title: Attitudes and Learning through Practice Are Key to Delivering Brief Interventions for Heavy Drinking in Primary Health Care: Analyses from the ODHIN Five Country Cluster Randomized Factorial Trial.
abstract: In this paper, we test path models that study the interrelations between primary health care provider attitudes towards working with drinkers, their screening and brief advice activity, and their receipt of training and support and financial reimbursement. Study participants were 756 primary health care providers from 120 primary health care units (PHCUs) in different locations throughout Catalonia, England, The Netherlands, Poland, and Sweden. Our interventions were training and support and financial reimbursement to providers. Our design was a randomized factorial trial with baseline measurement period, 12-week implementation period, and 9-month follow-up measurement period. Our outcome measures were: attitudes of individual providers in working with drinkers as measured by the Short Alcohol and Alcohol Problems Perception Questionnaire; and the proportion of consulting adult patients (age 18+ years) who screened positive and were given advice to reduce their alcohol consumption (intervention activity). We found that more positive attitudes were associated with higher intervention activity, and higher intervention activity was then associated with more positive attitudes. Training and support was associated with both positive changes in attitudes and higher intervention activity. Financial reimbursement was associated with more positive attitudes through its impact on higher intervention activity. We conclude that improving primary health care providers' screening and brief advice activity for heavy drinking requires a combination of training and support and on-the-job experience of actually delivering screening and brief advice activity.
authors.affiliation: Institute of Health and Society, Newcastle University, Newcastle NE1 7RU, UK. peteranderson.mail@gmail.com.|Department of Family Medicine, Maastricht University, Maastricht 6200, The Netherlands. peteranderson.mail@gmail.com.
authors.forename: Peter
authors.initials: P
authors.lastname: Anderson
authors.affiliation: Institute of Health and Society, Newcastle University, Newcastle NE1 7RU, UK. eileen.kaner@newcastle.ac.uk.
authors.forename: Eileen
authors.initials: E
authors.lastname: Kaner
authors.affiliation: Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare (IQ healthcare), Nijmegen 6525, The Netherlands. myrna.keurhorst@radboudumc.nl.|Centre for Nursing Research, Saxion University of Applied Sciences, Deventer 7513, The Netherlands. myrna.keurhorst@radboudumc.nl.
authors.forename: Myrna
authors.initials: M
authors.lastname: Keurhorst
authors.affiliation: Department of Medical Specialist, Linköping University, Motala 58183, Sweden. preben.bendtsen@liu.se.|Department of Medicine and Health, Linköping University, Motala 58183, Sweden. preben.bendtsen@liu.se.
authors.forename: Preben
authors.initials: P
authors.lastname: Bendtsen
authors.affiliation: Department of Family Medicine, Maastricht University, Maastricht 6200, The Netherlands. ben.vansteenkiste@maastrichtuniversity.nl.
authors.forename: Ben van
authors.initials: BV
authors.lastname: Steenkiste
authors.affiliation: Psychiatry Determent, Neurosciences Institute, Hospital Clínic, IDIBAPS, Barcelona 08003, Spain. TGUAL@clinic.cat.
authors.forename: Jillian
authors.initials: J
authors.lastname: Reynolds
authors.affiliation: Program on Substance Abuse, Public Health Agency, Government of Catalonia, Barcelona 08003, Spain. lidia.segura@gencat.cat.
authors.forename: Lidia
authors.initials: L
authors.lastname: Segura
authors.affiliation: Department of Psychiatry, Medical University of Warsaw, Warsaw 02-091, Poland. marcin.wojnar@wum.edu.pl.
authors.forename: Marcin
authors.initials: M
authors.lastname: Wojnar
authors.affiliation: Independent Laboratory of Family Physician Education, Pomeranian Medical University, Szczecin 70-204, Poland. wikarla@gazeta.pl.
authors.forename: Karolina
authors.initials: K
authors.lastname: Kłoda
authors.affiliation: Institute of Health and Society, Newcastle University, Newcastle NE1 7RU, UK. kathryn.parkinson@newcastle.ac.uk.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Parkinson
authors.affiliation: National Addiction Centre, Institute of Psychiatry, King's College London, London WC2B 5RL, UK. colin.drummond@kcl.ac.uk.|National Institute for Health Research Biomedical Research Centre for Mental Health, Maudsley NHS Foundation Trust, London SE5 8AF, UK. colin.drummond@kcl.ac.uk.
authors.forename: Colin
authors.initials: C
authors.lastname: Drummond
authors.affiliation: State Agency for Prevention of Alcohol-Related Problems, Warsaw 59620-2905, Poland. katarzyna.okulicz@parpa.pl.
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Okulicz-Kozaryn
authors.affiliation: Independent Laboratory of Family Physician Education, Pomeranian Medical University, Szczecin 70-204, Poland. roklr@sci.pam.szczecin.pl.
authors.forename: Artur
authors.initials: A
authors.lastname: Mierzecki
authors.affiliation: Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare (IQ healthcare), Nijmegen 6525, The Netherlands. Miranda.Laurant@radboudumc.nl.|Faculty of Health and Social Studies, HAN University of Applied Sciences, Nijmegen 6525, The Netherlands. Miranda.Laurant@radboudumc.nl.
authors.forename: Miranda
authors.initials: M
authors.lastname: Laurant
authors.affiliation: Health and Social Care Institute, Teesside University, Middesbrough TS1 3BX, UK. d.newbury-birch@tees.ac.uk.
authors.forename: Dorothy
authors.initials: D
authors.lastname: Newbury-Birch
authors.affiliation: Psychiatry Determent, Neurosciences Institute, Hospital Clínic, IDIBAPS, Barcelona 08003, Spain. jillianmreynolds@yahoo.com.
authors.forename: Antoni
authors.initials: A
authors.lastname: Gual
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000517:prevention & control*; D000435:Alcoholic Intoxication / Q000517:prevention & control*; D000437:Alcoholism / Q000534:rehabilitation*; D001291:Attitude of Health Personnel; D004739:England; D005260:Female; D006282:Health Personnel / Q000193:education* / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D017063:Outcome Assessment, Health Care; D011044:Poland; D011320:Primary Health Care / Q000379:methods*; D012017:Referral and Consultation; D013030:Spain; D011795:Surveys and Questionnaires; D013548:Sweden
keywords: financial reimbursement; heavy drinking; primary health care; role security; screening and brief advice; short alcohol and alcohol problems perception questionnaire; therapeutic commitment; training and support