1
|
Emenyonu N, Kekibiina A, Woolf-King S, Kyampire C, Fatch R, Dawson-Rose C, Muyindike W, Hahn J. Digital Health Screening in People With HIV in Uganda to Increase Alcohol Use Reporting: Qualitative Study on the Development and Testing of the Self-administered Digital Screener for Health. JMIR Form Res 2022; 6:e35015. [PMID: 36048519 PMCID: PMC9478818 DOI: 10.2196/35015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 06/10/2022] [Accepted: 07/21/2022] [Indexed: 11/16/2022] Open
Abstract
Background Alcohol consumption is a critical driver of the HIV epidemic worldwide, particularly in sub-Saharan Africa, where unhealthy alcohol use and HIV are prevalent. Brief alcohol interventions are effective in reducing alcohol use; however, they depend on effective screening for unhealthy alcohol use, which is often underreported. Thus, there is a need to develop methods to improve reporting of unhealthy alcohol use as an essential step toward referral to brief alcohol interventions. Self-administered digital health screeners may improve reporting. Objective This study aimed to develop and test a digital, easy-to-use self-administered health screener. The health screener was designed to be implemented in a busy, underresourced HIV treatment setting and used by patients with varying levels of literacy. Methods We conducted a qualitative study at the Immune Suppression Syndrome (ISS) Clinic of Mbarara Regional Referral Hospital in Uganda to develop and test a digital self-administered health screener. The health screener included a training module and assessed behaviors regarding general health, HIV care, and mental health as well as sensitive topics such as alcohol use and sexual health. We conducted focus group discussions with clinicians and patients with HIV of the Mbarara ISS Clinic who consumed alcohol to obtain input on the need for and content, format, and feasibility of the proposed screener. We iteratively revised a tablet-based screener with a subset of these participants, piloted the revised screener, and conducted individual semistructured in-depth interviews with 20 participants who had taken part in our previous studies on alcohol and HIV, including those who had previously underreported alcohol use and with low literacy. Results A total of 45 people (n=5, 11% clinicians and n=40, 89% Mbarara ISS Clinic patients) participated in the study. Of the patient participants, 65% (26/40) were male, 43% (17/40) had low literacy, and all (40/40, 100%) had self-reported alcohol use in previous studies. Clinicians and patients cited benefits such as time savings, easing of staff burden, mitigation of patient-provider tension around sensitive issues, and information communication, but also identified areas of training required, issues of security of the device, and confidentiality concerns. Patients also stated fear of forgetting how to use the tablet, making mistakes, and losing information as barriers to uptake. In pilot tests of the prototype, patients liked the feature of a recorded voice in the local language and found the screener easy to use, although many required additional help and training from the study staff to complete the screener. Conclusions We found a self-administered digital health screener to be appealing to patients and clinicians and usable in a busy HIV clinic setting, albeit with concerns about confidentiality and training. Such a screener may be useful in improving reporting of unhealthy alcohol use for referral to interventions.
Collapse
Affiliation(s)
- Nneka Emenyonu
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Allen Kekibiina
- MUST Grants Office, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Sarah Woolf-King
- Department of Psychology, Syracuse University, Syracuse, NY, United States
| | - Catherine Kyampire
- MUST Grants Office, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Robin Fatch
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Carol Dawson-Rose
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Winnie Muyindike
- MUST Grants Office, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Judith Hahn
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, United States
| |
Collapse
|
2
|
Dorey L, Lathlean J, Roderick P, Westwood G. Patient experiences of alcohol specialist nurse interventions in a general hospital, and onwards care pathways. J Adv Nurs 2021; 77:1945-1955. [PMID: 33590919 DOI: 10.1111/jan.14777] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 12/23/2020] [Accepted: 01/10/2021] [Indexed: 11/29/2022]
Abstract
AIMS To provide insight into patient experiences of a general hospital-based alcohol specialist nurse intervention during alcohol detoxification, experiences of alcohol specialist nurse hospital-based follow-up appointments (Pathway A) as well as the experiences of patients who did not have access to this additional help post detoxification (Pathway B). DESIGN A longitudinal qualitative study. METHODS A thematic analysis of semi-structured interviews (2016-2017) with 24 patient participants (N = 12 in each pathway; purposive selection) 1-4 weeks post-detoxification and at 3 and 6 months, to identify patient experiences of these interventions. RESULTS Participants gave accounts of how 'empathic' and 'straight talking' interactions with alcohol specialist nurses during detoxification helped them to 'open up' and orient towards change. After detoxification follow-up, outpatient appointments in the hospital setting were seen as supporting change in early recovery and engagement with a wider range of services. Those with no access to nurse follow-up described experiencing a 'void' in available help. Participants in both groups described barriers to engagement with community alcohol services, peer groups and access to help for mild-moderate mental health problems. CONCLUSION Patient accounts indicate alcohol specialist nurse interventions during and after unplanned detoxification in a hospital setting can help orient patients towards change and support early recovery. IMPACT Providing alcohol specialist nurse interventions in general hospitals offers one route to initiating recovery in alcohol-dependent patients. This has potential to improve the lives of those affected and to reduce related demands on hospital services, but further research is needed.
Collapse
Affiliation(s)
- Lucy Dorey
- Department of Psychology, Swansea University, Swansea, UK.,Faculty of Medicine, University of Southampton, Southampton, UK
| | - Judith Lathlean
- Faculty of Environmental and Life Sciences, School of Health Sciences, University of Southampton, Southampton, UK
| | - Paul Roderick
- Faculty of Medicine, School of Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | | |
Collapse
|
3
|
Addison M, Mcgovern R, Angus C, Becker F, Brennan A, Brown H, Coulton S, Crowe L, Gilvarry E, Hickman M, Howel D, Mccoll E, Muirhead C, Newbury-Birch D, Waqas M, Kaner E. Alcohol Screening and Brief Intervention in Police Custody Suites: Pilot Cluster Randomised Controlled Trial (AcCePT). Alcohol Alcohol 2018; 53:548-559. [PMID: 29889245 PMCID: PMC6104624 DOI: 10.1093/alcalc/agy039] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 05/23/2018] [Indexed: 01/27/2023] Open
Abstract
Aims There is a clear association between alcohol use and offending behaviour and significant police time is spent on alcohol-related incidents. This study aimed to test the feasibility of a trial of screening and brief intervention in police custody suites to reduce heavy drinking and re-offending behaviour. Short summary We achieved target recruitment and high brief intervention delivery if this occurred immediately after screening. Low rates of return for counselling and retention at follow-up were challenges for a definitive trial. Conversely, high consent rates for access to police data suggested at least some outcomes could be measured remotely. Methods A three-armed pilot Cluster Randomised Controlled Trial with an embedded qualitative interview-based process evaluation to explore acceptability issues in six police custody suites (north east and south west of the UK). Interventions included: 1. Screening only (Controls), 2. 10 min Brief Advice 3. Brief Advice plus 20 min of brief Counselling. Results Of 3330 arrestees approached: 2228 were eligible for screening (67%) and 720 consented (32%); 386 (54%) scored 8+ on AUDIT; and 205 (53%) were enroled (79 controls, 65 brief advice and 61 brief counselling). Follow-up rates at 6 and 12 months were 29% and 26%, respectively. However, routinely collected re-offending data were obtained for 193 (94%) participants. Indices of deprivation data were calculated for 184 (90%) participants; 37.6% of these resided in the 20% most deprived areas of UK. Qualitative data showed that all arrestees reported awareness that participation was voluntary, that the trial was separate from police work, and the majority said trial procedures were acceptable. Conclusion Despite hitting target recruitment and same-day brief intervention delivery, a future trial of alcohol screening and brief intervention in a police custody setting would only be feasible if routinely collected re-offending and health data were used for outcome measurement. Trial registration ISRCTN number: 89291046.
Collapse
Affiliation(s)
- Michelle Addison
- Institute of Health & Society, Newcastle University, Baddiley Clark Building, Richardson Road, Newcastle Upon Tyne, UK
| | - Ruth Mcgovern
- Institute of Health & Society, Newcastle University, Baddiley Clark Building, Richardson Road, Newcastle Upon Tyne, UK
| | - Colin Angus
- School of Health and Related Research, Health Economics and Decision Science, The University of Sheffield, Regent Court, 30 Regent Street, Sheffield, UK
| | - Frauke Becker
- Nuffield Department of Population Health, University of Oxford, UK
| | - Alan Brennan
- School of Health and Related Research, Health Economics and Decision Science, The University of Sheffield, Regent Court, 30 Regent Street, Sheffield, UK
| | - Heather Brown
- Institute of Health & Society, Newcastle University, Baddiley Clark Building, Richardson Road, Newcastle Upon Tyne, UK
| | - Simon Coulton
- Centre for Health Services Studies, University of Kent, Canterbury, Kent, UK
| | - Lisa Crowe
- Institute of Health & Society, Newcastle University, Baddiley Clark Building, Richardson Road, Newcastle Upon Tyne, UK
| | - Eilish Gilvarry
- Institute of Health & Society, Newcastle University, Baddiley Clark Building, Richardson Road, Newcastle Upon Tyne, UK
- Newcastle & North Tyneside Addictions Service, Plummer Court, Carliol Place, Newcastle upon Tyne, UK
| | - Matthew Hickman
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, UK
| | - Denise Howel
- Institute of Health & Society, Newcastle University, Baddiley Clark Building, Richardson Road, Newcastle Upon Tyne, UK
| | - Elaine Mccoll
- Institute of Health & Society, Newcastle University, Baddiley Clark Building, Richardson Road, Newcastle Upon Tyne, UK
| | - Colin Muirhead
- Institute of Health & Society, Newcastle University, Baddiley Clark Building, Richardson Road, Newcastle Upon Tyne, UK
| | | | - Muhammad Waqas
- Economics Division, Leeds University Business School, Leeds, UK
| | - Eileen Kaner
- Institute of Health & Society, Newcastle University, Baddiley Clark Building, Richardson Road, Newcastle Upon Tyne, UK
- Corresponding author: Institute of Health & Society, Newcastle University, Baddiley Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK. Tel: +44 (0)191 208 7884; E-mail:
| |
Collapse
|