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

Rosário, F.; Vasiljevic, M.; Pas, L.; Angus, C.; Ribeiro, C.; Fitzgerald, N.

Abstract

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.

Citation

Rosário, F., Vasiljevic, M., Pas, L., Angus, C., Ribeiro, C., & Fitzgerald, N. (2022). Efficacy of a theory-driven program to implement alcohol screening and brief interventions in primary health-care: a cluster randomized controlled trial. Addiction, 117(6), 1609-1621. https://doi.org/10.1111/add.15782

• Journal Article Type: Article
• Acceptance Date: Dec 8, 2021
• Online Publication Date: Jan 20, 2022
• Publication Date: 2022-06
• Deposit Date: Feb 2, 2022
• Publicly Available Date: Jan 20, 2023
• Journal: Addiction
• Print ISSN: 0965-2140
• Electronic ISSN: 1360-0443
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 117
• Issue: 6
• Pages: 1609-1621
• DOI: https://doi.org/10.1111/add.15782
• Public URL: https://durham-repository.worktribe.com/output/1215141