Exploring Ways to Reduce Heavy Drinking by Increasing Hope Among Midlife Women in Australia: Protocol for a Mixed Methods Study.

backgroundAlcohol consumption remains a major societal problem, contributing to myriad health conditions. Australian midlife women (aged 45-64 years) consume more alcohol than previous generations of midlife women and more than younger women now. Alcohol poses health risks that are unique to midlife women, including increased risk of breast cancer; 10% of breast cancers result from alcohol consumption and there is no "safe" limit. There is a global gap in knowledge about socially and culturally appropriate interventions for reducing alcohol consumption in these heavy-drinking groups of midlife women.

objectiveThe research questions (RQs) driving the study are as follows: RQ1-what are the shared social practices that constitute and connect alcohol consumption in each of the 4 case study groups of midlife women? RQ2-what are the perceptions of women in the case study groups about the "invisible hands" shaping alcohol consumption in their social worlds? RQ3-what are the possible "systems-level" interventions or strategies to counter or oppose the "invisible hands" impacting women's alcohol consumption? and RQ4-what is the validity, fidelity, and effectiveness of codeveloped critical consciousness interventions on alcohol-related social practices and consumption patterns?

methodsOur study will identify and implement ways to support the following groups of heavy-drinking midlife women to reduce their alcohol consumption (and their breast cancer risk): (1) women living in regional areas of Australia; (2) lesbian, gay, bisexual, transgender, queer, and other sexual orientation and gender identity women; (3) women living in poverty; and (4) women working in the corporate sector. An expert group of midlife women, termed a women's thought collective (WTC), will guide all stages of the study. Stage 1 (0-18 months) will collect qualitative data using social media analysis, netnography, photo elicitation, and ethnography to understand the forces oppressing women and shaping their alcohol consumption. We will recruit 50 participants in each of the case study groups. Stage 2 (19-24 months) will involve deliberative dialogue methods with the case study groups (15 participants per group) to identify policy-level changes required to support the reduction in participants' drinking. Stage 3 (25-36 months) will codevelop alcohol reduction interventions using critical consciousness development and then implement them using a quasi-experimental design. Primary outcomes are readiness to reduce alcohol and actual changes in consumption levels.

resultsThis protocol was funded by the Australian Research Council (DP250104494) for 3 years, starting in July 2025. Human research ethics committee approval has been granted (0457).

conclusionsExpected outcomes include community actions and policy levers for alcohol reduction, addressing the intersecting sociocultural, political, and commercial factors shaping alcohol use among midlife women. The findings will help inform strategies to counter oppressive forces or transform them into sources of hope, encouraging new practices that challenge social norms. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/72628.