Measuring and applying motivational constructs in a brief intervention for reducing harmful alcohol use in ED patients in Moshi, Tanzania (Preprint)

BACKGROUND Self Determination Theory (SDT) conceptualizes human motivation in terms of a spectrum. However, literature is scarce on how to measure self-determination in different languages or how self-determination can influence the effectiveness of healthcare interventions. OBJECTIVE The aim of this study was to translate and culturally adapt a psychometric questionnaire on self-determination (TSRQ) as well as SMS booster messages for a Brief Negotiational Intervention (BNI) aimed at reducing harmful alcohol use among injury patients presenting at Kilimanjaro Christian Medical Centre (KCMC) in Moshi, Tanzania. METHODS A mixed-methods approach was used to evaluate the psychometric properties of the TSRQ and SMS booster messages. Likert-scale surveys were administered to expert panels to assess translation quality and adherence to theory. RESULTS Quantitative analyses confirmed that the Swahili translation of the TSRQ accurately reflected SDT constructs. Exploratory Factor Analysis (EFA) revealed a two-domain model had a better fit than the original three-domain TSRQ. Expert panel surveys indicated that the SMS booster messages maintained strong connections to tenets of SDT. CONCLUSIONS This was the first study to conduct a cross-cultural validation of the TSRQ in Tanzania and Tanzanian Swahili and the first to implement and assess motivational constructs in SMS booster messages for a BNI to promote safe alcohol use. The TSRQ is a valid, clinically useful scale, but could be improved with more items. SMS booster messages touch on many SDT constructs, affirming their motivational utility.

Feasibility of SMS Booster for Alcohol Reduction in Injury Patients in Tanzania

BackgroundAlcohol use is associated with 3 million annual deaths globally. Harmful alcohol use, which is particularly prevalent in low- and middle-income countries (LMICs), often increases the probability of traumatic injury. Treatments for harmful alcohol use in LMICs, such as Tanzania, lack trained personnel and adequate infrastructure. The aim of this study was to assess the feasibility of using SMS boosters to augment a hospital based brief intervention (BNI) in this low resourced setting.Methods:We conducted a three stage, four arm feasibility trial of a culturally adapted BNI for injury patients with harmful and hazardous drinking admitted to Kilimanjaro Christian Medical Centre (KCMC) in Moshi, Tanzania. Post hospital discharge, two of the four arms included patients receiving either a standard or personalized short message service (SMS) booster to enhance and or perpetuate the effect of the in-hospital BNI. Text messages were sent weekly throughout a 3-month follow-up period. SMS feasibility was assessed according to the TIDier checklist evaluating what, when, how much, tailoring processes, modifications and how well (intervention fidelity). Data was collected with SMS logs and short answer surveys to participants. Results:While 42 study participants were intended to each receive 12 SMS over a three-month period, 38 received messages correctly, 6 did not receive messages but were supposed to, and 1 received a message who was not supposed to. Of the 258 attempted texts, 73% were successfully sent through the messaging system. Of the messages that failed delivery, the majority were not able to be sent due to participants travelling out of cellular service range or turning off their phones. Participants in both booster arms reported that messages were appropriate, and that they would appreciate the continuation of such reminders. At 6-month follow-up, 100% (n=11) of participants believed that the boosters had a positive impact on their behavior, with 90% reporting a large impact.ConclusionThis study demonstrated feasibility and acceptability of the integration of SMS mobile health technology to supplement this type of nurse-led BNI. SMS booster is a practical tool that can potentially prolong the impact of a brief hospital based intervention to enact behavioral change in injury patients with AUD.

Prevalence and correlates of common mental health problems and recent suicidal thoughts and behaviours among female sex workers in Nairobi, Kenya

Background Adverse childhood experiences (ACEs), poverty, violence and harmful alcohol/substance use are associated with poor mental health outcomes, but few studies have examined these risks among Female Sex Workers (FSWs). We examine the prevalence and correlates of common mental health problems including suicidal thoughts and behaviours among FSWs in Kenya. Methods Maisha Fiti is a longitudinal study among FSWs randomly selected from Sex Worker Outreach Programme (SWOP) clinics across Nairobi. Baseline behavioural-biological survey (n = 1003) data were collected June–December 2019. Mental health problems were assessed using the Patient Health Questionnaire (PHQ-9) for depression, the Generalised Anxiety Disorder tool (GAD-7) for anxiety, the Harvard Trauma Questionnaire (HTQ-17) for Post-Traumatic Stress Disorder (PTSD) and a two-item tool to measure recent suicidal thoughts/behaviours. Other measurement tools included the WHO Adverse Childhood Experiences (ACE) score, WHO Violence Against Women questionnaire, and the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). Descriptive statistics and multivariable logistic regression were conducted using a hierarchical modelling approach. Results Of 1039 eligible FSWs, 1003 FSWs participated in the study (response rate: 96%) with mean age 33.7 years. The prevalence of moderate/severe depression was 23.2%, moderate/severe anxiety 11.0%, PTSD 14.0% and recent suicidal thoughts/behaviours 10.2% (2.6% suicide attempt, 10.0% suicidal thoughts). Depression, anxiety, PTSD and recent suicidal thoughts/behaviours were all independently associated with higher ACE scores, recent hunger (missed a meal in last week due to financial difficulties), recent sexual/physical violence and increased harmful alcohol/substance. PTSD was additionally associated with increased chlamydia prevalence and recent suicidal thoughts/behaviours with low education and low socio-economic status. Mental health problems were less prevalent among women reporting social support. Conclusions The high burden of mental health problems indicates a need for accessible services tailored for FSWs alongside structural interventions addressing poverty, harmful alcohol/substance use and violence. Given the high rates of ACEs, early childhood and family interventions should be considered to prevent poor mental health outcomes.

Are dietary patterns in early childhood associated with alcohol consumption at the age of 17? Analysis of data from the Avon Longitudinal Study of Children and Parents (ALSPAC) prospective cohort study

Objective To examine the relationship between a posteriori dietary patterns in early childhood and alcohol consumption in adolescence. Design Data was obtained from the Avon Longitudinal Study of Children and Parents (ALSPAC) prospective cohort study. Dietary information was obtained using food frequency questionnaires at ages 3 and 7 years. The association between dietary patterns, derived using Principal Components Analysis (PCA) and the Alcohol Use Disorders Identification Test (AUDIT) scores (to assess harmful intake) and frequency of alcohol consumption at 17 years were examined. Secondary analysis considered sugar intake as a percentage of total energy intake. Setting Women who gave birth between 1 April 1991 and 31 December 1992 in the Avon area in southwest England were eligible for the ALSPAC cohort study. Participants 14,541 pregnancies were enrolled in ALSPAC during its initial recruitment phase. For this analysis, complete data was available for between 3148 and 3520 participants. Results Adherence to the “healthy” dietary pattern at both 3 and 7 years of age was positively associated with consuming more than one alcoholic drink per week at 17 years, whilst adherence to the ‘traditional’ dietary pattern at both ages was protective of harmful alcohol intake at 17. Sugar intake was not associated with either alcohol outcome after adjustment for ethnicity, maternal level of education, parental social class and maternal AUDIT score. Conclusions For the population studied, changes to diet in early childhood are unlikely to have an impact on harmful alcohol use in adolescence given the lack of consistency across the results.

69Effect of smoking on treatment outcomes among newly diagnosed Tuberculosis patients in Shimla city India

Background World health organization in 2015 had adopted “End TB Strategy” aimed at ending the global TB epidemic by 2035. Tobacco smoking has been reported to be associated with many aspects of TB disease, including increased vulnerability to being infected, recurrence with TB and related mortality. Methods A prospective cohort study was carried out among newly diagnosed tuberculosis patients of Shimla city which is the capital of Himachal Pradesh, a northern state of India. Data related to smoking status was collected using the standard questionnaire which was used for collection of data regarding tobacco use in Global Adult Tobacco Survey (GATS). Details of the participant’s final treatment outcomes after end of standardized treatment of 6 months was collected from the treatment records of the patients. Results 72 TB patients were included as study subjects. The prevalence of smoking came out to be 37.5%. In our analyses, the risk of unfavorable treatment outcomes was higher among smokers (p value 0.049), Smokeless tobacco users (p value 0.031) and those with history of harmful alcohol use (p value 0.002). Conclusions There is high prevalence of smoking among TB patients and risk factors associated with unfavorable treatment outcome are smoking, Smokeless tobacco and history of harmful alcohol use. Key messages Smoking and smokeless tobacco cessation programmes need to be targeted at Tuberculosis patients. Tuberculosis patients with alcohol related problems should be identified at the time of diagnosis and should be attached with de-addiction centre