title: Process evaluation of an environmental health risk audit and action plan intervention to reduce alcohol related violence in licensed premises.
abstract: Alcohol-related violence is associated with licensed premise environments and their management. There is a lack of evidence for effective interventions to address these, and there are significant barriers to implementation. This study aims to understand how development and implementation processes can facilitate intervention reach, fidelity and receipt and therefore provides key process data necessary to interpret the results of the randomised controlled trial conducted in parallel.
  
  
  
  A process evaluation, embedded within a randomised controlled trial. Intervention development and implementation were assessed via focus groups (n = 2) and semi-structured interviews (n = 22) with Environmental Health Practitioners (EHPs). Reach and fidelity were assessed via routinely collected intervention data, which was was collected from 276 licenced premises across Wales, UK. Case study semi-structured interviews with licensed premises proprietors (n = 30) explored intervention receipt.
  
  
  
  Intervention co-production with senior EHPs facilitated organisational adoption and implementation. Training events for EHPs played an important role in addressing wider organisational concerns regarding partnership working and the contextual integration of the intervention. EHPs delivered the intervention to 98 % of intervention premises; 35 % of premises should have received a follow up enforcement visit, however EHP confidence in dealing with alcohol risk factors meant only 7 % of premises received one. Premises therefore received a similar intervention dose regardless of baseline risk. Intervention receipt appeared to be greatest in premises with an existing commitment to prevention and those in urban environments.
  
  
  
  The study suggests that a collaborative approach to the development and diffusion of interventions is associated with high levels of organisational adoption, implementation and reach. However, the lack of enforcement visits represents implementation failure for a key mechanism of action that is likely to influence intervention effectiveness. To be effective, any future intervention may require a longer implementation period to develop EHP confidence in using enforcement approaches in this area and multiagency enforcement support, which includes the police, to deliver an adequate intervention dose.
authors.affiliation: DECIPHer, Cardiff School of Social Sciences, Cardiff University, 1-3 Museum Place, Cardiff, CF10 3BD, UK.
authors.forename: Annie
authors.initials: A
authors.lastname: Williams
authors.affiliation: Violence Research Group, School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, Cardiff, CF14 4XY, UK. mooresc2@cardiff.ac.uk.
authors.forename: Simon C
authors.initials: SC
authors.lastname: Moore
authors.affiliation: Violence Research Group, School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, Cardiff, CF14 4XY, UK.
authors.forename: Claire
authors.initials: C
authors.lastname: Shovelton
authors.affiliation: MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Lilybank Gardens, Glasgow, G12 8RZ, UK.
authors.forename: Laurence
authors.initials: L
authors.lastname: Moore
authors.affiliation: DECIPHer, Cardiff School of Social Sciences, Cardiff University, 1-3 Museum Place, Cardiff, CF10 3BD, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Murphy
mesh_terms: D000428:Alcohol Drinking / Q000523:psychology*; D006801:Humans; D008004:Licensure; D011634:Public Health; D012147:Restaurants / Q000331:legislation & jurisprudence*; D012307:Risk Factors; D014754:Violence / Q000517:prevention & control* / Q000706:statistics & numerical data*; D014852:Wales
keywords: Alcohol; Environment; Health and safety; Licensed premises; Night-time economy; Process evaluation; Violence