A new open-access paper in Implementation Science, co-authored by ISMH colleagues, is the first review worldwide to identify the theoretical underpinnings of what keeps primary healthcare doctors and nurses from advising alcohol consumers on cutting down.

Alcohol is a leading global risk factor for disease and premature death. Evidence shows that although many drinkers would cut down or stop drinking if advised to do so by a primary health care doctor or nurse, the vast majority of them leave their primary care appointment without being screened and/or advised.

The study, led by Dr. Frederico Rosário of the University of Lisbon, was a systematic review of the literature to identify the barriers and facilitators to the delivery of alcohol screening and brief interventions in primary care. Alcohol brief interventions are short, non-confrontational conversations aiming to motivate drinkers to reduce their consumption and/or their risk of harm. Alcohol brief interventions have historically been preceded by the use of a screening questionnaire to assess an individual’s consumption level and risk of alcohol problems. The authors used behaviour change theory to provide a better understanding of how the barriers could be addressed in order to change practitioners’ behaviour.

The review found multiple barriers to implementation of alcohol screening and brief intervention delivery. Lack of time, low sense of self-efficacy (confidence in their abilities) and lack of specific knowledge and training were among the most commonly found. The findings show the multiple factors underpinning the low delivery of alcohol screening and brief interventions by primary care practitioners, suggesting that more complex implementation programmes addressing several barriers may be needed to successfully change practitioners’ behaviour. The findings from this study were used to design and trial a programme to increase the rates of alcohol screening and brief intervention delivery in primary care, the results of which are expected soon.

Dr. Frederico Rosário led the study and was co-supervised in his PhD by ISMH Director, Niamh Fitzgerald and Cristina Ribeiro of the University of Lisbon.  This review also involved ISMH’s information specialist Kathryn Angus, and colleagues Maria Inês Santos of the Hospital Casa de Saúde São Mateus and Leo Pas of the Catholique University of Leuven. Link to the open-access paper: https://doi.org/10.1186/s13012-020-01073-0