(all)


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