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O’Donnell A, Anderson P, Schmidt C, Braddick F, Lopez-Pelayo H, Mejía-Trujillo J, Natera G, Arroyo M, Bautista N, Piazza M, Bustamante IV, Kokole D, Jackson K, Jane-Llopis E, Gual A, Schulte B. Tailoring an evidence-based clinical intervention and training package for the treatment and prevention of comorbid heavy drinking and depression in middle-income country settings: the development of the SCALA toolkit in Latin America. Glob Health Action 2022; 15:2080344. [PMID: 35867541 PMCID: PMC9310809 DOI: 10.1080/16549716.2022.2080344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/16/2022] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Effective interventions exist for heavy drinking and depression but to date there has been limited translation into routine practice in global health systems. This evidence-to-practice gap is particularly evident in low- and middle-income countries. The international SCALA project (Scale-up of Prevention and Management of Alcohol Use Disorders and Comorbid Depression in Latin America) sought to test the impact of multilevel implementation strategies on rates of primary health care-based measurement of alcohol consumption and identification of depression in Colombia, Mexico, and Peru. OBJECTIVE To describe the process of development and cultural adaptation of the clinical intervention and training package. METHODS We drew on Barrero and Castro's four-stage cultural adaption model: 1) information gathering, 2) preliminary adaption, 3) preliminary adaption tests, and 4) adaption refinement. The Tailored Implementation in Chronic Diseases checklist helped us identify potential factors that could affect implementation, with local stakeholder groups established to support the tailoring process, as per the Institute for Healthcare Improvement's Going to Scale Framework. RESULTS In Stage 1, international best practice guidelines for preventing heavy drinking and depression, and intelligence on the local implementation context, were synthesised to provide an outline clinical intervention and training package. In Stage 2, feedback was gathered from local stakeholders and materials refined accordingly. These materials were piloted with local trainers in Stage 3, leading to further refinements including developing additional tools to support delivery in busy primary care settings. Stage 4 comprised further adaptions in response to real-world implementation, a period that coincided with the onset of the COVID-19 pandemic, including translating the intervention and training package for online delivery, and higher priority for depression screening in the clinical pathway. CONCLUSION Our experience highlights the importance of meaningful engagement with local communities, alongside the need for continuous tailoring and adaptation, and collaborative decision-making.
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Affiliation(s)
- Amy O’Donnell
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Peter Anderson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Christiane Schmidt
- Centre of Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Fleur Braddick
- Addictions Unit, Psychiatry Department, Hospital Clínic, Barcelona, Spain
| | - Hugo Lopez-Pelayo
- Addictions Unit, Psychiatry Department, Hospital Clínic, Barcelona, Spain
- Red de Trastornos Adictivos, Instituto Carlos III. Sinesio Delgado, Madrid, Spain
- Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS); Rosselló, Barcelona, Spain
| | | | - Guillermina Natera
- Instituto Nacional de Psiquiatría Ram´on de la Fuente, Ciudad de México, Mexico
| | - Miriam Arroyo
- Instituto Nacional de Psiquiatría Ram´on de la Fuente, Ciudad de México, Mexico
| | - Natalia Bautista
- Instituto Nacional de Psiquiatría Ram´on de la Fuente, Ciudad de México, Mexico
| | - Marina Piazza
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, San Martin de Porres, Peru
| | - Ines V. Bustamante
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, San Martin de Porres, Peru
| | - Daša Kokole
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Katherine Jackson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Eva Jane-Llopis
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
- Institute for Mental Health Policy Research, Toronto, Ontario, Canada
- Univ. Ramon Llull, ESADE, Barcelona, Spain
| | - Antoni Gual
- Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS); Rosselló, Barcelona, Spain
| | - Bernd Schulte
- Centre of Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Solovei A, Jané-Llopis E, Mercken L, Bustamante I, Kokole D, Mejía-Trujillo J, Medina Aguilar PS, Natera Rey G, O'Donnell A, Piazza M, Schmidt CS, Anderson P, de Vries H. Effect of Community Support on the Implementation of Primary Health Care-Based Measurement of Alcohol Consumption. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2022; 23:224-236. [PMID: 35032246 PMCID: PMC8760585 DOI: 10.1007/s11121-021-01329-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2021] [Indexed: 10/25/2022]
Abstract
Alcohol measurement delivered by health care providers in primary health care settings is an efficacious and cost-effective intervention to reduce alcohol consumption among patients. However, this intervention is not yet routinely implemented in practice. Community support has been recommended as a strategy to stimulate the delivery of alcohol measurement by health care providers, yet evidence on the effectiveness of community support in this regard is scarce. The current study used a pre-post quasi-experimental design in order to investigate the effect of community support in three Latin American municipalities in Colombia, Mexico, and Peru on health care providers' rates of measuring alcohol consumption in their patients. The analysis is based on the first 5 months of implementation. Moreover, the study explored possible mechanisms underlying the effects of community support, through health care providers' awareness of support, as well as their attitudes, subjective norms, self-efficacy, and subsequent intention toward delivering the intervention. An ANOVA test indicated that community support had a significant effect on health care providers' rates of measuring alcohol consumption in their patients (F (1, 259) = 4.56, p = 0.034, ηp2 = 0.018). Moreover, a path analysis showed that community support had a significant indirect positive effect on providers' self-efficacy to deliver the intervention (b = 0.07, p = 0.008), which was mediated through awareness of support. Specifically, provision of community support resulted in a higher awareness of support among health care providers (b = 0.31, p < 0.001), which then led to higher self-efficacy to deliver brief alcohol advice (b = 0.23, p = 0.010). Results indicate that adoption of an alcohol measurement intervention by health care providers may be aided by community support, by directly impacting the rates of alcohol measurement sessions, and by increasing providers' self-efficacy to deliver this intervention, through increased awareness of support. Trial Registration ID: NCT03524599; Registered 15 May 2018; https://clinicaltrials.gov/ct2/show/NCT03524599.
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Affiliation(s)
- Adriana Solovei
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands.
| | - Eva Jané-Llopis
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
- Univ. Ramon Llull, ESADE, Barcelona, Spain
- Institute for Mental Health Policy Research, CAMH, 33 Russell Street, Toronto, Canada
| | - Liesbeth Mercken
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
- Department of Health Psychology, Faculty of Psychology, Open University, Heerlen, The Netherlands
| | - Inés Bustamante
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Daša Kokole
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | | | | | | | - Amy O'Donnell
- Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK
| | - Marina Piazza
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Christiane Sybille Schmidt
- Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Peter Anderson
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
- Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK
| | - Hein de Vries
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
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Solovei A, Manthey J, Anderson P, Mercken L, Jané Llopis E, Natera Rey G, Pérez Gómez A, Mejía Trujillo J, Bustamante I, Piazza M, Pérez de León A, Arroyo M, de Vries H, Rehm J, Evers S. Costs of an Alcohol Measurement Intervention in Three Latin American Countries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:700. [PMID: 35055522 PMCID: PMC8776036 DOI: 10.3390/ijerph19020700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 12/26/2021] [Accepted: 01/04/2022] [Indexed: 11/16/2022]
Abstract
Alcohol measurement in health care settings is an effective intervention for reducing alcohol-related harm. However, in many countries, costs related to alcohol measurement have not yet been transparently assessed, which may hinder its adoption and implementation. Costs of an alcohol measurement programme in three upper-middle-income Latin American countries were assessed via questionnaires and compared, as part of the quasi-experimental SCALA study. Additional to the intervention costs, the costs of three implementation strategies: standard training and clinical package, intensive training and clinical package, and community support, were assessed and subsequently translated into costs per additional alcohol measurement session. Results demonstrated that costs for one alcohol measurement session ranged between Int$ 0.67 and Int$ 1.23 in Colombia, Int$ 1.19 and Int$ 2.57 in Mexico, and Int$ 1.11 and Int$ 2.14 in Peru. Costs were mainly driven by the salaries of the health professionals. Implementation strategies costs per additional alcohol measurement session ranged between Int$ 1.24 and Int$ 6.17. In all three countries, standard training and a clinical package may be a promising implementation strategy with a relatively low cost per additional alcohol measurement session.
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Affiliation(s)
- Adriana Solovei
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, P. Debyeplein 1, 6229HA Maastricht, The Netherlands; (P.A.); (L.M.); (E.J.L.); (H.d.V.)
| | - Jakob Manthey
- Institute for Clinical Psychology and Psychotherapy, TU Dresden, Chemnitzer Str. 46, 01187 Dresden, Germany; (J.M.); (J.R.)
- Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
- Department of Psychiatry, Medical Faculty, University of Leipzig, Semmelweisstraße 10, 04103 Leipzig, Germany
| | - Peter Anderson
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, P. Debyeplein 1, 6229HA Maastricht, The Netherlands; (P.A.); (L.M.); (E.J.L.); (H.d.V.)
- Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne NE2 4AX, UK
| | - Liesbeth Mercken
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, P. Debyeplein 1, 6229HA Maastricht, The Netherlands; (P.A.); (L.M.); (E.J.L.); (H.d.V.)
- Department of Health Psychology, Faculty of Psychology and Educational Sciences, Open University Postbus 2960, 6401DL Heerlen, The Netherlands
| | - Eva Jané Llopis
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, P. Debyeplein 1, 6229HA Maastricht, The Netherlands; (P.A.); (L.M.); (E.J.L.); (H.d.V.)
- ESADE Business School, University Ramon Llull, Av. de Pedralbes, 60, 62, 08034 Barcelona, Spain
- Institute for Mental Health Policy Research, CAMH, 33 Russell Street, Toronto, ON M5S 2S1, Canada
| | - Guillermina Natera Rey
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Calz México-Xochimilco 101, Huipulco, Mexico City 14370, Mexico; (G.N.R.); (A.P.d.L.); (M.A.)
| | - Augusto Pérez Gómez
- Corporación Nuevos Rumbos, Calle 108 A # 4-15, Bogota 110111, Colombia; (A.P.G.); (J.M.T.)
| | - Juliana Mejía Trujillo
- Corporación Nuevos Rumbos, Calle 108 A # 4-15, Bogota 110111, Colombia; (A.P.G.); (J.M.T.)
| | - Inés Bustamante
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, Urb Ingeniería, Lima 15102, Peru; (I.B.); (M.P.)
| | - Marina Piazza
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, Urb Ingeniería, Lima 15102, Peru; (I.B.); (M.P.)
| | - Alejandra Pérez de León
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Calz México-Xochimilco 101, Huipulco, Mexico City 14370, Mexico; (G.N.R.); (A.P.d.L.); (M.A.)
| | - Miriam Arroyo
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Calz México-Xochimilco 101, Huipulco, Mexico City 14370, Mexico; (G.N.R.); (A.P.d.L.); (M.A.)
| | - Hein de Vries
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, P. Debyeplein 1, 6229HA Maastricht, The Netherlands; (P.A.); (L.M.); (E.J.L.); (H.d.V.)
| | - Jürgen Rehm
- Institute for Clinical Psychology and Psychotherapy, TU Dresden, Chemnitzer Str. 46, 01187 Dresden, Germany; (J.M.); (J.R.)
- Institute for Mental Health Policy Research, CAMH, 33 Russell Street, Toronto, ON M5S 2S1, Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th Floor, Toronto, ON M5T 3M7, Canada
- Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, ON M5T 1R8, Canada
- Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Trubetskaya Str., 8, b. 2, 119992 Moscow, Russia
| | - Silvia Evers
- Department of Health Services Research CAPHRI Care, Public Health Research Institute, Maastricht University, POB 616, 6200MD Maastricht, The Netherlands;
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