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

作者：Anderson Peter^*; Kaner Eileen; Keurhorst Myrna; Bendtsen Preben; van Steenkiste Ben; Reynolds Jillian; Segura Lidia; Wojnar Marcin; Kloda Karolina; Parkinson Kathryn; Drummond Colin; Okulicz Kozaryn Katarzyna; Mierzecki Artur; Laurant Miranda; Newbury Birch Dorothy; Gual Antoni

来源：International Journal of Environmental Research and Public Health, 2017, 14(2): 121.

DOI：10.3390/ijerph14020121

• primary health care
• heavy drinking
• screening and brief advice
• training and support
• financial reimbursement
• role security
• therapeutic commitment
• short alcohol and alcohol problems perception questionnaire

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.

• 出版日期2017-2