title: "A welfare recipient may be drinking, but as long as he does as told--he may drink himself to death": a qualitative analysis of project implementation barriers among Danish job consultants.
abstract: BACKGROUND
  This paper is embedded in a randomised controlled trial (Alcohol and Employment) that investigated whether welfare-to-work schemes combined with alcohol treatment were more effective than welfare-to-work schemes alone for helping unemployed welfare recipients with alcohol problems get back to employment and reduce their alcohol problems. The implementation of Alcohol and Employment turned out to be challenging, and fewer welfare recipients than expected were enrolled. The aim of this paper was to identify and investigate obstacles to the implementation of Alcohol and Employment. Our main objective was to study the job consultants' role in the implementation process as they were key personnel in conducting the trial.
  
  
  METHODS
  The process evaluation was conducted in four Danish municipalities in 2011-2012. Data for identifying factors important for the implementation were collected through observations and focus group interviews with job consultants. Data were analysed thematically and thoroughly discussed among members of the project team; emerging themes were then grouped and read again repeatedly until the themes were consistent.
  
  
  RESULTS
  Three themes emerged as the main factors influencing the degree of implementation of Alcohol and Employment: (1) The job consultants' personal attitudes toward alcohol were an important factor. The job consultants generally did not consider a high alcohol intake to be an impediment to employment, or they thought that alcohol problems were only symptoms of more profound problems. (2) The job consultants' perception of their own roles and responsibilities in relation to the welfare recipients was a barrier: they felt that addressing alcohol problems and at the same time sustaining trust with the welfare recipient was difficult. Also, they did not consider alcohol problems to be their responsibility. (3) Shortage of time and resources among the job consultants was determined to be an influential factor.
  
  
  CONCLUSIONS
  We identified important factors at the individual level among the job consultants who threatened the implementation of Alcohol and Employment. Future studies in similar settings can take advantage of these findings when preparing interventions that are implemented by job consultants or similar professionals.
  
  
  BACKGROUND
  ClinicalTrials.gov ID: NCT01416103.
authors.affiliation: National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A, Copenhagen, DK-1353, Denmark. mbha@niph.dk.
authors.forename: Maja Bæksgaard
authors.initials: MB
authors.lastname: Hansen
authors.affiliation: National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A, Copenhagen, DK-1353, Denmark. STKL@niph.dk.
authors.forename: Stine
authors.initials: S
authors.lastname: Kloster
authors.affiliation: National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A, Copenhagen, DK-1353, Denmark. idah@niph.dk.
authors.forename: Ida Høgstedt
authors.initials: IH
authors.lastname: Danquah
authors.affiliation: Unit of Clinical Alcohol Research, Institute of Clinical Research, University of Southern Denmark, JB Winsløwsvej 20, Entrance 220B, 1st floor, Odense, C DK-5000, Denmark. ansnielsen@health.sdu.dk.
authors.forename: Anette Søgaard
authors.initials: AS
authors.lastname: Nielsen
authors.affiliation: National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A, Copenhagen, DK-1353, Denmark. ulbe@niph.dk.
authors.forename: Ulrik
authors.initials: U
authors.lastname: Becker
authors.affiliation: National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A, Copenhagen, DK-1353, Denmark. titt@niph.dk.
authors.forename: Tine
authors.initials: T
authors.lastname: Tjørnhøj-Thomsen
authors.affiliation: National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A, Copenhagen, DK-1353, Denmark. jst@niph.dk.
authors.forename: Janne Schurmann
authors.initials: JS
authors.lastname: Tolstrup
mesh_terms: D000437:Alcoholism / Q000534:rehabilitation*; D001291:Attitude of Health Personnel; D003253:Consultants / Q000523:psychology*; D003718:Denmark; D004651:Employment; D017144:Focus Groups; D006801:Humans; D036301:Qualitative Research; D012946:Social Welfare; D011795:Surveys and Questionnaires; D014505:Urban Population