Communities in charge of alcohol (CICA): a protocol for a stepped-wedge randomised control trial of an alcohol health champions programme

Penny A Cook,Susan Hare,Suzanne Audrey,David Ottiwell,Elizabeth J Burns,Suzy C Hargreaves,Margaret Coffey,Kiran Kenth,Frank De Vocht,Steve Parrott,Cathy Ure,Paul Duffy,Kate Ardern

doi:10.1186/s12889-018-5410-0

Abstract

BackgroundCommunities In Charge of Alcohol (CICA) takes an Asset Based Community Development (ABCD) approach to reducing alcohol harm. Through a cascade training model, supported by a designated local co-ordinator, local volunteers are trained to become accredited ‘Alcohol Health Champions’ to provide brief opportunistic advice at an individual level and mobilise action on alcohol availability at a community level. The CICA programme is the first time that a devolved UK region has attempted to coordinate an approach to building health champion capacity, presenting an opportunity to investigate its implementation and impact at scale. This paper describes the protocol for a stepped wedge randomised controlled trial of an Alcohol Health Champions programme in Greater Manchester which aims to strengthen the evidence base of ABCD approaches for health improvement and reducing alcohol-related harm.MethodsA natural experiment that will examine the effect of CICA on area level alcohol-related hospital admissions, Accident and Emergency attendances, ambulance call outs, street-level crime and anti-social behaviour data. Using a stepped wedged randomised design (whereby the intervention is rolled out sequentially in a randomly assigned order), potential changes in health and criminal justice primary outcomes are analysed using mixed-effects log-rate models, differences-in-differences models and Bayesian structured time series models. An economic evaluation identifies the set-up and running costs of CICA using HM Treasury approved standardised methods and resolves cost-consequences by sector. A process evaluation explores the context, implementation and response to the intervention. Qualitative analyses utilise the Framework method to identify underlying themes.DiscussionWe will investigate: whether training lay people to offer brief advice and take action on licensing decisions has an impact on alcohol-related harm in local areas; the cost-consequences for health and criminal justice sectors, and; mechanisms that influence intervention outcomes. As well as providing evidence for the effectiveness of this intervention to reduce the harm from alcohol, this evaluation will contribute to broader understanding of asset based approaches to improve public health.Trial registrationISRCTN 81942890, date of registration 12/09/2017.

Highlights

Communities In Charge of Alcohol (CICA) takes an Asset Based Community Development (ABCD) approach to reducing alcohol harm
We anticipate the findings will be widely relevant across a range of topics, not just interventions to reduce alcohol harm
The results will be of interest to policy makers, commissioners and public health practitioners responsible for reducing alcohol harm at both a population and individual level

Summary

Introduction

Communities In Charge of Alcohol (CICA) takes an Asset Based Community Development (ABCD) approach to reducing alcohol harm. Interventions that are effective at reducing alcohol harm have been shown to operate at the individual level (i.e. brief advice about drinking [8]), the community level (e.g. licensing policies [9, 10] and measures that control access to alcohol [8]), and national level (e.g. alcohol pricing policy [2]). This protocol describes an evaluation of an intervention, ‘Communities In Charge of Alcohol’ (CICA), which aims to target alcohol harm at two levels; by influencing individuals (through brief intervention) and communities (through reducing the availability of alcohol)

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