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Nadkarni A, Bhatia U, Bedendo A, de Paula TCS, de Andrade Tostes JG, Segura-Garcia L, Tiburcio M, Andréasson S. Brief interventions for alcohol use disorders in low- and middle-income countries: barriers and potential solutions. Int J Ment Health Syst 2022; 16:36. [PMID: 35934695 PMCID: PMC9358825 DOI: 10.1186/s13033-022-00548-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 07/29/2022] [Indexed: 12/05/2022] Open
Abstract
Global alcohol consumption and harmful use of alcohol is projected to increase in the coming decades, and most of the increase will occur in low- and middle-income countries (LMICs); which calls for cost-effective measures to reduce alcohol exposure in these countries. One such evidence based measure is screening and brief intervention (BI) for alcohol problems. Some of the characteristics of BI make them a particularly appealing choice of interventions in low-resource settings. However, despite evidence of effectiveness, implementation of BI in LMICs is rare. In this paper we discuss barriers to implementation of BI in LMICs, with examples from Latin America and India. Key barriers to implementation of BI in LMICs are the lack of financial and structural resources. Specialized services for alcohol use disorders are limited or non-existent. Hence primary care is often the only possible alternative to implement BI. However, health professionals in such settings generally lack training to deal with these disorders. In our review of BI research in these countries, we find some promising results, primarily in countries from Latin America, but so far there is limited research on effectiveness. Appropriate evaluation of efficacy and effectiveness of BI is undermined by lack of generalisability and methodological limitations. No systematic and scientific efforts to explore the implementation and evaluation of BI in primary and community platforms of care have been published in India. Innovative strategies need to be deployed to overcome supply side barriers related to specialist manpower shortages in LMICs. There is a growing evidence on the effectiveness of non-specialist health workers, including lay counsellors, in delivering frontline psychological interventions for a range of disorders including alcohol use disorders in LMICs. This paper is intended to stimulate discussion among researchers, practitioners and policy-makers in LMICs because increasing access to evidence based care for alcohol use disorders in LMICs would need a concerted effort from all these stakeholders.
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Affiliation(s)
- Abhijit Nadkarni
- Centre for Global Mental Health (CGMH), Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK. .,Addictions Research Group, Sangath, Porvorim, Goa, India.
| | - Urvita Bhatia
- Addictions Research Group, Sangath, Porvorim, Goa, India.,Department of Psychology, Health and Professional Development at Oxford Brookes University, Oxford, UK
| | - Andre Bedendo
- Department of Psychobiology, Universidade Federal de São Paulo (UNIFESP), Sao Paulo, Brazil.,Department of Health Sciences, Faculty of Sciences, University of York, York, UK
| | | | - Joanna Gonçalves de Andrade Tostes
- Center for Research, Intervention and Evaluation on Alcohol & Drugs (CREPEIA), Department of Psychology, Universidade Federal de Juiz de Fora (UFJF), Juiz de Fora, Brazil
| | - Lidia Segura-Garcia
- Program on Substance Abuse, Public Health Agency of Catalonia, Barcelona, Spain.,Clincal Psychology and Health Department, Autonomous University of Barcelona, Barcelona, Spain
| | - Marcela Tiburcio
- Department of Social Sciences in Health, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Sven Andréasson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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McCambridge J. Reimagining brief interventions for alcohol: towards a paradigm fit for the twenty first century? : INEBRIA Nick Heather Lecture 2019: This lecture celebrates the work of Nick Heather in leading thinking in respect of both brief interventions and wider alcohol sciences. Addict Sci Clin Pract 2021; 16:41. [PMID: 34187582 PMCID: PMC8243462 DOI: 10.1186/s13722-021-00250-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 06/14/2021] [Indexed: 11/22/2022] Open
Abstract
Background There is no longer support for the idea that brief intervention programmes alone can contribute meaningfully to the improvement of population health relating to alcohol. As a result, calls for major innovations and paradigm shifts grow, notably among research leaders. This paper briefly examines the history of the development of the evidence-base from the landmark World Health Organisation projects on Screening and Brief Intervention (SBI) in the 1980s onwards. Particular attention is given to weaknesses in the theorisation of social influence and interventions design, and declining effect sizes over time. Although the old SBI paradigm may be exhausted where it has been applied, it has not been replaced by a new paradigm. Alcohol marketing encourages heavy drinking and today may have more powerful effects on thinking about alcohol, and about alcohol problems, than previously. The nature of the societal challenge being faced in an alcogenic environment in which alcohol is widely promoted and weakly regulated underpins consideration of the possibilities for contemporary evidence-informed public health responses. Evidence-informed perspectives in discourses on alcohol problems need to be strengthened in redeveloping rationales for brief interventions. This process needs to move away from sole reliance on a model based on a two-person discussion of alcohol, which is divorced from wider concerns the person may have. Reimagining the nature of brief interventions involves incorporating digital content, emphasising meso-level social processes based on material that people want to share, and seeking synergies with macro-level population and media issues, including alcohol policy measures. Conclusions Current versions of brief interventions may be simply too weak to contend with the pressures of an alcogenic environment. A new generation of brief interventions could have a key role to play in developing multi-level responses to the problems caused by alcohol.
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Affiliation(s)
- Jim McCambridge
- Department of Health Sciences, Seebohm Rowntree Building, University of York, Heslington, York, YO10 5DD, UK.
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Madden M, Morris S, Ogden M, Lewis D, Stewart D, O'Carroll RE, McCambridge J. Introducing alcohol as a drug in medicine reviews with pharmacists: Findings from a co-design workshop with patients. Drug Alcohol Rev 2021; 40:1028-1036. [PMID: 33648016 DOI: 10.1111/dar.13255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 11/13/2020] [Accepted: 01/01/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Alcohol poses a range of potential problems to people taking medications, but health professionals are usually not comfortable talking about drinking with patients. The Medicines and Alcohol Consultation aims to increase the capacity of pharmacists to conduct person-centred reviews in which alcohol is regarded as another drug to be discussed alongside medications. This paper explores sensitivities in discussing alcohol and views on the legitimacy of the Medicines and Alcohol Consultation intervention concept at a pharmacy-user intervention co-design workshop. METHODS A co-design workshop was held with 14 people recruited from UK community pharmacies who regularly drank alcohol and took medications for long-term conditions. This formed one element of a broader, iterative, intervention co-production process. Workshop discussions were audio-recorded and analysed thematically. RESULTS The basic intervention concept resonated well, though not entirely unproblematically. Participants were interested in receiving information on how medications interact with alcohol and how this might affect their own conditions, with which to make their own informed choices. Linking alcohol use to medicines gave legitimacy to pharmacists to raise alcohol in medicines reviews. Sensitivity in talking about alcohol was linked to vulnerability to negative judgement. DISCUSSION AND CONCLUSIONS Changing the framing of alcohol in medicines reviews, away from being regarded as a 'lifestyle issue' to being considered a drug directly linked to medicines use, safety and effectiveness, was welcomed by participants in this study.
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Affiliation(s)
- Mary Madden
- Department of Health Sciences, University of York, York, UK
| | | | - Margaret Ogden
- Department of Health Sciences, University of York, York, UK
| | - David Lewis
- Department of Health Sciences, University of York, York, UK
| | - Duncan Stewart
- Department of Health Sciences, University of York, York, UK
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Nadkarni A, Costa S, Gupta D, Fernandes D, Catalano A, Velleman R, Sambari S, Pednekar S, Hussain F, D'Souza E, Houde A, Chaudhuri N, Heath A. The systematic development of a mobile phone-delivered brief intervention for hazardous drinking in India. J Subst Abuse Treat 2021; 126:108331. [PMID: 34116809 DOI: 10.1016/j.jsat.2021.108331] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 12/29/2020] [Accepted: 02/04/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND The treatment gap for alcohol use disorders (AUD) in India is the highest among all mental health and substance use disorders. Despite evidence of the cost effectiveness of brief interventions (BIs) for hazardous drinking, implementation in low- and middle-income countries (LMICs) is rare due to several human resource-related barriers. This paper describes the processes and outputs of a study aimed at systematically developing a mobile phone-delivered BI to overcome such barriers. METHODS This is a mixed methods study with four steps: (1) Review of existing relevant evidence base by extracting data from studies cited in two recent, relevant and high-quality systematic reviews; (2) In-depth interviews (IDIs) with 11 national experts in addictions research and practice, and 22 hazardous drinkers; (3) Delphi survey (2 rounds) to identify components for the intervention package through consensus building; and (4) Content and intervention development workshops with a range of stakeholders to develop the intervention package. RESULTS The research team sourced 72 journal articles from two selected systematic reviews. Key content areas extracted from the studies included facts and statistics about health related to drinking behavior, self-reflection, goal-setting messages, motivational messages, and skills to manage risky situations. The IDIs with experts and hazardous drinkers endorsed most of these content areas as well. The Delphi survey achieved consensus on 19 content areas, which included targeted recommendations, personalized feedback and information, goal management, and coping skills. The content and intervention development workshops resulted in an intervention package delivered over 8 weeks, with the following seven themes guiding the content of the weekly messages: safe drinking/health education, alcohol reduction, drinking and risk management, drinking alternatives, situational content, urge management, and maintenance and relapse prevention. CONCLUSION The research team designed this study to consider contextual factors while developing the intervention, which is important to ensure acceptability and feasibility of the intervention. Interestingly, the contextually informed intervention components had several commonalities with BIs developed and tested in high-income countries.
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Affiliation(s)
- Abhijit Nadkarni
- Centre for Global Mental Health, Department of Population Health, London School of Hygiene and Tropical Medicine, UK; Addictions Research Group, Sangath, H No 451 (168), Bhatkar Waddo, Socorro, Bardez, Porvorim, Goa 403501, India.
| | - Sheina Costa
- Addictions Research Group, Sangath, H No 451 (168), Bhatkar Waddo, Socorro, Bardez, Porvorim, Goa 403501, India
| | - Devika Gupta
- Addictions Research Group, Sangath, H No 451 (168), Bhatkar Waddo, Socorro, Bardez, Porvorim, Goa 403501, India
| | - Danielle Fernandes
- Addictions Research Group, Sangath, H No 451 (168), Bhatkar Waddo, Socorro, Bardez, Porvorim, Goa 403501, India
| | - Alexander Catalano
- Addictions Research Group, Sangath, H No 451 (168), Bhatkar Waddo, Socorro, Bardez, Porvorim, Goa 403501, India; Columbia University, New York, USA
| | - Richard Velleman
- Addictions Research Group, Sangath, H No 451 (168), Bhatkar Waddo, Socorro, Bardez, Porvorim, Goa 403501, India; Department of Psychology, University of Bath, UK
| | - Seema Sambari
- Addictions Research Group, Sangath, H No 451 (168), Bhatkar Waddo, Socorro, Bardez, Porvorim, Goa 403501, India
| | - Subhash Pednekar
- Addictions Research Group, Sangath, H No 451 (168), Bhatkar Waddo, Socorro, Bardez, Porvorim, Goa 403501, India
| | - Farah Hussain
- Addictions Research Group, Sangath, H No 451 (168), Bhatkar Waddo, Socorro, Bardez, Porvorim, Goa 403501, India; Columbia University, New York, USA
| | - Ethel D'Souza
- Addictions Research Group, Sangath, H No 451 (168), Bhatkar Waddo, Socorro, Bardez, Porvorim, Goa 403501, India
| | - Amruta Houde
- Addictions Research Group, Sangath, H No 451 (168), Bhatkar Waddo, Socorro, Bardez, Porvorim, Goa 403501, India; Columbia University, New York, USA
| | - Neal Chaudhuri
- Addictions Research Group, Sangath, H No 451 (168), Bhatkar Waddo, Socorro, Bardez, Porvorim, Goa 403501, India
| | - Anna Heath
- Addictions Research Group, Sangath, H No 451 (168), Bhatkar Waddo, Socorro, Bardez, Porvorim, Goa 403501, India; Tees, Esk and Wear NHS Foundation Trust, UK
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Stewart D, van Dongen A, Watson M, Mandefield L, Atkin K, Dhital R, Foster B, Gough B, Hewitt C, Madden M, Morris S, O'Carroll R, Ogden M, Parrott S, Watson J, White S, Whittlesea C, McCambridge J. A pilot cluster randomised trial of the medicines and alcohol consultation (MAC): an intervention to discuss alcohol use in community pharmacy medicine review services. BMC Health Serv Res 2020; 20:943. [PMID: 33046094 PMCID: PMC7552554 DOI: 10.1186/s12913-020-05797-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 10/02/2020] [Indexed: 01/24/2023] Open
Abstract
Background Alcohol interventions are important to the developing public health role of community pharmacies. The Medicines and Alcohol Consultation (MAC) is a new intervention, co-produced with community pharmacists (CPs) and patients, which involves a CP practice development programme designed to integrate discussion of alcohol within existing NHS medicine review services. We conducted a pilot trial of the MAC and its delivery to investigate all study procedures to inform progression to a definitive trial. Methods This cluster pilot RCT was conducted in 10 community pharmacies in Yorkshire, UK, with a CP from each who regularly conducted Medicine Use Review (MUR) and New Medicine Service (NMS) consultations. Randomisation was conducted using a secure remote randomisation service. Intervention CPs (n = 5) were trained to deliver the MAC in MUR/NMS consultations. Control CPs (n = 5) provided these services as usual. Consecutive MUR/NMS patients were asked by CPs to participate, screened for eligibility (consumption of alcohol at least twice per week), and baseline data collected for those eligible. A two-month follow-up telephone interview was conducted. Blinding of CPs was not possible, but patients were blinded to the alcohol focus of the trial. Primary outcomes were total weekly UK units (8 g of ethanol per unit) of alcohol consumption in the week prior to follow-up, and confidence in medications management. Trial procedures were assessed by recruitment, attrition, and follow-up rates. Results 260 patients were approached by CPs to take part in the trial, 68% (n = 178) were assessed for eligibility and 30% (n = 54) of these patients were eligible. Almost all eligible patients (n = 51; 94%) consented to participate, of whom 92% (n = 47) were followed-up at 2 months; alcohol consumption was lower in the intervention arm and confidence in medication management reduced slightly for both groups. Exploration of recall issues at follow-up showed a high level of agreement between a two-item quantity/frequency measure and 7-day guided recall of alcohol consumption. Conclusions The pilot trial demonstrates the feasibility of implementing the MAC in community pharmacy and trial recruitment and data collection procedures. However, decommissioning of MURs means that it is not possible to conduct a definitive trial of the intervention in this service. Trial registration ISRCTN57447996
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Affiliation(s)
- Duncan Stewart
- Department of Health Sciences, University of York, York, UK.
| | | | | | | | - Karl Atkin
- Department of Health Sciences, University of York, York, UK
| | - Ranjita Dhital
- Department of Pharmacy, University of Reading, Reading, UK
| | | | - Brendan Gough
- School of Social Sciences, Leeds Beckett University, Leeds, UK
| | | | - Mary Madden
- Department of Health Sciences, University of York, York, UK
| | | | | | - Margaret Ogden
- Department of Health Sciences, University of York, York, UK
| | - Steve Parrott
- Department of Health Sciences, University of York, York, UK
| | - Judith Watson
- Department of Health Sciences, University of York, York, UK
| | - Sue White
- North of England Commissioning Support (NECS), Newcastle, UK
| | - Cate Whittlesea
- UCL School of Pharmacy, University College London, London, UK
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6
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Crombie IK, Irvine L, Williams B, Sniehotta FF, Petrie DJ, Jones C, Norrie J, Evans JMM, Emslie C, Rice PM, Slane PW, Humphris G, Ricketts IW, Melson AJ, Donnan PT, McKenzie A, Huang L, Achison M. Text message intervention to reduce frequency of binge drinking among disadvantaged men: the TRAM RCT. PUBLIC HEALTH RESEARCH 2018. [DOI: 10.3310/phr06060] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Socially disadvantaged men are more likely to binge drink frequently and to experience high levels of alcohol-related harm.
Objectives
To test the effectiveness and cost-effectiveness of a text message intervention in reducing the frequency of binge drinking among disadvantaged men.
Study design
A four-centre, parallel-group, pragmatic, individually randomised controlled trial was conducted. Randomisation was carried out using a secure remote web-based system. It was stratified by participating centre and recruitment method and restricted using block sizes of randomly varying lengths.
Setting
The study was conducted in the community. Members of the public helped to develop the study methods.
Participants
Participants were men aged 25–44 years who had ≥ 2 episodes of binge drinking (> 8 units of alcohol in a single session) in the preceding 28 days. Men were recruited from areas of high deprivation.
Interventions
An empirically and theoretically based text message intervention was delivered by 112 interactive text messages over a 12-week period. The control group received an attentional control comprising 89 text messages on general health.
Primary outcome measure
The primary outcome measure was the proportion of men consuming > 8 units of alcohol on ≥ 3 occasions (in the previous 28 days) at 12 months post intervention.
Results
The recruitment target of 798 was exceeded and 825 men were randomised. Retention was high and similar in the intervention (84.9%) and control (86.5%) groups. Most men in the intervention group engaged enthusiastically with the text messages: almost all (92%) replied to text messages and over two-thirds (67%) replied more than 10 times. The intervention was estimated to have had a modest, statistically non-significant effect on the primary outcome at the 12-month follow-up [odds ratio 0.79, 95% confidence interval (CI) 0.57 to 1.08]. This corresponds to a net reduction of 5.7% in regular binge drinking. Five secondary outcomes showed small non-significant and inconsistent effects on alcohol consumption, with one suggesting a positive effect and four suggesting an adverse effect. Both the short- and the long-term cost per quality-adjusted life-year (QALY) analysis suggested that the brief intervention was dominated by a ‘do-nothing’ option. The intervention’s impacts on patterns of alcohol consumption, QALYs and downstream costs were inconsistent and uncertain.
Limitations
The study used an active control that, combined with the recruitment procedures and baseline assessments, could have biased the treatment effect towards the null. The measurement of alcohol consumption relied on self-reported drinking.
Conclusions
The trial has demonstrated that it is possible to recruit and retain large numbers of socially disadvantaged men in a research study. The text messages delivered a complex theoretically and empirically based intervention that fostered enthusiastic engagement with the key components of the behaviour change sequence. The intervention produced a modest, statistically non-significant effect on the primary outcome, with wide CIs. Further research is needed to reduce uncertainty about the treatment effect. The methods developed for this study provide a platform for the design and testing of interventions to reduce inequalities in health.
Future work
A future trial could reduce the uncertainty around the treatment effect of the intervention.
Trial registration
Current Controlled Trials ISRCTN07695192.
Funding
This study was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 6, No. 6. See NIHR Journals Library website for further information.
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Affiliation(s)
- Iain K Crombie
- Division of Population Health Sciences, School of Medicine, University of Dundee, Dundee, UK
| | - Linda Irvine
- Division of Population Health Sciences, School of Medicine, University of Dundee, Dundee, UK
| | - Brian Williams
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Falko F Sniehotta
- Institute of Health and Society, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Dennis J Petrie
- Centre for Health Economics, Monash Business School, Monash University, Melbourne, VIC, Australia
| | - Claire Jones
- Health Informatics Centre, University of Dundee, Dundee, UK
| | - John Norrie
- Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, UK
| | - Josie MM Evans
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Carol Emslie
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Peter M Rice
- Division of Neuroscience, School of Medicine, University of Dundee, Dundee, UK
| | - Peter W Slane
- Erskine Practice, Arthurstone Medical Centre, Dundee, UK
| | - Gerry Humphris
- School of Medicine, Medical and Biological Sciences, University of St Andrews, St Andrews, UK
| | | | - Ambrose J Melson
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Peter T Donnan
- Division of Population Health Sciences, School of Medicine, University of Dundee, Dundee, UK
| | - Andrew McKenzie
- Division of Population Health Sciences, School of Medicine, University of Dundee, Dundee, UK
| | - Li Huang
- Centre for Health Policy, School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Marcus Achison
- Division of Population Health Sciences, School of Medicine, University of Dundee, Dundee, UK
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7
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Stead M, Parkes T, Nicoll A, Wilson S, Burgess C, Eadie D, Fitzgerald N, McKell J, Reid G, Jepson R, McAteer J, Bauld L. Delivery of alcohol brief interventions in community-based youth work settings: exploring feasibility and acceptability in a qualitative study. BMC Public Health 2017; 17:357. [PMID: 28438195 PMCID: PMC5404319 DOI: 10.1186/s12889-017-4256-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 04/11/2017] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Alcohol Brief Interventions (ABIs) are increasingly being delivered in community-based youth work settings. However, little attention has been paid to how they are being implemented in such settings, or to their feasibility and acceptability for practitioners or young people. The aim of this qualitative study was to explore the context, feasibility and acceptability of ABI delivery in youth work projects across Scotland. METHODS Individual, paired and group interviews were conducted with practitioners and young people in nine community projects that were either involved in the delivery of ABIs or were considering doing so in the near future. A thematic analysis approach was used to analyse data. RESULTS ABIs were delivered in a diverse range of youth work settings including the side of football pitches, on the streets as part of outreach activities, and in sexual health drop-in centres for young people. ABI delivery differed in a number of important ways from delivery in other health settings such as primary care, particularly in being largely opportunistic and flexible in nature. ABIs were adapted by staff in line with the ethos of their project and their own roles, and to avoid jeopardising their relationships with young people. Young people reacted positively to the idea of having conversations about alcohol with youth project workers, but confirmed practitioners' views about the importance of these conversations taking place in the context of an existing trusting relationship. CONCLUSION ABIs were feasible in a range of youth work settings with some adaptation. Acceptability to staff was strongly influenced by perceived benefits, and the extent to which ABIs fitted with their project's ethos. Young people were largely comfortable with such conversations. Future implementation efforts should be based on detailed consideration of current practice and contexts. Flexible models of delivery, where professional judgement can be exercised over defined but adaptable content, may be better appreciated by staff and encourage further development of ABI activity.
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Affiliation(s)
- Martine Stead
- Institute for Social Marketing, Faculty of Health Sciences and Sport, University of Stirling, Stirling, FK9 4LA UK
| | - Tessa Parkes
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, FK9 4LA UK
| | - Avril Nicoll
- Nursing, Midwifery and Allied Health Professions Research Unit, Faculty of Health Sciences and Sport, University of Stirling, Stirling, FK9 4LA UK
| | - Sarah Wilson
- Faculty of Social Science, Colin Bell Building, University of Stirling, Stirling, FK9 4LA UK
| | - Cheryl Burgess
- Faculty of Social Science, Colin Bell Building, University of Stirling, Stirling, FK9 4LA UK
| | - Douglas Eadie
- Institute for Social Marketing, Faculty of Health Sciences and Sport, University of Stirling, Stirling, FK9 4LA UK
| | - Niamh Fitzgerald
- Institute for Social Marketing, UK Centre for Tobacco and Alcohol Studies, Faculty of Health Sciences and Sport, University of Stirling, Stirling, FK9 4LA UK
| | - Jennifer McKell
- Institute for Social Marketing, Faculty of Health Sciences and Sport, University of Stirling, Stirling, FK9 4LA UK
| | | | - Ruth Jepson
- The Scottish Collaboration for Public Health Research (SCPHRP), 20 West Richmond Street, Edinburgh, EH8 9DX UK
| | - John McAteer
- The Scottish Collaboration for Public Health Research (SCPHRP), 20 West Richmond Street, Edinburgh, EH8 9DX UK
| | - Linda Bauld
- Institute for Social Marketing, UK Centre for Tobacco and Alcohol Studies, Faculty of Health Sciences and Sport, University of Stirling, Stirling, FK9 4LA UK
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8
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Qualitative process study of community pharmacist brief alcohol intervention effectiveness trial: Can research participation effects explain a null finding? Drug Alcohol Depend 2016; 161:36-41. [PMID: 26875673 DOI: 10.1016/j.drugalcdep.2016.01.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 12/16/2015] [Accepted: 01/10/2016] [Indexed: 11/23/2022]
Abstract
AIMS This qualitative process study, nested within a randomised controlled trial evaluating community pharmacist brief alcohol intervention delivery, aims to explore participants' engagement with the trial, so as to identify whether research participation effects may explain why the brief intervention was not found to be effective. METHOD Qualitative interviews were conducted with 24 randomly selected participants approximately one month after the end of the trial. Semi structured Interviews were conducted by telephone in which participants were asked to give a chronological account of their trial participation, leading to a discussion of possible impacts. These were digitally recorded, transcribed verbatim, and analysed using the Framework method. RESULTS A range of motivations for taking part in the trial were identified, including pharmacy visitors wanting to obtain an assessment of their drinking. Participants in both arms of the trial spoke of the potent effect that screening had on them. All participants were exposed to discussions about alcohol with empathic pharmacists and, as this is an integral intervention component, this constitutes contamination. Participants' pre-existing ideas about the nature of alcohol problems had an important bearing on how relevant they thought the intervention was to them. CONCLUSION A detailed appreciation of participant engagement with the trial can provide a strong basis for interpretation of trial outcome data, and in this instance does help explain the null finding. Other findings also indicate the need for dedicated studies of public understanding of the nature of alcohol problems, and their implications for receptivity to brief interventions.
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9
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Fitzgerald N, Platt L, Heywood S, McCambridge J. Large-scale implementation of alcohol brief interventions in new settings in Scotland: a qualitative interview study of a national programme. BMC Public Health 2015; 15:289. [PMID: 25886312 PMCID: PMC4391282 DOI: 10.1186/s12889-015-1527-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 02/12/2015] [Indexed: 02/04/2023] Open
Abstract
Background This study aimed to explore experiences of implementation of alcohol brief interventions (ABIs) in settings outside of primary healthcare in the Scottish national programme. The focus of the study was on strategies and learning to support ABI implementation in settings outside of primary healthcare in general, rather on issues specific to any single setting. Methods 14 semi-structured telephone interviews were conducted with senior implementation leaders in antenatal, accident and emergency and wider settings and audio-recorded. Interviews were analysed inductively. Results The process of achieving large-scale, routine implementation of ABI proved challenging for all involved across the settings. Interviewees reported their experiences and identified five main strategies as helpful for strategic implementation efforts in any setting: (1) Having a high-profile target for the number of ABIs delivered in a specific time period with clarity about whose responsibility it was to implement the target; (2) Gaining support from senior staff from the start; (3) Adapting the intervention, using a pragmatic, collaborative approach, to fit with current practice; (4) Establishing practical and robust recording, monitoring and reporting systems for intervention delivery, prior to widespread implementation; and (5) Establishing close working relationships with frontline staff including flexible approaches to training and readily available support. Conclusions This qualitative study suggests that even with significant national support, funding and a specific delivery target, ABI implementation in new settings is not straightforward. Those responsible for planning similar initiatives should critically consider the relevance and value of the five implementation strategies identified.
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Affiliation(s)
- Niamh Fitzgerald
- Institute for Social Marketing, UK Centre for Tobacco and Alcohol Studies, University of Stirling, Stirling, FK9 4LA, , Scotland, UK. .,Institute for Health and Wellbeing Research, Robert Gordon University, Riverside Campus, Aberdeen, AB10 7GJ, UK.
| | - Lucy Platt
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
| | - Susie Heywood
- Glasgow City Community Health Partnership, North-East Sector, Eastbank Health Promotion & Training Centre, Academy Street, Glasgow, G32 9AA, UK.
| | - Jim McCambridge
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
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10
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Fitzgerald N, Molloy H, MacDonald F, McCambridge J. Alcohol brief interventions practice following training for multidisciplinary health and social care teams: a qualitative interview study. Drug Alcohol Rev 2014; 34:185-93. [PMID: 25196713 PMCID: PMC4405088 DOI: 10.1111/dar.12193] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Accepted: 07/14/2014] [Indexed: 11/27/2022]
Abstract
INTRODUCTION AND AIMS Few studies of the implementation of alcohol brief interventions (ABI) have been conducted in community settings such as mental health, social work and criminal justice teams. This qualitative interview study sought to explore the impact of training on ABI delivery by staff from a variety of such teams. DESIGN AND METHODS Fifteen semi-structured telephone interviews were carried out with trained practitioners and with managers to explore the use of, perceived need for and approaches to ABI delivery and recording with clients, and compatibility of ABIs with current practice. Interviews were analysed thematically using an inductive approach. RESULTS Very few practitioners reported delivery of any ABIs following training primarily because they felt ABIs to be inappropriate for their clients. According to practitioners, this was either because they drank too much or too little to benefit. Practitioners reported a range of current activities relating to alcohol, and some felt that their knowledge and confidence were improved following training. One practitioner reported ABI delivery and was considered a training success, while expectations of ABIs did not fit with current practice including assessment procedures for the remainder. DISCUSSION AND CONCLUSIONS Identified barriers to ABI delivery included issues relating to individual practitioners, their teams, current practice and the ABI model. They are likely to be best addressed by strategic team- and setting-specific approaches to implementation, of which training is only one part.
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Affiliation(s)
- Niamh Fitzgerald
- Institute for Social Marketing, UK Centre for Tobacco and Alcohol Studies, School of Health Sciences, University of Stirling, Stirling, FK9 4LA, UK
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11
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McCambridge J, Rollnick S. Should brief interventions in primary care address alcohol problems more strongly? Addiction 2014; 109:1054-8. [PMID: 24433291 PMCID: PMC4153955 DOI: 10.1111/add.12388] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Revised: 07/11/2013] [Accepted: 10/15/2013] [Indexed: 12/02/2022]
Abstract
BACKGROUND Brief interventions have well-established small effects on alcohol consumption among hazardous and harmful drinkers in primary care, and national large-scale programmes are being implemented in many countries for public health reasons. METHODS This paper examines data from reviews and draws upon older brief intervention studies and recent developments in the literature on motivational interviewing to consider the capacity of brief interventions to benefit those with problems, including those with severe problems. RESULTS Effects on alcohol problems have been shown much less consistently, and evidence cannot be claimed to be strong for any outcomes other than reduced consumption. Combinations of advice and motivational interviewing are a promising target for evaluation in trials, and more detailed studies of the conduct of brief interventions are needed. CONCLUSIONS We propose that brief interventions in primary care may be more effective if they offer appropriate content in a person-centred manner, addressing patient concerns more directly.
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Affiliation(s)
- Jim McCambridge
- Faculty of Public Health and Policy, London School of Hygiene and Tropical MedicineLondon, UK
| | - Stephen Rollnick
- Institute of Primary Care and Public Health, School of Medicine, Cardiff UniversityCardiff, UK
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12
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McCambridge J, Rollnick S. Big issues. Addiction 2014; 109:1063-5. [PMID: 24903287 DOI: 10.1111/add.12587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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13
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McCambridge J. Commentary on Schwartz et al. (2014): Where next for face-to-face, person-to-person, computerized and online brief interventions for drug users? Addiction 2014; 109:1099-100. [PMID: 24903288 DOI: 10.1111/add.12588] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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15
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Patel V, Weobong B, Nadkarni A, Weiss HA, Anand A, Naik S, Bhat B, Pereira J, Araya R, Dimidjian S, Hollon SD, King M, McCambridge J, McDaid D, Murthy P, Velleman R, Fairburn CG, Kirkwood B. The effectiveness and cost-effectiveness of lay counsellor-delivered psychological treatments for harmful and dependent drinking and moderate to severe depression in primary care in India: PREMIUM study protocol for randomized controlled trials. Trials 2014; 15:101. [PMID: 24690184 PMCID: PMC4230277 DOI: 10.1186/1745-6215-15-101] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2013] [Accepted: 03/19/2014] [Indexed: 05/16/2023] Open
Abstract
Background The leading mental health causes of the global burden of disease are depression in women and alcohol use disorders in men. A major hurdle to the implementation of evidence-based psychological treatments in primary care in developing countries is the non-availability of skilled human resources. The aim of these trials is to evaluate the effectiveness and cost-effectiveness of two psychological treatments developed for the treatment of depression and alcohol use disorders in primary care in India. Methods/design This study protocol is for parallel group, randomized controlled trials (Healthy Activity Program for moderate to severe depression, Counselling for Alcohol Problems for harmful and dependent drinking) in eight primary health centres in Goa, India. Adult primary care attendees will be screened with the Patient Health Questionnaire for depression and, in men only, the Alcohol Use Disorders Identification Test for drinking problems. Screen-positive attendees will be invited to participate; men who screen positive for both disorders will be invited to participate in the Counselling for Alcohol Problems trial. Those who consent will be allocated in a 1:1 ratio to receive either the respective psychological treatment plus enhanced usual care or enhanced usual care only using a computer generated allocation sequence, stratified by primary health centre and, for depression, by sex. The enhanced usual care comprises providing primary health centre doctors with contextualized World Health Organization guidelines and screening results. Psychological treatments will be delivered by lay counsellors, over a maximum period of three months. Primary outcomes are severity of disorder and remission rates at three months post-enrolment and, for the Counselling for Alcohol Problems trial, drinking and the impact of drinking on daily lives. Secondary outcomes include severity of disorder and remission rates at 12 months, disability scores, suicidal behaviour and economic impact, and cost-effectiveness at three and 12 months. 500 participants with depression and 400 participants with harmful drinking will be recruited. Primary analyses will be intention-to-treat. Discussion These trials may offer a new approach for the treatment of moderate-severe depression and drinking problems in primary care that is potentially scalable as it relies on delivery by a single pool of lay counsellors. Trial registration Both trials are registered with the International Society for the Registration of Clinical Trials (Healthy Activity Programme registration number ISRCTN95149997; Counselling for Alcohol Problems registration number ISRCTN76465238).
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Affiliation(s)
- Vikram Patel
- Sangath Centre, Alto-Porvorim, 403521 Goa, India.
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16
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McCambridge J, Cunningham JA. The early history of ideas on brief interventions for alcohol. Addiction 2014; 109:538-46. [PMID: 24354855 PMCID: PMC3992901 DOI: 10.1111/add.12458] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Revised: 08/06/2013] [Accepted: 12/11/2013] [Indexed: 11/29/2022]
Abstract
AIMS This study explores the early development of brief interventions for alcohol using a history of ideas approach with a particular focus on intervention content. METHODS The source publications of the key primary studies published from approximately 1962 to 1992 were examined, followed by a brief review of the earliest reviews in this field. These studies were placed in the context of developments in alcohol research and in public health. RESULTS After early pioneering work on brief interventions, further advances were not made until thinking about alcohol problems and their treatment, most notably on controlled drinking, along with wider changes in public health, created new conditions for progress. There was then a golden era of rapid advance in the late 1980s and early 1990s, when preventing the development of problem drinking became important for public health reasons, in addition to helping already problematic drinkers. Many research challenges identified at that time remain to be met. The content of brief interventions changed over the period of study, although not in ways well informed by research advances, and there were also obvious continuities, with a renewed emphasis on the facilitation of self-change being one important consequence of the development of internet applications. CONCLUSIONS Ideas about brief interventions have changed in important ways. Brief interventions have been studied with different populations of drinkers, with aims embracing both individual and population-level perspectives, and without well-specified contents. The brief intervention field is an appropriate target for further historical investigations, which may help thinking about addressing alcohol and other problems.
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Affiliation(s)
- Jim McCambridge
- Faculty of Public Health and Policy, London School of Hygiene and Tropical MedicineLondon, UK,Correspondence to: Jim McCambridge, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK. E-mail:
| | - John A Cunningham
- Centre for Mental Health Research, The Australian National UniversityCanberra, Australia,Centre for Addiction and Mental HealthToronto, Canada
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17
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Gaume J, McCambridge J, Bertholet N, Daeppen JB. Mechanisms of action of brief alcohol interventions remain largely unknown - a narrative review. Front Psychiatry 2014; 5:108. [PMID: 25206342 PMCID: PMC4143721 DOI: 10.3389/fpsyt.2014.00108] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 08/06/2014] [Indexed: 11/13/2022] Open
Abstract
A growing body of evidence has shown the efficacy of brief intervention (BI) for hazardous and harmful alcohol use in primary health care settings. Evidence for efficacy in other settings and effectiveness when implemented at larger scale are disappointing. Indeed, BI comprises varying content; exploring BI content and mechanisms of action may be a promising way to enhance efficacy and effectiveness. Medline and PsychInfo, as well as references of retrieved publications were searched for original research or review on active ingredients (components or mechanisms) of face-to-face BIs [and its subtypes, including brief advice and brief motivational interviewing (BMI)] for alcohol. Overall, BI active ingredients have been scarcely investigated, almost only within BMI, and mostly among patients in the emergency room, young adults, and US college students. This body of research has shown that personalized feedback may be an effective component; specific MI techniques showed mixed findings; decisional balance findings tended to suggest a potential detrimental effect; while change plan exercises, advice to reduce or stop drinking, presenting alternative change options, and moderation strategies are promising but need further study. Client change talk is a potential mediator of BMI effects; change in norm perceptions and enhanced discrepancy between current behavior and broader life goals and values have received preliminary support; readiness to change was only partially supported as a mediator; while enhanced awareness of drinking, perceived risks/benefits of alcohol use, alcohol treatment seeking, and self-efficacy were seldom studied and have as yet found no significant support as such. Research is obviously limited and has provided no clear and consistent evidence on the mechanisms of alcohol BI. How BI achieves the effects seen in randomized trials remains mostly unknown and should be investigated to inform the development of more effective interventions.
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Affiliation(s)
- Jacques Gaume
- Alcohol Treatment Center, Department of Community Health and Medicine, Lausanne University Hospital , Lausanne , Switzerland
| | - Jim McCambridge
- Department of Social and Environmental Health Research, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine , London , UK
| | - Nicolas Bertholet
- Alcohol Treatment Center, Department of Community Health and Medicine, Lausanne University Hospital , Lausanne , Switzerland
| | - Jean-Bernard Daeppen
- Alcohol Treatment Center, Department of Community Health and Medicine, Lausanne University Hospital , Lausanne , Switzerland
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Dhital R, Norman I, Whittlesea C, McCambridge J. Effectiveness of alcohol brief intervention delivered by community pharmacists: study protocol of a two-arm randomised controlled trial. BMC Public Health 2013; 13:152. [PMID: 23419053 PMCID: PMC3583737 DOI: 10.1186/1471-2458-13-152] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Accepted: 02/14/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is strong evidence to support the effectiveness of Brief Intervention (BI) in reducing alcohol consumption in primary healthcare. METHODS AND DESIGN This study is a two-arm randomised controlled trial to determine the effectiveness of BI delivered by community pharmacists in their pharmacies. Eligible and consenting participants (aged 18 years or older) will be randomised in equal numbers to either a BI delivered by 17 community pharmacists or a non-intervention control condition. The intervention will be a brief motivational discussion to support a reduction in alcohol consumption and will take approximately 10 minutes to deliver. Participants randomised to the control arm will be given an alcohol information leaflet with no opportunity for discussion. Study pharmacists will be volunteers who respond to an invitation to participate, sent to all community pharmacists in the London borough of Hammersmith and Fulham. Participating pharmacists will receive 7 hours training on trial procedures and the delivery of BI. Pharmacy support staff will also receive training (4 hours) on how to approach and inform pharmacy customers about the study, with formal trial recruitment undertaken by the pharmacist in a consultation room. At three month follow up, alcohol consumption and related problems will be assessed with the Alcohol Use Disorders Identification Test (AUDIT) administered by telephone. DISCUSSION The UK Department of Health's stated aim is to involve community pharmacists in the delivery of BI to reduce alcohol harms. This will be the first RCT study to assess the effectiveness of BI delivered by community pharmacists. Given this policy context, it is pragmatic in design. TRIAL REGISTRATION Current Controlled Trials ISRCTN95216873.
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Affiliation(s)
- Ranjita Dhital
- King's College London, Florence Nightingale School of Nursing and Midwifery, 57 Waterloo Road, SE1 8WA London, UK.
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