Abstract

Providing alcohol screening and brief advice (SBA) in primary health care (PHC) can be an effective measure to reduce alcohol consumption. To aid successful implementation in an upper middle-income country context, this study investigates the perceived appropriateness of the programme and the perceived barriers to its implementation in PHC settings in three Latin American countries: Colombia, Mexico and Peru, as part of larger implementation study (SCALA). An online survey based on the Tailored Implementation for Chronic Diseases (TICD) implementation framework was disseminated in the three countries to key stakeholders with experience in the topic and/or setting (both health professionals and other roles, for example regional health administrators and national experts). In total, 55 respondents participated (66% response rate). For responses to both appropriateness and barriers questions, frequencies were computed, and country comparisons were made using Chi square and Kruskal-Wallis non-parametric tests. Alcohol SBA was seen as an appropriate programme to reduce heavy alcohol use in PHC and a range of providers were considered suitable for its delivery, such as general practitioners, nurses, psychologists and social workers. Contextual factors such as patients' normalised perception of their heavy drinking, lack of on-going support for providers, difficulty of accessing referral services and lenient alcohol control laws were the highest rated barriers. Country differences were found for two barriers: Peruvian respondents rated SBA guidelines as less clear than Mexican (Mann-Whitney U = -18.10, P = 0.001), and more strongly indicated lack of available screening instruments than Colombian (Mann-Whitney U = -12.82, P = 0.035) and Mexican respondents (Mann-Whitney U = -13.56, P = 0.018). The study shows the need to address contextual factors for successful implementation of SBA in practice. General congruence between the countries suggests that similar approaches can be used to encourage widespread implementation of SBA in all three studied countries, with minor tailoring based on the few country-specific barriers.

Highlights

  • In all global comparative risk assessments, alcohol use is amongst the 10 leading risk factors for both deaths and disability adjusted life years

  • Alcohol screening and brief advice (SBA) was seen as an appropriate programme to reduce heavy alcohol use in primary health care (PHC) and a range of providers were considered suitable for its delivery, such as general practitioners, nurses, psychologists and social workers

  • Considering the fit of provider, respondents in all three countries indicated four types of professionals to be appropriate to carry out alcohol SBA: general practitioners (GPs), nurses, psychologists and social workers

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Summary

Introduction

In all global comparative risk assessments, alcohol use is amongst the 10 leading risk factors for both deaths and disability adjusted life years The estimated percentages of deaths attributable to alcohol in the three countries ranged between 6.4 and 11% for males and 1.2–2.1% for females, and percentages of total attributable disability adjusted life years were above the world average at 7.6–12% for males and 2.1–3% for females (Gakidou et al, 2017; GBD 2016 Alcohol Collaborators, 2018) These estimations show that the three countries could benefit from widespread implementation of measures to decrease heavy drinking in order to reduce the alcohol-related harm. Results: Alcohol SBA was seen as an appropriate programme to reduce heavy alcohol use in PHC and a range of providers were considered suitable for its delivery, such as general practitioners, nurses, psychologists and social workers Contextual factors such as patients’ normalised perception of their heavy drinking, lack of on-going support for providers, difficulty of accessing referral services and lenient alcohol control laws were the highest rated barriers. General congruence between the countries suggests that similar approaches can be used to encourage widespread implementation of SBA in all three studied countries, with minor tailoring based on the few country-specific barriers

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