Health-care professionals' attitudes across different hospital departments regarding alcohol-related presentations

Navigating challenges and opportunities: perspectives on digital service development in substance use disorder treatment

BACKGROUND

Some people with substance use disorders (SUD) can experience multiple co-occurring social problems. Digital solutions have been developed to support effective and cost-effective social welfare and healthcare in addictions treatment. Given the varying severity of problems from alcohol and other drug use, digital service tools can save money and provide tailored care.

OBJECTIVE

In this study we aimed to understand the perspectives of those who develop digital service tools on people with SUD and treatment encounters. As a case, we interviewed those who have been involved in the development of a digital client segmentation tool The Navigator.

METHODS

Ten (N = 10) semi-structured interviews were conducted with professionals involved in digital client segmentation tool development and were analysed with inductive content analysis. Participants were asked about the development of the Navigator from the perspectives of their own role as developers, the clients, the effectiveness of the services, and decision-making processes.

FINDINGS

Some people with SUD may face several obstacles when using digital services. Digital divide, feared or experienced stigma and biased attitudes, complex life situations, and difficulties in committing to treatment were identified as challenges. Nevertheless, digital solutions can offer the clients alternative ways of using the services that can better meet their individual needs. The anonymity and facelessness of digital solutions can reduce the fear of immediate judgement. Implementing digital solutions in substance use work poses challenges due to chronic staff shortages. Digitalisation often results in the creation of multiple simultaneously managed channels, potentially reducing time-consumption but increasing the perceived workload. There is a call for multi-professionalism, acknowledging inequalities between various disciplines within the field.

Understanding Nurse Perceptions of Caring for Patients With Alcohol Use Disorder: A Cross-Sectional Study

BACKGROUND

Alcohol use disorder (AUD), the problematic consumption of alcohol, affects 107 million people worldwide. Individuals with AUD experience high morbidity and increased mortality. Nurses practicing in acute care are ideally positioned to deliver quality interventions to patients with AUD, including screening and brief intervention; formal training and assessment of baseline knowledge, attitudes, and perceptions are necessary.

AIMS AND OBJECTIVES

The aim of this study was to explore the knowledge, attitudes, and perceptions of acute care nurses caring for patients with AUD.

DESIGN

This study used a cross-sectional survey design.

METHODS

The Survey of Attitudes and Perceptions was completed by 93 nurses working in six acute care centers (seven medicine units) across Alberta. Data were analyzed using descriptive and inferential statistics.

RESULTS

Few participants reported receiving any prior structured training on AUD, with the majority reporting limited knowledge of alcohol and the effects of alcohol consumption. Although most participants said that caring for patients with AUD was a part of their professional role, few felt satisfied or motivated to work with this group of patients. Responses to individual questions or subdomains of the survey did not significantly differ by length of time in professional role, employment status, or sex.

CONCLUSION

Our results indicate that nurses need to learn more about caring for patients with AUD. Developing tailored educational interventions that are mindful of the importance of knowledge, support, satisfaction, and motivation is necessary to improve the quality of care for patients with AUD.

Exploring Lithuanian social workers' attitudes towards individuals with alcohol usage problems

Aim: Social workers are at the front line of helping individuals experiencing alcohol usage, due to their professional duties, ideology and values that underpin it. In Lithuania, where social work still continues to develop in both practice and education, it is crucial to supplement with relevant information to strengthen social work's response to issues with alcohol usage. Therefore, the aim of this study was to explore social workers' attitudes towards individuals with alcohol usage problems. Methods: In total, 149 Lithuanian social workers completed a web survey that gathered information about education, work experience and workplace, and filled in the Short Alcohol and Alcohol Problems Perception Questionnaire (SAAPPQ) to measure their attitude towards individuals with alcohol usage problems. Results: The social workers showed a positive attitude towards individuals with alcohol usage problems (mean 35.81 [SD 4.8]). Attitude domain analysis revealed Role Legitimacy (91.3% above the midpoint) to reflect the most positive attitudes and Work Satisfaction (24.2% above the midpoint) to reflect the least positive attitudes. Those with master's degrees scored higher on the total SAAPPQ (t = -2.44, p = 0.016) and its subscales Work Satisfaction (t = -2.52, p = 0.013) and Therapeutic Commitment (t = -2.21, p = 0.029). Having 6-13 years of work experience (mean SAAPPQ = 37.02 [SD 5.11]) was associated with a more positive attitude compared to those with less than 5 years of experience (mean SAAPPQ = 34.08 [SD 3.87]). Conclusion: Although social workers understand their professional responsibility to work with individuals with alcohol usage problems, their dedication to work, motivation and task-specific self-esteem are low. The results also support education, as those with master's degrees showed more positive attitudes. This study further encourages support for social workers just beginning their career, who might report lower attitudes towards individuals with alcohol usage problems.

Validation of the Nurses' Skills to Care for Alcohol-Intoxicated Patients in Emergency Department (NSCAIP-ED) instrument

Aim To report the development and validation of the Nurses' Skills to Care for Alcohol-Intoxicated Patients in Emergency Department instrument, shortened NSCAIP-ED. Methods: A mixed-methods design was used to develop the instrument. It was used to conduct a survey where ED nurses self-evaluated their skills to care for acutely ill alcohol-intoxicated patients (N = 1220, n = 252). The data were utilised to perform instrument validation using confirmatory factor analysis (CFA) and Cronbach's alpha. Results: The construct validity was tested statistically. The CFA model fit indicators showed mostly acceptable fit (chi-square test p < 0.001; RMSEA 0.079; CFI 0.923; TLI 0.918; SRMR 0.084) and instruments' scales had well acceptable Cronbach's alpha values (all alphas were in the range of 0.866-0.912). Conclusions: The NSCAIP-ED is a feasible and reliable instrument that can be used when measuring nurses' skills to care for alcohol-intoxicated patients in the ED. This instrument could be useful for nursing managers in EDs for evaluating their nursing staff's skills in the care area in question, but also for designing continuing education based on the results.

Stigmatization of people with addiction by health professionals: Current knowledge. A scoping review

Background

Stigma of people with substance and non-substance use disorders (SNSUD) is a long-known phenomenon. The aim of this review was to assess the stigmatization, by health professionals, of people with SNSUD, its characteristics and change over time.

Methods

A scoping review of literature reviews was conducted with systematic search of PubMed, Scopus and PsycINFO databases.

Results

From the 19 selected reviews, all focused on people with SUD (PWSUD) only and 20 % to 51 % of health professionals had negative attitudes/beliefs about SUD. Addiction training and clinical experience with PWSUD were associated with a less negative attitude. Health professionals' negative beliefs, lack of time or support were associated with less involvement in addiction care. Tobacco use disorder, SUDs other than alcohol and tobacco, relapse, psychiatric comorbidity or criminal records were associated with a more negative attitude. The influence of several variables potentially related to stigmatization was inconsistent across selected reviews. The evolution of stigmatization over time was not systematically assessed and showed mixed results.

Conclusions

The stigmatization of PWSUD has an impact on their care, and a change in some variables could reduce its importance: moral model of addiction, health professionals' negative beliefs, lack of training, time, and role support. Teaching what addiction is according to the medical chronic disease model, and developing stigma-focused training could improve caregivers' attitudes and further reduce stigma. Further studies are needed to determine whether stigma of PWSUD by health professionals has changed over time and to characterize stigma for people with non-substance use disorders.

Integrated nursing care for people with combined mental health and substance use disorders

Many health problems arise from mental, neurological, and substance use disorders. These disorders are highly prevalent and complex and contribute to poor health outcomes, premature mortality, security risk, social isolation, and global and national economic loss. Mental health and substance use disorders are among Australia's top four causes of disease burden. Our objective was to investigate and synthesize contemporary literature regarding factors that influence nurses' delivery of integrated care to people with combined mental health and substance use disorders within mental health services. We systematically searched five electronic databases with a limit on publications from 2009 to 2021. The search yielded 26 articles. Following thematic analysis, three themes were identified: individual nursing characteristics, nursing education, and professional development characteristics, and organizational factors. This study reveals that there is a fundamental absence of adequate integrative models of care within mental health services to enable the optimal nursing care of people with combined mental health and substance use disorders. Future research is needed to determine nurses' perceptions and factors influencing their role as participants in integrative care. The results could strengthen nurses' contributions in developing/adopting integrative models of care and contribute to clinical, educational, and organizational development.

Do health professionals' attitudes towards alcohol use matter for alcohol prevention efforts? Results from the WIRUS-OHS study

BACKGROUND

Use of alcohol is a major public health issue, representing the 7^th largest burden of disease in the world. Workplaces offer a unique arena for health initiatives addressing alcohol use, where occupational health services (OHS) personnel play an important role. However, we do not know if the extent of such initiatives may be influenced by personal drinking attitudes among OHS personnel. Thus, the aim of the study was to explore how drinking attitudes among OHS personnel were associated with their frequency of working with alcohol-related cases and with their views on alcohol prevention activities in the OHS.

METHODS

The WIRUS project included a cross-sectional survey of attitudes and practices among OHS personnel (n = 325) employed by Norwegian OHS services (n = 69), who informed about sociodemographic and professional characteristics, drinking attitudes, frequency of cases with alcohol-related issues, and perceptions toward the role of the OHS in primary, secondary, and tertiary alcohol prevention activities. Measures of associations were examined with linear and logistic regression models.

RESULTS

Drinking attitudes were unrelated to the frequency of working with alcohol-related cases. Physicians, psychologists, and nurses had higher frequency of working with alcohol-related cases, compared to those with other professional backgrounds (β = 0.46, p = 0.01). Drinking attitudes were also unrelated to attitudes towards primary/secondary/tertiary alcohol prevention activities in the OHS, while female OHS personnel were more positive towards increased primary alcohol prevention activities in the OHS (OR: 1.82, p < 0.05). Only marginal portions (1%-3%) of the variance in attitudes towards alcohol prevention activities in the OHS were accounted for by the models.

CONCLUSION

This study did not find evidence of associations between OHS personnel's drinking attitudes and their practices and attitudes towards alcohol prevention activities. The lack of association between OHS personnel's attitudes towards alcohol use and their attitudes and practices relating to alcohol prevention in the workplace might point towards professionalism, as personal attitudes appear not to interfere with their priorities and professional mission. Given the small amount of outcome variance explained by the tested models, other variables should be used in future studies.

Examining the Attitudes of Non-Psychiatric Practicing Healthcare Workers Towards Patients With Alcohol Problems in General Hospital Setting

BACKGROUND AND OBJECTIVES

Problematic alcohol-use affect the physical and mental well-being of hospitalised individuals and may receive screening and brief-intervention during treatment. Non-psychiatric doctors and nurses might respond inadequately due to negative attitudes and beliefs. This study aimed to examine these attitudes of non-psychiatric workers in the medical and surgical wards.

METHODS

A total of 457 doctors and 1643 nurses were recruited from the medical, surgical and orthopaedic disciplines over a period of 4 months. Three questionnaires were administered: demographics, Alcohol & Alcohol-Problems Perceptions Questionnaire (AAPPQ) and Staff Perception of Alcohol Treatment Resources.

RESULTS

About 128 doctors and 785 nurses responded. Around 75.5% doctors and 51.9% nurses endorsed role-legitimacy in the AAPPQ. Both the doctor (86.7%) and nurse (77.6%) groups agreed on the importance to initiate intervention for patients with problematic alcohol-use in daily work. Both groups were sceptical and negative towards these patients endorsing low-level role-adequacy (41.2%), role-support (36.9%), motivation (36.5%), task-specific self-esteem (25.1) as well as work satisfaction (20.5%).

CONCLUSION/DISCUSSION

Doctors and nurses demonstrated low levels of therapeutic commitments towards patients with problematic alcohol-use thereby necessitating the introduction of in-house programmes to educate, empower and emphasise the importance of therapeutic contact with patients for alcohol intervention.

SCIENTIFIC SIGNIFICANCE

The prompt identification and treatment of patients with alcohol problems are contingent on the workers' attitudes towards them. This study's results should spark a nation-wide interest to improve the training and recognition of such patients and providing adequate educational resources.

Undergraduate nursing student knowledge and attitudes of healthcare consumers with problematic alcohol and other drug use: A scoping review

Problematic alcohol and other drug use has a significant societal, personal, and financial burden. Nurses are key in responding to problematic alcohol and other drug use; however, research indicates many nurses hold negative attitudes towards people with substance and alcohol use disorders. Further, little content exists in most undergraduate degrees to address stigma held by new nurses. The objective of this scoping review, structured using Arksey and O'Malley's (International Journal of Social Research Methodology: Theory and Practice, 8 (1), 19-32, 2005) framework, is to examine studies that either explore or attempt to improve the knowledge and attitudes of undergraduate nurses caring for people who use alcohol and other drugs. Our initial search located 610 articles, and after screening, 14 articles were appraised using the Mixed Methods Appraisal Tool (MMAT) and included in this review. Most of the papers appraised were small, localized studies using evaluation methods considered low quality, but showed promising results in addressing stigma and confidence in providing care to people who use alcohol and other drugs. This review indicates that a consistent direction for improving knowledge and attitudes among undergraduate nursing students working with people who use alcohol and other drugs is urgently needed. Further studies of interventions, tested with more rigorous evaluation methodologies, are required to extend existing work in this area.

Health Professionals' Attitudes Toward Alcoholism and Associated Issues: A Comparative Study in a Brazilian Sample

Attitudes of health professionals have an effect on the quality of care provided to individuals with alcohol use disorders. The identification of health professionals' attitudes supports strategies that promote positive attitudes and improve the quality of the health care provided to this population. This is a descriptive cross-sectional study with 831 health professionals. Data were collected using the scale of attitudes toward alcohol, alcohol use disorder, and individuals with alcohol use disorders. Pearson test, Analysis of Variance, and Bayesian linear regression were used to analyze the data. There was a predominance of positive attitudes among all professional categories, with the exception of attitudes toward the etiology of alcohol use disorder and attitudes toward alcoholic beverages and their use. The respondent's age and professional category influenced his or her attitudes toward alcohol and associated issues. There are differences in the attitudes of professionals from different professional groups, which may contribute to inconsistencies in the care provided for individuals with alcohol use disorders. The results of our study suggest that strategies regarding the training and continuing education of health professionals that consider the particularities of each profession be instituted to improve professionals' attitudes, thus improving their ability to address issues related to alcohol use disorders and encourage alcoholic patients to engage in treatment.

The Care of the Patients With Alcohol Intoxication in the Emergency Department of a Central Hospital: Nurses' Skills, Knowledge, and Attitudes

AIM

The aim of the study was to describe nurses' skills, knowledge of care, and attitudes toward the care of patients with alcohol intoxication in the emergency department.

METHOD

The data were collected using theme interviews in 2016. The study participants were nurses working in the emergency department (n = 6) that has a sobering unit. The data were analyzed using inductive content analysis.

RESULTS

On the basis of the interviewees' descriptions, five main categories were formed: the skills to discuss the use of alcohol on arrival, safety skills, teamwork skills, the skills to organize follow-up care, and nurses' attitudes and ethics in patients' care. Asking about the use of alcohol as well as the use of a screening tool varied. The interviewees emphasized the skills to anticipate the risk of violence as well as ensuring the safety of the working environment. Nurses' attitudes were seen as the ability to regulate negative emotions raised by the patient. Factors related to nurses' attitudes emerged in patients' behavioral disorders and commitment to treatment. Despite some negative feelings toward patients, nurses thought that it is important to ensure ethicality in patients' care.

CONCLUSIONS

The nurses' skills and knowledge of care and attitudes toward patients with alcohol intoxication varied. There is a need for additional training on issues relating to the treatment of patients with alcohol intoxication.

Assessing the impact of computerised and written advice in changing the habit and behaviour of alcohol use in patients who have suffered alcohol-related facial injuries-a pilot study

PURPOSE

Alcohol screening and a brief intervention (SBI) can be effective in changing harmful drinking behaviour and reducing the chance of future alcohol-related traumas. However, there is no standardised method in its application. This study aims to deliver a novel method of SBI to patients with alcohol-related facial fractures and to assess changes in their alcohol intake and attitudes to drinking following this intervention.

METHODS

Twenty consecutive patients at two Victorian Hospitals were consented to undergo a novel SBI program. This study analysed the results of the initial survey and the follow-up survey completed at least 3 months later.

RESULTS

Of the 20 patients recruited for the initial survey, 18 returned for the follow-up (90% response rate). All patients were males, 50% were aged between 18 and 29 years, 61% involved in interpersonal violence, 56% sustained mandibular fractures and 89% underwent surgery. The alcohol risk score increased in the follow-up survey; however, the relationship is not statistically significant. A high proportion of the patients were still unaware of their risk. Patients showed greater awareness of their drinking and willingness to accept help and more readiness to accept written advice rather than computerised materials.

CONCLUSION

This study found a high rate of acceptance among trauma patients to the intervention program. Although there was no significant change in the risk scores between the initial and follow-up surveys, certain subgroup was more amenable to the intervention given. There is generally an improvement in the attitudes towards and knowledge of harmful drinking.

Providing physical health care for people accessing mental health services: Clinicians' perceptions of their role

The prevalence of health risk behaviours and associated poor physical health is high in people with severe mental illness. Mental health service guidelines and policies stipulate that mental health services should address physical health of people who access services. This study reports results from a large, interdisciplinary, cross-sectional study exploring mental health clinicians' (n = 385) views of role legitimacy in physical health service provision. All disciplines reported that mental health clinicians have a role to play in addressing the physical health of consumers. Among mental health clinicians, psychiatrists and mental health nurses received higher endorsement than allied health clinicians in relation to the provision of physical health care, with primary care providers including general practitioners also ranking highly. As community mental health services routinely appoint allied health staff to case management roles, a challenge for services and a challenge for clinicians are to ensure that physical health and the effects of medication are monitored appropriately and systematically. Online and telephone support services received relatively lower endorsement. As the availability of nonface to face services increases, there is a need to explore their utility in this population and where appropriate promote their uptake.

Emergency clinicians' perceived self-efficacy in the care of intoxicated women victims of violence

BACKGROUND

Previous research has identified perceived self-efficacy to be a vital component of clinicians' positive attitudes towards caring for intoxicated patients and women who have been assaulted. To date, little is known about the perceived self-efficacy and influences among emergency clinicians towards intoxicated women victims of violence.

METHOD

Using mixed methods, 179 emergency clinicians were surveyed and 22 emergency clinicians were interviewed in South Australia about their education/training, their awareness and use of best practice guidelines and tools, and their perceived self-efficacy toward treating intoxicated women victims of violence.

FINDINGS

There were statistically significant relationships between use of best practice tools (n = 32) and knowledge (χ² = 6.52; p = .02) and confidence (χ² = 6.52; p = .02) treating women victims of violence. There were also statistically significant relationships between previous alcohol and other drug education/training and knowledge (n = 43), skills and confidence treating both intoxicated patients (χ² = 7.85; p = .01) and women victims of violence (χ² = 11.63; p < .01). The interviews identified four themes about confidence, knowledge and use of research evidence, education and training, and resources.

CONCLUSION

Emergency clinicians reported low levels of perceived self-efficacy, and infrequent use of guidelines and tools to support the care of intoxicated women victims of violence. Participants wanted more knowledge and education/training in caring for intoxicated women who have been assaulted, as they felt lacking in these skills.

Scale of attitudes toward alcohol - Spanish version: evidences of validity and reliability

Objective:

validate the Scale of attitudes toward alcohol, alcoholism and individuals with alcohol use disorders in its Spanish version.

Method:

methodological study, involving 300 Colombian nurses. Adopting the classical theory, confirmatory factor analysis was applied without prior examination, based on the strong historical evidence of the factorial structure of the original scale to determine the construct validity of this Spanish version. To assess the reliability, Cronbach’s Alpha and Mc Donalid’s Omega coefficients were used.

Results:

the confirmatory factor analysis indicated the good fit of the scale model in a four-factor distribution, with a cut-off point at 3.2, demonstrating 66.7% of sensitivity.

Conclusions:

the Scale of attitudes toward alcohol, alcoholism and individuals with alcohol use disorders in Spanish presented robust psychometric qualities, affirming that the instrument possesses a solid factorial structure and reliability and is capable of precisely measuring the nurses’ atittudes towards the phenomenon proposed.

Overcoming professionals' challenging experiences to promote a trustful therapeutic alliance in addiction treatment: A qualitative study

BACKGROUND AND AIMS

A good therapeutic alliance plays a major role in the healing process. Professionals working in addiction treatment report high levels of psychological distress related to work and this may challenge the establishment of a trustful therapeutic alliance, and lead to a loss of care quality provided to service users. The purpose of this study was to investigate the experience of specialized professionals, its effects on trust and the therapeutic alliance, and the means to restore them.

DESIGN

We conducted a qualitative study using a semi-structured questionnaire and a narrative tool. Discourse was extracted from focus groups and individual interviews and analyzed following the Interpretative Phenomenological Analysis method.

PARTICIPANTS

Twenty-six professionals from three addiction treatment centers in the Paris area were interviewed.

FINDINGS

The difficulties weighing on the care alliance were described by the participants in terms of their nature, their effects and means to overcome them. Emotional drain leads to a climate of relational distrust and the temptation to desert or over-control patients. Teambuilding, specific training and self-care are viewed as means to restore a therapeutic alliance based on an appropriate type of trust.

CONCLUSIONS

Distrust deriving from professionals' challenging experiences may lead to worrying consequences. Promoting democratic organization of care structures, specific training, and also responsible self-care on the part of professionals could help to restore a type of trust that helps to establish a therapeutic alliance suited to service user individualities. This could ultimately be beneficial for user care, professional wellbeing and team functioning.

Spanish version of the scale of attitudes toward alcohol, alcoholism and alcoholics: content validation

ABSTACT Objective: to describe the process of translation and cultural adaptation of the scale of attitudes towards alcohol, alcoholism and alcoholics into the Spanish language. Methods: this was a methodological study, which followed the international guidelines for translation and adaptation of measurement scales. Results: During the process of translation and cultural adaptation of scale of attitudes towards alcohol, alcoholism and alcoholics to the Spanish language, the items were adjusted based on semantic, idiomatic and conceptual equivalence of the expressions contained in the scale of attitudes towards alcohol, alcoholism and alcoholics. Content validation indicated satisfactory validity indexes, with Intraclass Correlation Coefficient (ICC) (0.97), Content Validity Index (CVI) (0.92), and the Prevalence Adjusted Bias Adjusted Kappa (PABAK) (0.80). Conclusion: the scale of attitudes towards alcohol, alcoholism and alcoholics, adapted and translated into the Spanish language, presented content validity with satisfactory indexes, which affirmed that the instrument was adapted for the Colombian context. The next step will be evaluation of its psychometric properties in order to guarantee reliability for its use in Hispanic populations.

[Substance related disorder in emergency services: Which attitudes?]

INTRODUCTION

Substance related disorders are more prevalent in emergency services than in the general population, about 20% of individuals in emergency care test positive for alcohol. Emergency services are strategic places to identify alcohol misuse. Attitudes to individuals presenting substance related disorders are important in developing therapeutic relationships and applying interventions.

OBJECTIVE

This study explores the attitudes of an emergency staff to these individuals across a range of roles, and evolution in face of an addictology care improvement.

METHOD

Data were gathered from an emergency service sample from the emergency department of a general hospital in Morlaix (France). We used a short questionnaire, adapted from previous similar French studies.

RESULTS

Twenty-five persons answered the first questionnaire and 18 the second. A self-administrated attitudes questionnaire showed its interest in our study and helped us to identify attitudes and to initiate a reflection on behaviours in emergency care. Moreover, it helped to change attitudes towards individuals presenting substance related disorders. The daily setting of an addictive disorders specialized unit in emergency changed the point of view on addictive disorders of both physicians and nurses. We showed differences in addictive related disorders prevalence perception among patients attending emergency care between the two evaluations. But we also showed that physicians and nurses stressed that it was more difficult to ask patients in emergency care on the second evaluation, after and despite a daily addictive disorders specialized setting. We showed several limits in emergency staff care relationship with patients with substance related disorders. They identified difficulties to talk about addictive disorders, especially in younger and older patients. Regarding literature, we discuss our study limits and different ways of improving addictology care in emergency services.

Impact of primary healthcare providers' initial role security and therapeutic commitment on implementing brief interventions in managing risky alcohol consumption: a cluster randomised factorial trial

BACKGROUND

Brief interventions in primary healthcare are cost-effective in reducing drinking problems but poorly implemented in routine practice. Although evidence about implementing brief interventions is growing, knowledge is limited with regard to impact of initial role security and therapeutic commitment on brief intervention implementation.

METHODS

In a cluster randomised factorial trial, 120 primary healthcare units (PHCUs) were randomised to eight groups: care as usual, training and support, financial reimbursement, and the opportunity to refer patients to an internet-based brief intervention (e-BI); paired combinations of these three strategies, and all three strategies combined. To explore the impact of initial role security and therapeutic commitment on implementing brief interventions, we performed multilevel linear regression analyses adapted to the factorial design.

RESULTS

Data from 746 providers from 120 PHCUs were included in the analyses. Baseline role security and therapeutic commitment were found not to influence implementation of brief interventions. Furthermore, there were no significant interactions between these characteristics and allocated implementation groups.

CONCLUSIONS

The extent to which providers changed their brief intervention delivery following experience of different implementation strategies was not determined by their initial attitudes towards alcohol problems. In future research, more attention is needed to unravel the causal relation between practitioners' attitudes, their actual behaviour and care improvement strategies to enhance implementation science.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT01501552.