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O'Donnell A, Anderson P, Schmidt C, Braddick F, Lopez-Pelayo H, Mejía-Trujillo J, Natera G, Arroyo M, Bautista N, Piazza M, Bustamante IV, Kokole D, Jackson K, Jane-Llopis E, Gual A, Schulte B. Tailoring an evidence-based clinical intervention and training package for the treatment and prevention of comorbid heavy drinking and depression in middle-income country settings: the development of the SCALA toolkit in Latin America. Glob Health Action 2022; 15:2080344. [PMID: 35867541 PMCID: PMC9310809 DOI: 10.1080/16549716.2022.2080344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Effective interventions exist for heavy drinking and depression but to date there has been limited translation into routine practice in global health systems. This evidence-to-practice gap is particularly evident in low- and middle-income countries. The international SCALA project (Scale-up of Prevention and Management of Alcohol Use Disorders and Comorbid Depression in Latin America) sought to test the impact of multilevel implementation strategies on rates of primary health care-based measurement of alcohol consumption and identification of depression in Colombia, Mexico, and Peru. OBJECTIVE To describe the process of development and cultural adaptation of the clinical intervention and training package. METHODS We drew on Barrero and Castro's four-stage cultural adaption model: 1) information gathering, 2) preliminary adaption, 3) preliminary adaption tests, and 4) adaption refinement. The Tailored Implementation in Chronic Diseases checklist helped us identify potential factors that could affect implementation, with local stakeholder groups established to support the tailoring process, as per the Institute for Healthcare Improvement's Going to Scale Framework. RESULTS In Stage 1, international best practice guidelines for preventing heavy drinking and depression, and intelligence on the local implementation context, were synthesised to provide an outline clinical intervention and training package. In Stage 2, feedback was gathered from local stakeholders and materials refined accordingly. These materials were piloted with local trainers in Stage 3, leading to further refinements including developing additional tools to support delivery in busy primary care settings. Stage 4 comprised further adaptions in response to real-world implementation, a period that coincided with the onset of the COVID-19 pandemic, including translating the intervention and training package for online delivery, and higher priority for depression screening in the clinical pathway. CONCLUSION Our experience highlights the importance of meaningful engagement with local communities, alongside the need for continuous tailoring and adaptation, and collaborative decision-making.
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Affiliation(s)
- Amy O'Donnell
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Peter Anderson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.,Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Christiane Schmidt
- Centre of Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Fleur Braddick
- Addictions Unit, Psychiatry Department, Hospital Clínic, Barcelona, Spain
| | - Hugo Lopez-Pelayo
- Addictions Unit, Psychiatry Department, Hospital Clínic, Barcelona, Spain.,Red de Trastornos Adictivos, Instituto Carlos III. Sinesio Delgado, Madrid, Spain.,Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS); Rosselló, Barcelona, Spain
| | | | - Guillermina Natera
- Instituto Nacional de Psiquiatría Ram´on de la Fuente, Ciudad de México, Mexico
| | - Miriam Arroyo
- Instituto Nacional de Psiquiatría Ram´on de la Fuente, Ciudad de México, Mexico
| | - Natalia Bautista
- Instituto Nacional de Psiquiatría Ram´on de la Fuente, Ciudad de México, Mexico
| | - Marina Piazza
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, San Martin de Porres, Peru
| | - Ines V Bustamante
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, San Martin de Porres, Peru
| | - Daša Kokole
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Katherine Jackson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Eva Jane-Llopis
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.,Institute for Mental Health Policy Research, Toronto, Ontario, Canada.,Univ. Ramon Llull, ESADE, Barcelona, Spain
| | - Antoni Gual
- Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS); Rosselló, Barcelona, Spain
| | - Bernd Schulte
- Centre of Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Rosário F, Vasiljevic M, Pas L, Angus C, Ribeiro C, Fitzgerald N. Efficacy of a theory-driven program to implement alcohol screening and brief interventions in primary health-care: a cluster randomized controlled trial. Addiction 2022; 117:1609-1621. [PMID: 34935229 DOI: 10.1111/add.15782] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 12/06/2021] [Indexed: 11/30/2022]
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.
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Affiliation(s)
- Frederico Rosário
- Instituto de Medicina Preventiva e Saúde Pública, Faculty of Medicine, Lisbon University, Lisbon, Portugal.,Agrupamento de Centros de Saúde Dão Lafões, Viseu, Portugal
| | - Milica Vasiljevic
- Department of Psychology, Durham University, Durham, UK.,Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Leo Pas
- Academic Centre for General Practice, KU Leuven, Leuven, Belgium
| | - Colin Angus
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Cristina Ribeiro
- Instituto de Medicina Preventiva e Saúde Pública, Faculty of Medicine, Lisbon University, Lisbon, Portugal
| | - Niamh Fitzgerald
- Institute for Social Marketing & Health (ISMH), Faculty of Health Sciences & Sport, University of Stirling, Stirling, Scotland, UK
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Kokole D, Jané-Llopis E, Natera Rey G, Aguilar NB, Medina Aguilar PS, Mejía-Trujillo J, Mora K, Restrepo N, Bustamante I, Piazza M, O’Donnell A, Solovei A, Mercken L, Schmidt CS, Lopez-Pelayo H, Matrai S, Braddick F, Gual A, Rehm J, Anderson P, de Vries H. Training primary health care providers in Colombia, Mexico and Peru to increase alcohol screening: Mixed-methods process evaluation of implementation strategy. IMPLEMENTATION RESEARCH AND PRACTICE 2022; 3:26334895221112693. [PMID: 37091075 PMCID: PMC9924276 DOI: 10.1177/26334895221112693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Initial results from the SCALA study demonstrated that training primary health care providers is an effective implementation strategy to increase alcohol screening in Colombia, Mexico and Peru, but did not show evidence of superior performance for the standard compared to the shorter training arm. This paper elaborates on those outcomes by examining the relationship of training-related process evaluation indicators with the alcohol screening practice. Methods A mix of convergent and exploratory mixed-methods design was employed. Data sources included training documentation, post-training questionnaires, observation forms, self-report forms and interviews. Available quantitative data were compared on outcome measure - providers' alcohol screening. Results Training reach was high: three hundred fifty-two providers (72.3% of all eligible) participated in one or more training or booster sessions. Country differences in session length reflected adaptation to previous topic knowledge and experience of the providers. Overall, 49% of attendees conducted alcohol screening in practice. A higher dose received was positively associated with screening, but there was no difference between standard and short training arms. Although the training sessions were well received by participants, satisfaction with training and perceived utility for practice were not associated with screening. Profession, but not age or gender, was associated with screening: in Colombia and Mexico, doctors and psychologists were more likely to screen (although the latter represented only a small proportion of the sample) and in Peru, only psychologists. Conclusions The SCALA training programme was well received by the participants and led to half of the participating providers conducting alcohol screening in their primary health care practice. The dose received and the professional role were the key factors associated with conducting the alcohol screening in practice.Plain Language Summary: Primary health care providers can play an important role in detecting heavy drinkers among their consulting patients, and training can be an effective implementation strategy to increase alcohol screening and detection. Existing training literature predominantly focuses on evaluating trainings in high-income countries, or evaluating their effectiveness rather than implementation. As part of SCALA (Scale-up of Prevention and Management of Alcohol Use Disorders in Latin America) study, we evaluated training as implementation strategy to increase alcohol screening in primary health care in a middle-income context. Overall, 72.3% of eligible providers attended the training and 49% of training attendees conducted alcohol screening in practice after attending the training. Our process evaluation suggests that simple intervention with sufficient time to practice, adapted to limited provider availability, is optimal to balance training feasibility and effectiveness; that booster sessions are especially important in context with lower organizational or structural support; and that ongoing training refinement during the implementation period is necessary.
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Affiliation(s)
- Daša Kokole
- Department of Health Promotion, CAPHRI Care and Public Health
Research Institute, Maastricht University, POB 616, 6200 MD, Maastricht, The Netherlands
| | - Eva Jané-Llopis
- Department of Health Promotion, CAPHRI Care and Public Health
Research Institute, Maastricht University, POB 616, 6200 MD, Maastricht, The Netherlands
- Univ. Ramon Llull, ESADE, Avenida de Pedralbes, 60, 62, 08034 Barcelona, Spain
- Institute for Mental Health Policy
Research, CAMH, 33 Russell Street, Toronto, ON M5S 2S1, Canada
| | - Guillermina Natera Rey
- Instituto Nacional de Psiquiatría Ramón
de la Fuente Muñiz, Calz México-Xochimilco 101, Huipulco, 14370 Ciudad de México,
CDMX, Mexico
| | - Natalia Bautista Aguilar
- Instituto Nacional de Psiquiatría Ramón
de la Fuente Muñiz, Calz México-Xochimilco 101, Huipulco, 14370 Ciudad de México,
CDMX, Mexico
| | - Perla Sonia Medina Aguilar
- Instituto Nacional de Psiquiatría Ramón
de la Fuente Muñiz, Calz México-Xochimilco 101, Huipulco, 14370 Ciudad de México,
CDMX, Mexico
| | | | - Katherine Mora
- Corporación Nuevos Rumbos, Calle 108 A # 4-15, Bogotá,
Colombia
| | | | - Ines Bustamante
- School of Public Health and Administration, Universidad Peruana Cayetano
Heredia, Ave. Honorio Delgado 430, Urb. Ingeniería, S.M.P. Lima -
Perú
| | - Marina Piazza
- School of Public Health and Administration, Universidad Peruana Cayetano
Heredia, Ave. Honorio Delgado 430, Urb. Ingeniería, S.M.P. Lima -
Perú
| | - Amy O’Donnell
- Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne
NE2 4AX, UK
| | - Adriana Solovei
- Department of Health Promotion, CAPHRI Care and Public Health
Research Institute, Maastricht University, POB 616, 6200 MD, Maastricht, The Netherlands
| | - Liesbeth Mercken
- Department of Health Promotion, CAPHRI Care and Public Health
Research Institute, Maastricht University, POB 616, 6200 MD, Maastricht, The Netherlands
- Department of Health Psychology, Open University, Valkenburgerweg 177, 6419 AT Heerlen, the Netherlands
| | - Christiane Sybille Schmidt
- Centre for Interdisciplinary Addiction Research (ZIS), Department of
Psychiatry and Psychotherapy, University Medical Centre
Hamburg-Eppendorf, Hamburg, Germany
| | - Hugo Lopez-Pelayo
- Addictions Unit, Psychiatry Dept, Hospital Clínic, Villarroel 170, 08036 Barcelona, Spain
- Red de Trastornos Adictivos, Instituto Carlos III, Sinesio Delgado, 4, 28029 – Madrid, Spain
- Institut d’Investigacions Biomèdiques
August Pi Sunyer (IDIBAPS), Rosselló, 149-153, 08036 Barcelona, Spain
| | - Silvia Matrai
- Addictions Unit, Psychiatry Dept, Hospital Clínic, Villarroel 170, 08036 Barcelona, Spain
| | - Fleur Braddick
- Addictions Unit, Psychiatry Dept, Hospital Clínic, Villarroel 170, 08036 Barcelona, Spain
| | - Antoni Gual
- Addictions Unit, Psychiatry Dept, Hospital Clínic, Villarroel 170, 08036 Barcelona, Spain
- Red de Trastornos Adictivos, Instituto Carlos III, Sinesio Delgado, 4, 28029 – Madrid, Spain
- Institut d’Investigacions Biomèdiques
August Pi Sunyer (IDIBAPS), Rosselló, 149-153, 08036 Barcelona, Spain
| | - Jürgen Rehm
- Institute for Mental Health Policy
Research, CAMH, 33 Russell Street, Toronto, ON M5S 2S1, Canada
- Institute for Clinical Psychology and Psychotherapy, TU Dresden, Chemnitzer Str. 46, 01187 Dresden, Germany
- Dalla Lana School of Public
Health, University of Toronto, 155 College Street, 6th Floor, Toronto, ON M5T 3M7,
Canada
- Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, ON M5T 1R8,
Canada
- Department of International Health Projects, Institute for
Leadership and Health Management, I.M. Sechenov First Moscow State Medical
University, Trubetskaya str., 8, b. 2, 119992, Moscow, Russian Federation
| | - Peter Anderson
- Department of Health Promotion, CAPHRI Care and Public Health
Research Institute, Maastricht University, POB 616, 6200 MD, Maastricht, The Netherlands
- Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne
NE2 4AX, UK
| | - Hein de Vries
- Department of Health Promotion, CAPHRI Care and Public Health
Research Institute, Maastricht University, POB 616, 6200 MD, Maastricht, The Netherlands
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