Factors Associated with Primary Health Care Providers’ Alcohol Screening Behavior in Colombia, Mexico and Peru

Kokole, Daša; Jané‐Llopis, Eva; Mercken, Liesbeth; Piazza, Marina; Bustamante, Inés; Rey, Guillermina Natera; Medina, Perla; Pérez-Gómez, Augusto; Mejía-Trujillo, Juliana; O’Donnell, Amy; Kaner, Eileen; Gual, Antoni; Schmidt, Christiane Sybille; Schulte, Bernd; Candel, Math J. J. M.; Vries, Hein de; Anderson, Peter

doi:10.1080/08897077.2021.1903658

Cited by 6 publications

(6 citation statements)

References 40 publications

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“…The amount of training and support tested in the present trial was substantially higher than that delivered in many programs tested so far (ranging 2-9 h) [32,34,35,41,42]. Longer training sessions for busy primary care providers could be demotivating for some and The provision of written guidelines to the control group had little effect, in line with evidence showing that passive dissemination of guidelines alone is unlikely to result in behavior change [43].…”

Section: Discussionsupporting

confidence: 54%

“…The amount of training and support tested in the present trial was substantially higher than that delivered in many programs tested so far (ranging 2–9 h) [32, 34, 35, 41, 42]. Longer training sessions for busy primary care providers could be demotivating for some and could in some settings act as a barrier to implementation.…”

Section: Discussionmentioning

confidence: 95%

“…Therefore, the time spent in training should be carefully considered to achieve the right balance between training length and efficacy in changing the behavior of interest. Support from leadership and local policymakers can also be key in implementation efforts [42], including making more complex and time‐consuming implementation programs available to all primary care providers. Given our results, the potential of similar behavior change theory‐based interventions should be further explored, as a potential way of increasing the implementation of alcohol screening in general practice in other countries and settings.…”

Section: Discussionmentioning

confidence: 99%

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Efficacy of a theory‐driven program to implement alcohol screening and brief interventions in primary health‐care: a cluster randomized controlled trial

et al. 2022

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Background and Aims Screening and brief interventions (SBI) in primary health‐care practices (PHCP) are effective in reducing reported alcohol consumption, but have not been routinely implemented. Most programs seeking to improve implementation rates have lacked a theoretical rationale. This study aimed to test whether a theory‐based intervention for PHCPs could significantly increase alcohol SBI delivery. Design Two‐arm, cluster‐randomized controlled, parallel, 12‐month follow‐up, trial. Setting PHCPs in Portugal. Participants Staff from 12 PHCPs (n = 222, 81.1% women): nurses (35.6%), general practitioners (28.8%), receptionists (26.1%) and family medicine residents (9.5%); patients screened for alcohol use: intervention n = 8062; controls n = 58. Intervention and Comparator PHCPs were randomized to receive a training and support program (n = 6; 110 participants) tailored to the barriers and facilitators for implementing alcohol SBIs following the principles of the Behavior Change Wheel/Theoretical Domains Framework approach, or to a waiting‐list control (n = 6; 112 participants). Training was delivered over the first 12 weeks of the trial. Measurements The primary outcome was the proportion of eligible patients screened (unit of analysis: patient list). Secondary outcomes included the brief intervention (BI) rate per screen‐positive patient and the population‐based BI rate (unit of analysis: patient list), and changes in health providers’ perceptions of barriers to implementation and alcohol‐related knowledge (unit of analysis: health provider). Findings The implementation program had a significant effect on the screening activity in the intervention practices compared with control practices at the 12‐month follow‐up (21.7% vs. 0.16%, intention‐to‐treat analysis, p = 0.003). Although no significant difference was found on the BI rate per screen‐positive patient (intervention 85.7% vs. control 63.6%, p = 0.55, Bayes factor = 0.28), the intervention was effective in increasing the population‐based BI rate (intervention 0.69% vs. control 0.02%, p = 0.006). Health providers in the intervention arm reported fewer barriers to SBI implementation and higher levels of alcohol‐related knowledge at 12‐month follow‐up than those in control practices. Conclusion A theory‐based implementation program, which included training and support activities, significantly increased alcohol screening and population‐based brief intervention rates in primary care.

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Section: Discussionsupporting

confidence: 54%

Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

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Efficacy of a theory‐driven program to implement alcohol screening and brief interventions in primary health‐care: a cluster randomized controlled trial

et al. 2022

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“…Some key issues highlighted during this process concerned the limited skills and capacity of trainers in the target municipalities, and the restricted opportunities for specialist mental health or alcohol treatment referrals from PHC [ 74 ]. We also identified a particular need for training to help boost self-efficacy amongst PHC providers in relation to alcohol identification practices across the three participating countries [ 75 ]. The output from this stage was a proposed structure and outline content for the intervention and training package, in English and Spanish, respectively, including: a top-level clinical protocol; more detailed guidance for PHC providers; patient information leaflets on heavy drinking and depression; an outline training manual for trainers; and materials for use in train-new-trainer sessions.…”

Section: Resultsmentioning

confidence: 99%

Tailoring an evidence-based clinical intervention and training package for the treatment and prevention of comorbid heavy drinking and depression in middle-income country settings: the development of the SCALA toolkit in Latin America

O’Donnell

Anderson

Schmidt

et al. 2022

Global Health Action

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Background Effective interventions exist for heavy drinking and depression but to date there has been limited translation into routine practice in global health systems. This evidence-to-practice gap is particularly evident in low- and middle-income countries. The international SCALA project (Scale-up of Prevention and Management of Alcohol Use Disorders and Comorbid Depression in Latin America) sought to test the impact of multilevel implementation strategies on rates of primary health care-based measurement of alcohol consumption and identification of depression in Colombia, Mexico, and Peru. Objective To describe the process of development and cultural adaptation of the clinical intervention and training package. Methods We drew on Barrero and Castro’s four-stage cultural adaption model: 1) information gathering, 2) preliminary adaption, 3) preliminary adaption tests, and 4) adaption refinement. The Tailored Implementation in Chronic Diseases checklist helped us identify potential factors that could affect implementation, with local stakeholder groups established to support the tailoring process, as per the Institute for Healthcare Improvement’s Going to Scale Framework. Results In Stage 1, international best practice guidelines for preventing heavy drinking and depression, and intelligence on the local implementation context, were synthesised to provide an outline clinical intervention and training package. In Stage 2, feedback was gathered from local stakeholders and materials refined accordingly. These materials were piloted with local trainers in Stage 3, leading to further refinements including developing additional tools to support delivery in busy primary care settings. Stage 4 comprised further adaptions in response to real-world implementation, a period that coincided with the onset of the COVID-19 pandemic, including translating the intervention and training package for online delivery, and higher priority for depression screening in the clinical pathway. Conclusion Our experience highlights the importance of meaningful engagement with local communities, alongside the need for continuous tailoring and adaptation, and collaborative decision-making.

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“…The country-dependent dose delivered shows that the length of the training was adapted based on the countries’ needs and familiarity of the target population with the topics (e.g. in Mexico, the depression part could be shortened as providers were already familiar with the topic through the World Health Organization's Mental Health Gap Action Programme trainings ( World Health Organization, 2008 ), whereas for most participants in Peru the topic of alcohol screening was completely new ( Kokole et al, 2021 ).…”

Section: Discussionmentioning

confidence: 99%

Training primary health care providers in Colombia, Mexico and Peru to increase alcohol screening: Mixed-methods process evaluation of implementation strategy

Kokole

Jané‐Llopis

Rey

et al. 2022

Implementation Research and Practice

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Background Initial results from the SCALA study demonstrated that training primary health care providers is an effective implementation strategy to increase alcohol screening in Colombia, Mexico and Peru, but did not show evidence of superior performance for the standard compared to the shorter training arm. This paper elaborates on those outcomes by examining the relationship of training-related process evaluation indicators with the alcohol screening practice. Methods A mix of convergent and exploratory mixed-methods design was employed. Data sources included training documentation, post-training questionnaires, observation forms, self-report forms and interviews. Available quantitative data were compared on outcome measure – providers’ alcohol screening. Results Training reach was high: three hundred fifty-two providers (72.3% of all eligible) participated in one or more training or booster sessions. Country differences in session length reflected adaptation to previous topic knowledge and experience of the providers. Overall, 49% of attendees conducted alcohol screening in practice. A higher dose received was positively associated with screening, but there was no difference between standard and short training arms. Although the training sessions were well received by participants, satisfaction with training and perceived utility for practice were not associated with screening. Profession, but not age or gender, was associated with screening: in Colombia and Mexico, doctors and psychologists were more likely to screen (although the latter represented only a small proportion of the sample) and in Peru, only psychologists. Conclusions The SCALA training programme was well received by the participants and led to half of the participating providers conducting alcohol screening in their primary health care practice. The dose received and the professional role were the key factors associated with conducting the alcohol screening in practice. Plain Language Summary: Primary health care providers can play an important role in detecting heavy drinkers among their consulting patients, and training can be an effective implementation strategy to increase alcohol screening and detection. Existing training literature predominantly focuses on evaluating trainings in high-income countries, or evaluating their effectiveness rather than implementation. As part of SCALA (Scale-up of Prevention and Management of Alcohol Use Disorders in Latin America) study, we evaluated training as implementation strategy to increase alcohol screening in primary health care in a middle-income context. Overall, 72.3% of eligible providers attended the training and 49% of training attendees conducted alcohol screening in practice after attending the training. Our process evaluation suggests that simple intervention with sufficient time to practice, adapted to limited provider availability, is optimal to balance training feasibility and effectiveness; that booster sessions are especially important in context with lower organizational or structural support; and that ongoing training refinement during the implementation period is necessary.

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Factors Associated with Primary Health Care Providers’ Alcohol Screening Behavior in Colombia, Mexico and Peru

Cited by 6 publications

References 40 publications

Efficacy of a theory‐driven program to implement alcohol screening and brief interventions in primary health‐care: a cluster randomized controlled trial

Efficacy of a theory‐driven program to implement alcohol screening and brief interventions in primary health‐care: a cluster randomized controlled trial

Tailoring an evidence-based clinical intervention and training package for the treatment and prevention of comorbid heavy drinking and depression in middle-income country settings: the development of the SCALA toolkit in Latin America

Training primary health care providers in Colombia, Mexico and Peru to increase alcohol screening: Mixed-methods process evaluation of implementation strategy

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