title: Impact of primary healthcare providers' initial role security and therapeutic commitment on implementing brief interventions in managing risky alcohol consumption: a cluster randomised factorial trial.
abstract: BACKGROUND
  Brief interventions in primary healthcare are cost-effective in reducing drinking problems but poorly implemented in routine practice. Although evidence about implementing brief interventions is growing, knowledge is limited with regard to impact of initial role security and therapeutic commitment on brief intervention implementation.
  
  
  METHODS
  In a cluster randomised factorial trial, 120 primary healthcare units (PHCUs) were randomised to eight groups: care as usual, training and support, financial reimbursement, and the opportunity to refer patients to an internet-based brief intervention (e-BI); paired combinations of these three strategies, and all three strategies combined. To explore the impact of initial role security and therapeutic commitment on implementing brief interventions, we performed multilevel linear regression analyses adapted to the factorial design.
  
  
  RESULTS
  Data from 746 providers from 120 PHCUs were included in the analyses. Baseline role security and therapeutic commitment were found not to influence implementation of brief interventions. Furthermore, there were no significant interactions between these characteristics and allocated implementation groups.
  
  
  CONCLUSIONS
  The extent to which providers changed their brief intervention delivery following experience of different implementation strategies was not determined by their initial attitudes towards alcohol problems. In future research, more attention is needed to unravel the causal relation between practitioners' attitudes, their actual behaviour and care improvement strategies to enhance implementation science.
  
  
  BACKGROUND
  ClinicalTrials.gov: NCT01501552.
authors.affiliation: Radboud Institute for Health Sciences, Radboud Center for Quality of Healthcare (IQ healthcare), Radboud university medical center, Nijmegen, The Netherlands. Myrna.keurhorst@radboudumc.nl.|Centre for Nursing Research, Saxion University of Applied Sciences, Deventer, Enschede, The Netherlands. Myrna.keurhorst@radboudumc.nl.
authors.forename: M
authors.initials: M
authors.lastname: Keurhorst
authors.affiliation: Institute of Health and Society, Newcastle University, Newcastle, England, UK.|Department of Family Medicine, School CAPHRI, Maastricht University, Maastricht, The Netherlands.
authors.forename: P
authors.initials: P
authors.lastname: Anderson
authors.affiliation: Radboud Institute for Health Sciences, Radboud Center for Quality of Healthcare (IQ healthcare), Radboud university medical center, Nijmegen, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Heinen
authors.affiliation: Department of Medical Specialist and Department of Medicine and Health Sciences, Linköping University, Motala, Sweden.
authors.forename: Preben
authors.initials: P
authors.lastname: Bendtsen
authors.affiliation: Program on Substance Abuse, Public Health Agency, Government of Catalonia, Barcelona, Spain.
authors.forename: Begoña
authors.initials: B
authors.lastname: Baena
authors.affiliation: State Agency for Prevention of Alcohol-Related Problems, Warsaw, Poland.
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Brzózka
authors.affiliation: Program on Substance Abuse, Public Health Agency, Government of Catalonia, Barcelona, Spain.
authors.forename: Joan
authors.initials: J
authors.lastname: Colom
authors.affiliation: National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
authors.forename: Paolo
authors.initials: P
authors.lastname: Deluca
authors.affiliation: National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
authors.forename: Colin
authors.initials: C
authors.lastname: Drummond
authors.affiliation: Institute of Health and Society, Newcastle University, Newcastle, England, UK.
authors.forename: Eileen
authors.initials: E
authors.lastname: Kaner
authors.affiliation: Independent Laboratory of Family Physician Education, Pomeranian Medical University in Szczecin, Szczecin, Poland.
authors.forename: Karolina
authors.initials: K
authors.lastname: Kłoda
authors.affiliation: Independent Laboratory of Family Physician Education, Pomeranian Medical University in Szczecin, Szczecin, Poland.
authors.forename: Artur
authors.initials: A
authors.lastname: Mierzecki
authors.affiliation: School of Health & Social Care, University of Teesside, Middlesbrough, UK.
authors.forename: Dorothy
authors.initials: D
authors.lastname: Newbury-Birch
authors.affiliation: State Agency for Prevention of Alcohol-Related Problems, Warsaw, Poland.
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Okulicz-Kozaryn
authors.affiliation: Program on Substance Abuse, Public Health Agency, Government of Catalonia, Barcelona, Spain.
authors.forename: Jorge
authors.initials: J
authors.lastname: Palacio-Vieira
authors.affiliation: Institute of Health and Society, Newcastle University, Newcastle, England, UK.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Parkinson
authors.affiliation: Hospital Clínic de Barcelona, Fundació Clínic per a la Recerca Biomèdica, Barcelona, Spain.
authors.forename: Jillian
authors.initials: J
authors.lastname: Reynolds
authors.affiliation: Department of Family Medicine, School CAPHRI, Maastricht University, Maastricht, The Netherlands.
authors.forename: Gaby
authors.initials: G
authors.lastname: Ronda
authors.affiliation: Program on Substance Abuse, Public Health Agency, Government of Catalonia, Barcelona, Spain.
authors.forename: Lidia
authors.initials: L
authors.lastname: Segura
authors.affiliation: State Agency for Prevention of Alcohol-Related Problems, Warsaw, Poland.
authors.forename: Luiza
authors.initials: L
authors.lastname: Słodownik
authors.affiliation: Department of Social Medicine, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Fredrik
authors.initials: F
authors.lastname: Spak
authors.affiliation: Department of Family Medicine, School CAPHRI, Maastricht University, Maastricht, The Netherlands.
authors.forename: Ben
authors.initials: B
authors.lastname: van Steenkiste
authors.affiliation: Department of Primary Care and Population Health, University College London, London, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Wallace
authors.affiliation: National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
authors.forename: Amy
authors.initials: A
authors.lastname: Wolstenholme
authors.affiliation: Medical University of Warsaw, Warsaw, Poland.
authors.forename: Marcin
authors.initials: M
authors.lastname: Wojnar
authors.affiliation: Hospital Clínic de Barcelona, IDIBAPS, Barcelona, Spain.
authors.forename: Antoni
authors.initials: A
authors.lastname: Gual
authors.affiliation: Radboud Institute for Health Sciences, Radboud Center for Quality of Healthcare (IQ healthcare), Radboud university medical center, Nijmegen, The Netherlands.|Faculty of Health and Social Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Laurant
authors.affiliation: Radboud Institute for Health Sciences, Radboud Center for Quality of Healthcare (IQ healthcare), Radboud university medical center, Nijmegen, The Netherlands.|Department of General Practice and Health Services Research, University Heidelberg Hospital, Heidelberg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Wensing
mesh_terms: D000437:Alcoholism / Q000517:prevention & control*; D001291:Attitude of Health Personnel; D016000:Cluster Analysis; D005260:Female; D006284:Health Plan Implementation / Q000379:methods; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D007588:Job Satisfaction; D008297:Male; D008875:Middle Aged; D009042:Motivation; D010819:Physician's Role; D011320:Primary Health Care / Q000379:methods*; D012309:Risk-Taking
keywords: Brief interventions; Implementation research; Primary healthcare; Provider influences; Risky drinking