Feasibility of alcohol screening and brief intervention in primary health care in Kazakhstan: study protocol of a pilot cluster randomised trial

Abstract

Background: Identifying and addressing heavy drinking represents a major public health priority worldwide. Whilst the majority of alcohol screening and brief intervention (ASBI) research has been conducted in western, highincome countries, evidence is growing that ASBI can also impact positively on heavy drinkers in low-and middleincome country populations. This mixed methods study aims to assess the feasibility of conducting a fully randomised controlled trial of the effectiveness of ASBI in primary care in Kazakhstan and explore the feasibility and acceptability of implementing ASBI in this setting from patients' and physicians' perspectives. Methods: Six primary health care units in the region of Pavlodar will be cluster randomised to either an intervention (WHO manualised 5 min alcohol brief intervention plus alcohol leaflet) or control group (simple feedback plus alcohol leaflet). Primary feasibility measures will be rates of participation at baseline and retention of eligible patients at the 3-month follow-up point. Patient/physician questionnaires and physician focus groups will assess additional dimensions of feasibility, as well as acceptability, according to the RE-AIM framework: Reach (rates of eligible patients screened/received advice); Effectiveness (change in AUDIT-C score); Adoption (rate/ representativeness of participating physicians); Implementation (quality of ASBI/barriers and facilitators to delivery); and Maintenance (potential sustainability of intervention). Discussion: This is the first trial of the feasibility and acceptability of ASBI in Kazakhstan. As the planning and assessment of implementation determinants is based on the RE-AIM framework, the project outcomes will be relevant for the future development, tailoring and implementation of ASBI in Kazakhstan.

Alcohol Screening and Brief Intervention in Primary Health Care in Kazakhstan—Results of a Cluster Randomised Pilot Study

“…Furthermore, it has to be considered, that the number of physicians in the control arm was low and the respective outcomes need to be handled with caution. In the study protocol we assumed that 4,000 patients needed to be screened to result in a sample size of 400 patients with a positive AUDIT-C score [ 29 ]. Although we reached the expected number of patients eligible for alcohol screening according to the inclusion criteria, only 15.7% of them were actually screened.…”

“…However, since ASBI is intended to achieve a sustainable change in behavior, the observation period should cover at least a few weeks to reflect such a change [ 38 ]. Thus, the effect analysis was based on a smaller number of patients than expected which led to a low statistical power, and it was carried out as a per protocol analysis only [ 29 ]. Finally, the results on adoption were based on the responses of fewer than the 112 invited physicians, and data on implementation were only available from 19 out of 31 physicians trained within the study.…”

“…In the control arm physicians were introduced to the screening procedures with AUDIT-C and AUDIT by the local research staff. The trainers were experienced in Motivational Interviewing (MI) techniques and in providing training courses for health professionals [ 29 ].…”

“…The RE-AIM framework for implementation studies was used to support the evaluation of feasibility and implementation outcomes [ 33 ]. Although this trial was directed towards feasibility (based on the five RE-AIM dimensions) the change in AUDIT-C score was chosen as a primary outcome criterion [ 29 ]. Outcome measures selected to assess the dimensions Reach and Effectiveness were the rate of eligible patients and the proportions of patients screened and intervened at baseline, and the change in AUDIT-C score between baseline and follow-up.…”

“…Scientific studies on ASBI have not yet been carried out in Kazakhstan. The primary aim of this pilot cluster-randomised trial was to assess the feasibility of ASBI implementation in primary health care units (PHCU) in Kazakhstan and to compare its efficacy against simple feedback as a control intervention [ 29 ].…”