Process evaluation of the implementation of a screening and brief intervention program for alcohol risk in primary health care: An experience in Brazil.
OBJECTIVE
Screening and brief intervention (SBI) are considered good prevention strategies for alcohol-related problems in Primary Health Care (PHC). The aim of this study was to evaluate the process of an SBI implementation program for alcohol risk use and evaluate the factors that facilitated or impeded this implementation, in two PHC settings at the Brazilian city of Juiz de Fora.


METHODS
Case 1 public PHC services and case 2 the PHC service of the Military Police. Participants were trained on SBI strategies and supervised during 6 months. The qualitative methodology of action research was used. Data were analysed using thematic analysis.


RESULTS
Case 1: 70 participants; facilitating factors: good expectations about the project; simplicity of SBI technique; collaborative way the project was planned. Barriers: lack of time; discomfort in dealing with alcohol issues; focus on alcohol-dependence; unstable political environment; other priorities; difficulties in patients' referral. Case 2: nine participants. Facilitating factors: simplicity of SBI technique; collaborative way the project was planned; importance of alcohol issues; data confidentiality and the voluntary work to do SBI. Barriers: only one health professional in the group; the variability of the institutional support; organisational culture about alcohol use.


CONCLUSIONS
The barriers and facilitators were related to two main factors: organisational culture and personal attitudes. The action research provided the opportunity to bridge the gap between research and practice, but it also showed that SBI faces significant challenges before it can be implemented as a routine procedure in PHC settings in Brazil.
Amaral
Michaela B
MB
Department of Psychobiology, Universidade Federal de São Paulo (UNIFESP), São Paulo-SP, Brazil.
Ronzani
Telmo M
TM
Souza-Formigoni
Maria Lucia O
ML
D000328:Adult; D000428:Alcohol Drinking / Q000517:prevention & control; D019973:Alcohol-Related Disorders / Q000517:prevention & control*; D001938:Brazil; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D015279:Organizational Culture; D011320:Primary Health Care / Q000379:methods; D011614:Psychotherapy, Brief / Q000379:methods*; D012306:Risk