1
|
Sørensen JB, Lee KSK, Dawson A, Dawson A, Senarathna L, Pushpakumara PHGJ, Rajapakse T, Konradsen F, Glozier N, Conigrave KM, Siriwardhana P, Hansen D, Buhl A, Priyadhasana C, Senawirathna K, Herath M, Mantillake S, Fonseka P, Pearson M. Evaluating the programme and behavior change theories of a community alcohol education intervention in rural Sri Lanka: a study protocol. Glob Health Action 2023; 16:2273625. [PMID: 37971492 PMCID: PMC10795635 DOI: 10.1080/16549716.2023.2273625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 10/17/2023] [Indexed: 11/19/2023] Open
Abstract
Risky alcohol use is a major public health problem globally and in Sri Lanka. While a reduction in alcohol consumption can result in physical, mental, and social benefits, behaviour change is difficult to achieve. Effective, context-adapted interventions are required to minimise alcohol-related harm at a community level. THEATRE is a complex, community-based intervention evaluating whether a promising Sri Lankan pilot study that utilised arts-based research to moderate alcohol use can be scaled up. While the scaled-up pilot study protocol is presented elsewhere, the aim of this protocol paper is to describe the intervention programme theory and evaluation design, and modifications made to the study resulting from COVID-19 and the financial crisis. Drawing on the Behaviour Change Wheel (BCW) and Theoretical Domains Framework, behaviour change theories are presented with potential pathways to guide implementation and evaluation. Alcohol consumption patterns and context of drinking is detailed. The multifaceted intervention targets individuals and communities using arts-based interventions. Four of nine BCW functions are employed in the design of the intervention: education, persuasion, modelling and enablement, and training. Modifications made to the study due to COVID-19 and the financial crisis are described. Ethical approval was obtained from the Ethics Review Committee, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka (ERC/2018/21-July 2018 and Feb 2022) and the University of Sydney (2019/006). Findings will be disseminated locally to community members and key stakeholders and via international peer-reviewed publications.
Collapse
Affiliation(s)
| | - K. S. Kylie Lee
- NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, Discipline of Addiction Medicine, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
- The Edith Collins Centre (Translational Research in Alcohol Drugs and Toxicology), Royal Price Alfred Hospital, Camperdown, NSW, Australia
- Centre for Alcohol Policy Research, La Trobe University, Bundoora, VIC, Australia
- National Drug Research Institute, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
- Burnet Institute, Melbourne, Victoria, Australia
| | - Andrew Dawson
- The Edith Collins Centre (Translational Research in Alcohol Drugs and Toxicology), Royal Price Alfred Hospital, Camperdown, NSW, Australia
- Faculty of Medicine, South Asian Clinical Toxicology Collaboration, University of Peradeniya, Peradeniya, Sri Lanka
| | - Angela Dawson
- School of Public Health, University of Technology Sydney, Sydney, Australia
| | - Lalith Senarathna
- Faculty of Medicine, South Asian Clinical Toxicology Collaboration, University of Peradeniya, Peradeniya, Sri Lanka
- Faculty of Applied Sciences, Rajarata University of Sri Lanka, Mihintale, Sri Lanka
| | - P. H. G. Janaka Pushpakumara
- Faculty of Medicine, South Asian Clinical Toxicology Collaboration, University of Peradeniya, Peradeniya, Sri Lanka
- Department of Family Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | - Thilini Rajapakse
- Faculty of Medicine, South Asian Clinical Toxicology Collaboration, University of Peradeniya, Peradeniya, Sri Lanka
- Department of Psychiatry, University of Peradeniya, Peradeniya, Sri Lanka
| | - Flemming Konradsen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Nick Glozier
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- ARC Centre of Excellence for Children and Families over the Life Course, Sydney, Australia
| | - Katherine M. Conigrave
- The Edith Collins Centre (Translational Research in Alcohol Drugs and Toxicology), Royal Price Alfred Hospital, Camperdown, NSW, Australia
- Royal Prince Alfred Hospital, Drug Health Services, Sydney, NSW, Australia
- Faculty of Medicine and Health, Central Clinical School, Camperdown, NSW, Australia
| | - Prabash Siriwardhana
- Faculty of Medicine, South Asian Clinical Toxicology Collaboration, University of Peradeniya, Peradeniya, Sri Lanka
- Department of Sociology, Rajarata University of Sri Lanka, Mihintale, Sri Lanka
| | | | - Alexandra Buhl
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Chamill Priyadhasana
- Faculty of Medicine, South Asian Clinical Toxicology Collaboration, University of Peradeniya, Peradeniya, Sri Lanka
| | - Kamal Senawirathna
- Faculty of Medicine, South Asian Clinical Toxicology Collaboration, University of Peradeniya, Peradeniya, Sri Lanka
| | - Malith Herath
- Faculty of Medicine, South Asian Clinical Toxicology Collaboration, University of Peradeniya, Peradeniya, Sri Lanka
| | | | | | - Melissa Pearson
- Faculty of Medicine, South Asian Clinical Toxicology Collaboration, University of Peradeniya, Peradeniya, Sri Lanka
- Central Clinical School, University of Sydney, Sydney, Australia
| |
Collapse
|
2
|
Pearson M, Dawson A, Raubenheimer J, Senerathna L, Conigrave K, Lee KSK, Rajapakse T, Pushpakumara PHGJ, Siribaddana S, Soerensen JB, Konradsen F, Jan S, Dawson AJ, Buckley N, Abeysinghe R, Siriwardhana P, Priyadarshana C, Haber PS, Dzidowska M, Abeykoon P, Glozier N. Community-based alcohol education intervention (THEATRE) study to reduce harmful effects of alcohol in rural Sri Lanka: design and adaptation of a mixed-methods stepped wedge cluster randomised control trial. BMJ Open 2023; 13:e064722. [PMID: 37321807 PMCID: PMC10276966 DOI: 10.1136/bmjopen-2022-064722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 04/19/2023] [Indexed: 06/17/2023] Open
Abstract
INTRODUCTION Alcohol consumption is a leading cause of mortality, morbidity and adverse social sequelae in Sri Lanka. Effective community-based, culturally adapted or context-specific interventions are required to minimise these harms. We designed a mixed-methods stepped wedge cluster randomised control trial of a complex alcohol intervention. This paper describes the initial trial protocol and subsequent modifications following COVID-19. METHODS AND ANALYSIS We aimed to recruit 20 villages (approximately n=4000) in rural Sri Lanka. The proposed intervention consisted of health screening clinics, alcohol brief intervention, participatory drama, film, and public health promotion materials to be delivered over 12 weeks.Following disruptions to the trial resulting from the Easter bombings in 2019, COVID-19 and a national financial crisis, we adapted the study in two main ways. First, the interventions were reconfigured for hybrid delivery. Second, a rolling pre-post study evaluating changes in alcohol use, mental health, social capital and financial stress as the primary outcome and implementation and ex-ante economic analysis as secondary outcomes. ETHICS AND DISSEMINATION The original study and amendments have been reviewed and granted ethical approval by Rajarata University of Sri Lanka (ERC/2018/21-July 2018 and February 2022) and the University of Sydney (2019/006). Findings will be disseminated locally in collaboration with the community and stakeholders.The new hybrid approach may be more adaptable, scalable and generalisable than the planned intervention. The changes will allow a closer assessment of individual interventions while enabling the evaluation of this discontinuous event through a naturalistic trial design. This may assist other researchers facing similar disruptions to community-based studies. TRIAL REGISTRATION The trial is registered with the Sri Lanka Clinical Trials Registry; https://slctr.lk/trials/slctr-2018-037.
Collapse
Affiliation(s)
- Melissa Pearson
- Centre for Pesticide Suicide Prevention, College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, UK
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
- South Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Peradeniya, Sri Lanka
| | - Andrew Dawson
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
- South Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Peradeniya, Sri Lanka
| | - Jacques Raubenheimer
- Biomedical Informatics and Digital Health, University of Sydney, Sydney, New South Wales, Australia
| | - Lalith Senerathna
- South Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Peradeniya, Sri Lanka
- Department of Health Promotion, Faculty of Applied Sciences, Rajarata University of Sri Lanka, Mihintale, Sri Lanka
| | - Katherine Conigrave
- Sydney Medical School, Royal Prince Albert Hospital, Camperdown, New South Wales, Australia
- NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
- The Edith Collins Centre (Translational Research in Alcohol Drugs and Toxicology), Sydney Local Health District, Camperdown, New South Wales, Australia
| | - K S Kylie Lee
- NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
- The Edith Collins Centre (Translational Research in Alcohol Drugs and Toxicology), Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Thilini Rajapakse
- South Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Peradeniya, Sri Lanka
- Department of Psychiatry, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Pahala Hangidi Gedara Janaka Pushpakumara
- South Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Peradeniya, Sri Lanka
- Department of Family Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Peradeniya, Sri Lanka
| | - Sisira Siribaddana
- Department of Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | - Jane Brandt Soerensen
- Global Health Section, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Flemming Konradsen
- Global Health Section, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Stephen Jan
- The George Institute for Global Health, Sydney, New South Wales, Australia
| | - Angela J Dawson
- Faculty of Health, World Health Collaborating Centre, University of Technology, Sydney, Sydney, New South Wales, Australia
| | - Nicholas Buckley
- South Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Peradeniya, Sri Lanka
- Biomedical Informatics and Digital Health, University of Sydney, Sydney, New South Wales, Australia
| | - Ranil Abeysinghe
- Department of Psychiatry, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Prabash Siriwardhana
- South Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Peradeniya, Sri Lanka
- Department of Health Promotion, Faculty of Applied Sciences, Rajarata University of Sri Lanka, Mihintale, Sri Lanka
| | - Chamil Priyadarshana
- South Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Peradeniya, Sri Lanka
| | - Paul S Haber
- Sydney Medical School, Royal Prince Albert Hospital, Camperdown, New South Wales, Australia
- NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
- The Edith Collins Centre (Translational Research in Alcohol Drugs and Toxicology), Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Monika Dzidowska
- NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | | | - Nick Glozier
- Brain and Mind Research Institute, University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
3
|
Rajapakse T, Russell AE, Kidger J, Bandara P, López-López JA, Senarathna L, Metcalfe C, Gunnell D, Knipe D. Childhood adversity and self-poisoning: A hospital case control study in Sri Lanka. PLoS One 2020; 15:e0242437. [PMID: 33211766 PMCID: PMC7676676 DOI: 10.1371/journal.pone.0242437] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 11/03/2020] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Adverse childhood experiences (ACE) have been recognized as an important risk factor for suicidal behaviour among adults, but evidence from low and middle-income countries is lacking. This study explored associations between ACE and hospital admission due to non-fatal self-poisoning in Sri Lanka. METHODS This was a case-control study. Adults admitted to a tertiary care hospital for medical management of self-poisoning were included as cases, and age and sex matched controls were recruited from the outpatient department. ACE were measured using the World Health Organization's Childhood Adversity Scale. Logistic regression models adjusting for age, sex, ethnicity, and religion were used to quantify the association between ACE and self-poisoning. RESULTS The study included 235 cases and 451 controls. Cases were 2.5 times (95% CI 1.8, 3.6) more likely to report an ACE than controls and had higher ACE scores. Childhood physical abuse (OR 4.7, 95% CI 1.2, 19.0) and emotional abuse or neglect (OR 3.7, 95% CI 1.3, 10.1, and 3.7, 95% CI 2.3, 6.0 respectively), increased the risk of self-poisoning in adulthood, as did witnessing household violence (OR 2.2, 95% CI 1.4, 3.4), growing up in a household with a mentally ill or suicidal household member (OR 2.1, 95% CI 1.2, 3.4), and experiencing parental death/separation/divorce (OR 3.1, 95% CI 2.0, 4.9) as a child. CONCLUSIONS Reducing exposures to ACEs should be a priority for prevention of suicide and self-harm in Sri Lanka. Innovative methods to increase support for children facing adversity should be explored.
Collapse
Affiliation(s)
- Thilini Rajapakse
- Department of Psychiatry, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Abigail Emma Russell
- Centre for Academic Mental Health, Population Health Sciences, University of Bristol Medical School, Bristol, United Kingdom
| | - Judi Kidger
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Piumee Bandara
- Translational Health Research Institute, Western Sydney University, Sydney, New South Wales, Australia
| | - José A. López-López
- Department of Basic Psychology & Methodology, Faculty of Psychology, University of Murcia, Murcia, Spain
| | - Lalith Senarathna
- Department of Health Promotion, Faculty of Applied Sciences, Rajarata University of Sri Lanka, Mihinthale, Sri Lanka
| | - Chris Metcalfe
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - David Gunnell
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- National Institute of Health Research Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, United Kingdom
| | - Duleeka Knipe
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- The South Asian Clinical Toxicology Research Collaboration (SACTRC), Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| |
Collapse
|
4
|
Sørensen JB, Konradsen F, Agampodi T, Sørensen BR, Pearson M, Siribaddana S, Rheinländer T. A qualitative exploration of rural and semi-urban Sri Lankan men's alcohol consumption. Glob Public Health 2020; 15:678-690. [PMID: 32301401 PMCID: PMC7391794 DOI: 10.1080/17441692.2019.1642366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Harmful alcohol drinking can have health and socio-economic consequences. However, consumption is also associated with pleasure and symbolic meanings. Alcohol intake is increasing in Sri Lanka. In-depth explorations of alcohol patterns are needed to inform interventions and policies. Qualitative data were collected over 11 months in 2014 and 2015 in the North Central Province of Sri Lanka. Ten focus group discussions were conducted in gender, age and geographically (rural and semi-urban) segregated groups. Observations were conducted at alcohol selling establishments and social gatherings. Bourdieu’s concepts practice, habitus, symbolic capital and distinction were used for the analysis. Three groups of consumers emerged: moderate consumers, abstainers and heavy drinkers. They each exercised distinctions through social codes of conduct within and towards other groups of consumers. Symbolic capital was expressed through choice of alcohol. Norms of ‘acceptable consumption’ were defined as ‘moderate drinking’ in covert, social and contained settings. Public, uncontrolled and solitary consumption violated norms of appropriate consumption. Young consumers communicated a ‘modern lifestyle’ through their consumption. This study found that alcohol practices mirrored social norms in this Sri Lankan setting. Alcohol and drug prevention and intervention efforts should take this into account.
Collapse
Affiliation(s)
- Jane Brandt Sørensen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Faculty of Medicine, South Asian Clinical Toxicology Research Collaboration (SACTRC), University of Peradeniya, Peradeniya, Sri Lanka
| | - Flemming Konradsen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Faculty of Medicine, South Asian Clinical Toxicology Research Collaboration (SACTRC), University of Peradeniya, Peradeniya, Sri Lanka
| | - Thilini Agampodi
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | | | - Melissa Pearson
- Faculty of Medicine, South Asian Clinical Toxicology Research Collaboration (SACTRC), University of Peradeniya, Peradeniya, Sri Lanka.,School of Clinical Sciences and Community Health, The University of Edinburgh, Edinburgh, Scotland
| | - Sisira Siribaddana
- Department of Medicine, Faculty of Medicine & Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | - Thilde Rheinländer
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Faculty of Medicine, South Asian Clinical Toxicology Research Collaboration (SACTRC), University of Peradeniya, Peradeniya, Sri Lanka
| |
Collapse
|