Blended-eLearning Improves Alcohol Use Care in Kenya: Pragmatic Randomized Control Trial Results and Parallel Qualitative Study Implications

Abstract

Alcohol use is the 5th most important risk factor contributing to the global burden of diseases, with stigma and a lack of trained health workers as the main barriers to adequate care. This study assesses the impact of providing blended-eLearning courses teaching the alcohol, smoking, and substance involvement screening test (ASSIST) screening and its linked brief intervention (BI). In public and private facilities, two randomized control trials (RCTs) showed large and similar decreases in alcohol use in those receiving the BI compared to those receiving only the ASSIST feedback. Qualitative findings confirm a meaningful reduction in alcohol consumption; decrease in stigma and significant practice change, suggesting lay health workers and clinicians can learn effective interventions through blended-eLearning; and significantly improve alcohol use care in a low- and middle-income country (LMIC) context. In addition, our study provides insight into why lay health workers feedback led to a similar decrease in alcohol consumption compared to those who also received a BI by clinicians.

Blended-eLearning Impact on Health Worker Stigma Toward Alcohol, Tobacco, and Other Psychoactive Substance Users

“…Furthermore, some recent studies cast doubt on the added effectiveness of in-person contact-based interventions compared to others and that online contact can also be effective (Jorm, 2020;Imperato et al, 2021). Alternatively, the ASI might not have the sensitivity to measure a further decrease in stigma in the Kenyan context, as our program of research, especially our qualitative findings (Clair et al, 2022a(Clair et al, , 2022b, supports a further decrease in stigma during that period (Clair et al, 2016a(Clair et al, , 2016b(Clair et al, , 2016c(Clair et al, , 2019. Findings for eDATA-K suggest that there was not only a further reduction in stigma but that the stigma reduction, alongside increased self-efficacy, promoted large changes in behaviors in health workers, as well as being by the RCT participants (Clair et al, 2022b) and that those stigma changes promoted the continuation of the services after the end of the RCT (Clair et al, 2022a(Clair et al, , 2022b.…”

“…Alternatively, the ASI might not have the sensitivity to measure a further decrease in stigma in the Kenyan context, as our program of research, especially our qualitative findings (Clair et al, 2022a(Clair et al, , 2022b, supports a further decrease in stigma during that period (Clair et al, 2016a(Clair et al, , 2016b(Clair et al, , 2016c(Clair et al, , 2019. Findings for eDATA-K suggest that there was not only a further reduction in stigma but that the stigma reduction, alongside increased self-efficacy, promoted large changes in behaviors in health workers, as well as being by the RCT participants (Clair et al, 2022b) and that those stigma changes promoted the continuation of the services after the end of the RCT (Clair et al, 2022a(Clair et al, , 2022b. Those qualitative findings raise the question of the validity of the adjusted ASI stigma scale in measuring changes in stigma and stigmatizing behaviors in health workers in an LMIC context.…”

“…An associated comprehensive mixed-methods research program evaluated the impact of the training on health workers and patients' outcomes: the computer-based drug and alcohol Training and Assessment in Kenya (eDATA-K), under which this study is nested. Other eDATA-K studies are published elsewhere (Clair et al, 2022a;Clair et al, 2016aClair et al, , 2016bClair et al, , 2016cClair et al, , 2019Clair et al, , 2022bHsiang-Te Tsuei et al, 2017).…”