Process evaluation of an environmental health risk audit and action plan intervention to reduce alcohol related violence in licensed premises

Abstract

BackgroundAlcohol-related violence is associated with licensed premise environments and their management. There is a lack of evidence for effective interventions to address these, and there are significant barriers to implementation. This study aims to understand how development and implementation processes can facilitate intervention reach, fidelity and receipt and therefore provides key process data necessary to interpret the results of the randomised controlled trial conducted in parallel.MethodsA process evaluation, embedded within a randomised controlled trial. Intervention development and implementation were assessed via focus groups (n = 2) and semi-structured interviews (n = 22) with Environmental Health Practitioners (EHPs). Reach and fidelity were assessed via routinely collected intervention data, which was was collected from 276 licenced premises across Wales, UK. Case study semi-structured interviews with licensed premises proprietors (n = 30) explored intervention receipt.ResultsIntervention co-production with senior EHPs facilitated organisational adoption and implementation. Training events for EHPs played an important role in addressing wider organisational concerns regarding partnership working and the contextual integration of the intervention. EHPs delivered the intervention to 98 % of intervention premises; 35 % of premises should have received a follow up enforcement visit, however EHP confidence in dealing with alcohol risk factors meant only 7 % of premises received one. Premises therefore received a similar intervention dose regardless of baseline risk. Intervention receipt appeared to be greatest in premises with an existing commitment to prevention and those in urban environments.ConclusionsThe study suggests that a collaborative approach to the development and diffusion of interventions is associated with high levels of organisational adoption, implementation and reach. However, the lack of enforcement visits represents implementation failure for a key mechanism of action that is likely to influence intervention effectiveness. To be effective, any future intervention may require a longer implementation period to develop EHP confidence in using enforcement approaches in this area and multiagency enforcement support, which includes the police, to deliver an adequate intervention dose.

The effectiveness of an intervention to reduce alcohol‐related violence in premises licensed for the sale and on‐site consumption of alcohol: a randomized controlled trial

“…The collaborative approach to the intervention aided the successful adoption, development and implementation of SMILE within EHP working practices, resulting in high levels of premises reach and the successful completion of a robust randomized controlled trial in a complex area of study. However, data presented here and confirmed in an embedded process evaluation highlight implementation failure of a key intervention mechanism of action: the expected follow‐up enforcement visits were not delivered by EHPs . This raises questions about EHPs confidence in this new area of work.…”

“…This raises questions about EHPs confidence in this new area of work. Future delivery of statutory interventions may require partnership working with more experienced partners, such as licensing officers, to overcome EHP resistance . The earlier feasibility study that informed the current trial was not conducted by EHPs, but a private organization that was not partnered with the police and licensing.…”

“…It was undertaken and reported in accordance with the Consolidated Standards Of Reporting Trial (CONSORT) . Details of pre‐registered hypotheses, design, intervention development and logic models are available elsewhere .…”

“…EHPs work mainly with health and safety legislation, which is applicable to all businesses whether licensed or not, and they have a ‘violence in the work‐place’ remit. While EHPs had little experience working with licensed premises , they had regulatory powers that enabled their entry into premises, needed to overcome the expected unwillingness of premises to engage , and they are trained to conduct work‐place risk assessments . Premises were not able to opt out of the study.…”

“…We further sought to (3) explore intervention dose on outcomes. An embedded process evaluation assessed fidelity, reach, acceptability and dose, results from which are available elsewhere .…”