Impeding and facilitating factors for the implementation of alcohol interventions in hospitals: a qualitative and exploratory study among Dutch healthcare professionals

Background Non-moderated alcohol use is more prevalent among hospitalized patients compared to the general population. However, many hospitals fail to find and intervene with people with alcohol problems. We aimed to conduct an exploration of impeding and facilitating factors experienced by healthcare professionals in implementation of alcohol interventions in Dutch general hospitals. In addition, we explored the alcohol interventions used in the selected hospitals and involved stakeholders. Methods Through a qualitative study, semi-structured telephone interviews were conducted with twenty healthcare professionals working in or in collaboration with six different general hospitals. Results Healthcare professionals indicated impeding and facilitating factors in the areas of motivation, knowledge and skills, patient characteristics, protocol, internal and external collaboration/support, resources, role suitability and societal support. Five different categories of approaches to identify and intervene with non-moderated alcohol use and 18 involved stakeholders from both inside and outside the hospital were found. Conclusions Implementation of alcohol interventions for patients in Dutch general hospitals still seems to be in its infancy. Respondents emphasized the importance of one clear protocol on how to tackle alcohol problems within their hospital, repeated training on alcohol-related knowledge and skills, (clinical) “champions” that support healthcare professionals and developing and maintaining collaborations with stakeholders within and outside the hospital.

Brief Alcohol Interventions With Older Adults: Results of a Systematic Review of Literature

Older persons are especially vulnerable to the negative effects of alcohol misuse. National reports show that the older-adult population is the least likely group to perceive a need for treatment and be screened for alcohol-related problems. Little research has examined the impact of brief interventions on different drinking outcomes in at-risk older adults. To address this gap, the current study sought to systematically review empirical literature examining the effectiveness of brief alcohol interventions (BAI) implemented with adults (≥50) engaged in at-risk drinking. The authors developed specific a priori inclusion criteria (e.g., alcohol-related outcome measures, randomized controlled trials, RCT) before beginning the search process. Key terms were entered into 9 databases to yield an initial pool of 5,909 articles, from which 5,572 were excluded. A total of 337 articles remained, from which an additional 89 were excluded. Next, the authors independently reviewed 248 full-text, empirical articles and subsequently excluded 237 that did not satisfy inclusion criteria. Thus, the current systematic review yielded 11 studies representing RCT or experimental designs that employed random assignment. Findings of the review indicated that 7 (63.6%) studies showed a positive effect, with only 1 showing no positive effect of the intervention. For the remaining 3 (27.2%), the positive effect of the intervention was not conclusively determined due to study design issues. Overall findings suggest that BAI are effective in reducing alcohol consumption in the older-adult population. Additional evidence is needed to further knowledge consistent with recent initiatives (e.g., Age-Friendly Health Systems, 4Ms) that promote healthy aging.

Refining the content and design of an alcohol reduction app, Drink Less, to improve its usability and effectiveness: a mixed methods approach

Background: Digital interventions have the potential to reduce alcohol consumption, although evidence on the effectiveness of apps is lacking. Drink Less is a popular, evidence-informed app with good usability, putting it in a strong position to be improved upon prior to conducting a confirmatory evaluation. This paper describes the process of refining Drink Less to improve its usability and likely effectiveness. Methods: The refinement consisted of three phases and involved qualitative and quantitative (mixed) methods: i) identifying changes to app content, based on findings from an initial evaluation of Drink Less, an updated review of digital alcohol interventions and a content analysis of user feedback; ii) designing new app modules with public input and a consultation with app developers and researchers; and iii) improving the app’s usability through user testing. Results: As a result of the updated review of digital alcohol interventions and user feedback analysis in Phase 1, three new modules: ‘Behaviour Substitution’, ‘Information about Antecedents’ and ‘Insights’, were added to the app. One existing module – ‘Identity Change’ – was removed based on the initial evaluation of Drink Less. Phases 2 and 3 resulted in changes to existing features, such as improving the navigational structure and onboarding process, and clarifying how to edit drinks and goals. Conclusions: A mixed methods approach was used to refine the content and design of Drink Less, providing insights into how to improve its usability and likely effectiveness. Drink Less is now ready for a confirmatory evaluation.

Addressing complex pharmacy consultations: methods used to develop a person-centred intervention to highlight alcohol within pharmacist reviews of medications

Background Alcohol is challenging to discuss, and patients may be reluctant to disclose drinking partly because of concern about being judged. This report presents an overview of the development of a medications review intervention co-produced with the pharmacy profession and with patients, which breaks new ground by seeking to give appropriate attention to alcohol within these consultations. Methods This intervention was developed in a series of stages and refined through conceptual discussion, literature review, observational and interview studies, and consultations with advisory groups. In this study we reflect on this process, paying particular attention to the methods used, where lessons may inform innovations in other complex clinical consultations. Results Early work with patients and pharmacists infused the entire process with a heightened sense of the complexity of consultations in everyday practice, prompting careful deliberation on the implications for intervention development. This required the research team to be highly responsive to both co-production inputs and data gathered in formally conducted studies, and to be committed to working through the implications for intervention design. The intervention thus evolved significantly over time, with the greatest transformations resulting from patient and pharmacist co-design workshops in the second stage of the process, where pharmacists elaborated on the nature of the need for training in particular. The original research plans provided a helpful structure, and unanticipated issues for investigation emerged throughout the process. This underscored the need to engage dynamically with changing contexts and contents and to avoid rigid adherence to any early prescribed plan. Conclusions Alcohol interventions are complex and require careful developmental research. This can be a messy enterprise, which can nonetheless shed new insights into the challenges involved in optimising interventions, and how to meet them, if embraced with an attitude of openness to learning. We found that exposing our own research plans to scrutiny resulted in changes to the intervention design that gained the confidence of different stakeholders. Our understanding of the methods used, and their consequences, may be bounded by the person-centred nature of this particular intervention.

Māori perspectives on alcohol

ABSTRACTAimMāori suffer disproportionately from alcohol-related harm in Aotearoa New Zealand. With the view toward informing potential alcohol interventions for Māori, this study synthesises studies on alcohol and alcohol-related harm. MethodsUsing a Māori-centered approach, a narrative review of qualitative studies of Māori perspectives on alcohol was conducted. Journal databases, repositories, and websites were searched for relevant studies published since 2000. A thematic analysis was conducted and emergent themes were synthesised. ResultsEight studies were identified for inclusion. Whanaungatanga was identified as a contributor to alcohol use in included studies. Other motivations were ‘fitting in’, escape from stress, achieving ‘the buzz’, and coping with historical trauma. Among included literature, a strong cultural identity was a deterrent to alcohol overuse. Māori voiced a desire to be involved with local alcohol policy decisions. ConclusionAlthough Māori are a high-priority group, there remains a substantial gap in research on Māori perspectives toward alcohol interventions which is reflective of an underinvestment in Kaupapa Māori research. Future interventions for Māori may be more effective if these interventions focus on enhancing whanaungatanga without the presence of alcohol, consider the variable motivations for drinking, and utilise culturally appropriate methods to encourage reduced harm from alcohol use.

Refining the content and design of an alcohol reduction app, Drink Less, to improve its usability and effectiveness: a mixed methods approach

Background: Digital interventions have the potential to reduce alcohol consumption, although evidence on the effectiveness of apps is lacking. Drink Less is a popular, evidence-informed app with good usability, putting it in a strong position to be improved upon prior to conducting a confirmatory evaluation. This paper describes the process of refining Drink Less to improve its usability and likely effectiveness. Methods: The refinement consisted of three phases and involved qualitative and quantitative (mixed) methods: i) identifying changes to app content, based on findings from an initial evaluation of Drink Less, an updated review of digital alcohol interventions and a content analysis of user feedback; ii) designing new app modules with public input and a consultation with app developers and researchers; and iii) improving the app’s usability through user testing. Results: As a result of the updated review of digital alcohol interventions and user feedback analysis in Phase 1, three new modules: ‘Behaviour Substitution’, ‘Information about Antecedents’ and ‘Insights’, were added to the app. One existing module – ‘Identity Change’ – was removed based on the initial evaluation of Drink Less. Phases 2 and 3 resulted in changes to existing features, such as improving the navigational structure and onboarding process, and clarifying how to edit drinks and goals. Conclusions: A mixed methods approach was used to refine the content and design of Drink Less, providing insights into how to improve its usability and likely effectiveness. Drink Less is now ready for a confirmatory evaluation.