Pragmatic approaches for addressing alcohol in general practice: Development of a tailored implementation intervention

Potthoff, Sebastian, O'Donnell, Amy Jane, Karlsen, Andrea Taksdal, Brendryen, Håvar and Lid, Torgeir Gilje (2022) Pragmatic approaches for addressing alcohol in general practice: Development of a tailored implementation intervention. Frontiers in Health Services, 2. p. 940383. ISSN 2813-0146

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Introduction: Alcohol consumption is a leading global risk factor for ill-health and premature death. Alcohol screening and brief interventions (SBI) delivered in primary care is effective at reducing alcohol consumption, but routine implementation remains problematic. Screening all patients for excessive drinking (universal screening) is resource-intensive and may be at odds with general practitioners' (GPs') perceived professional role. This study aimed to develop a tailored, theory-based training intervention to strengthen GPs' ability to address alcohol and to manage alcohol-related health problems through a pragmatic approach based on clinical relevance.

Methods: A qualitative study design involving focus group interviews and a structured questionnaire for free text replies with GPs in Norway. Behavioral analysis assessed factors influencing delivery of SBI according to the ‘capability, opportunity, motivation and behavior' (COM-B) model to inform intervention development using the Behavior Change Wheel. Qualitative data were analyzed using framework analysis and an iterative approach was adopted to develop the training.

Results: A purposive sample of GPs attended the focus groups (n = 25) and completed the questionnaire (n = 55). Four areas required additional support including: understanding the link between alcohol use and health problems; opening up the conversation on alcohol use; addressing alcohol and dealing with obstacles; and following-up and maintaining change. Findings informed the development of a four-session interactive training intervention and a digital intervention for providing support for patients between consultations to address the identified needs.

Conclusion: This work highlights the value of pragmatic, relevance-based clinical strategies, as opposed to universal screening approaches to addressing alcohol in primary care. A pragmatic approach is more in line with GPs existing sclinical skill set and holds the potential to improve widespread uptake and implementation of SBI in routine primary care.

Item Type: Article
Additional Information: Funding information: This study did not have any specific funding but was conducted as part of the authors' regular employment. SP is a member of the NIHR Applied Research Collaboration North East and North Cumbria (NIHR200173). AO is funded by a National Institute for Health Research (NIHR), Advanced Fellowship (grant reference: NIHR300616). The views expressed are those of the author (s) and not necessarily those of the NIHR or the Department of Health and Social Care.
Uncontrolled Keywords: alcohol, targeted screening, brief intervention, implementation, implementation determinants, tailoring, behavior change, behavior change wheel
Subjects: B700 Nursing
B900 Others in Subjects allied to Medicine
L500 Social Work
Department: Faculties > Health and Life Sciences > Social Work, Education and Community Wellbeing
Depositing User: Elena Carlaw
Date Deposited: 21 Dec 2022 10:07
Last Modified: 21 Dec 2022 10:15

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