title: Barriers and facilitators to implementing screening and brief intervention for alcohol misuse: a systematic review of qualitative evidence.
abstract: BACKGROUND
  This review aimed to synthesize qualitative evidence for barriers and facilitators to effective implementation of screening and brief intervention for alcohol misuse in adults and children over 10 years.
  
  
  METHODS
  A search of medical and social science databases was carried out and augmented by hand-searching of reference lists and contents of key journals. Qualitative evidence was synthesized thematically.
  
  
  RESULTS
  A total of 47 papers varying in design and quality were included in the review. Most evaluated implementation in primary care settings. Implementation was reported to be limited by lack of resources, training and support from management, as well as workload. The appropriateness of context in which discussions take place was reported as an acceptability factor for patients and practitioners. Health professionals require sufficient knowledge about alcohol guidelines and risk in order to implement screening and intervention to those most in need.
  
  
  CONCLUSIONS
  Whilst brief screening and brief intervention have been shown to be effective in some settings, this review has identified a number of barriers and facilitators to implementation. Adequate resources, training and the identification of those at risk without stereotyping are the main facilitators in primary care. More research is needed to assess implementation in other settings.
authors.affiliation: School of Health and Related Research, University of Sheffield, Sheffield S1 4DA, UK. m.johnson@sheffield.ac.uk
authors.forename: M
authors.initials: M
authors.lastname: Johnson
authors.forename: R
authors.initials: R
authors.lastname: Jackson
authors.forename: L
authors.initials: L
authors.lastname: Guillaume
authors.forename: P
authors.initials: P
authors.lastname: Meier
authors.forename: E
authors.initials: E
authors.lastname: Goyder
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000175:diagnosis* / Q000517:prevention & control; D002648:Child; D006284:Health Plan Implementation; D006297:Health Services Accessibility; D006302:Health Services Research; D006801:Humans; D011785:Quality Assurance, Health Care