Effect of Community Support on the Implementation of Primary Health Care-Based Measurement of Alcohol Consumption

Adriana Solovei, Eva Jané-Llopis, Liesbeth Mercken, Inés Bustamante, Daša Kokole, Juliana Mejía-Trujillo, Perla Sonia Medina Aguilar, Guillermina Natera Rey, Amy O'Donnell, Marina Piazza, Christiane Sybille Schmidt, Peter Anderson, Hein de Vries, Adriana Solovei, Eva Jané-Llopis, Liesbeth Mercken, Inés Bustamante, Daša Kokole, Juliana Mejía-Trujillo, Perla Sonia Medina Aguilar, Guillermina Natera Rey, Amy O'Donnell, Marina Piazza, Christiane Sybille Schmidt, Peter Anderson, Hein de Vries

Abstract

Alcohol measurement delivered by health care providers in primary health care settings is an efficacious and cost-effective intervention to reduce alcohol consumption among patients. However, this intervention is not yet routinely implemented in practice. Community support has been recommended as a strategy to stimulate the delivery of alcohol measurement by health care providers, yet evidence on the effectiveness of community support in this regard is scarce. The current study used a pre-post quasi-experimental design in order to investigate the effect of community support in three Latin American municipalities in Colombia, Mexico, and Peru on health care providers' rates of measuring alcohol consumption in their patients. The analysis is based on the first 5 months of implementation. Moreover, the study explored possible mechanisms underlying the effects of community support, through health care providers' awareness of support, as well as their attitudes, subjective norms, self-efficacy, and subsequent intention toward delivering the intervention. An ANOVA test indicated that community support had a significant effect on health care providers' rates of measuring alcohol consumption in their patients (F (1, 259) = 4.56, p = 0.034, ηp2 = 0.018). Moreover, a path analysis showed that community support had a significant indirect positive effect on providers' self-efficacy to deliver the intervention (b = 0.07, p = 0.008), which was mediated through awareness of support. Specifically, provision of community support resulted in a higher awareness of support among health care providers (b = 0.31, p < 0.001), which then led to higher self-efficacy to deliver brief alcohol advice (b = 0.23, p = 0.010). Results indicate that adoption of an alcohol measurement intervention by health care providers may be aided by community support, by directly impacting the rates of alcohol measurement sessions, and by increasing providers' self-efficacy to deliver this intervention, through increased awareness of support. Trial Registration ID: NCT03524599; Registered 15 May 2018; https://ichgcp.net/clinical-trials-registry/NCT03524599.

Keywords: Alcohol measurement; Alcohol prevention; Brief alcohol advice; Community support; Primary health care.

Conflict of interest statement

The authors declare no competing interests.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
SCALA study flow based on the analyses in the current study
Fig. 2
Fig. 2
SCALA community support implemented in the first 5 months of implementation
Fig. 3
Fig. 3
Significant and marginally-significant relationships identified in the path analysis model. Note: P-values smaller than 0.001 are indicated by ***, p-values smaller than 0.05 are indicated by *

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