[Show abstract][Hide abstract] ABSTRACT: Title: A pilot feasibility trial cluster randomised controlled trial of screening and brief alcohol intervention to prevent hazardous drinking in young people aged 14-15 in a high school setting (SIPS JR-HIGH)
Authors: Dorothy Newbury-Birch, Stephanie O’Neil, Amy O’Donnell, Simon Coulton, Denise Howel, Elaine McColl, Elaine Stamp, Erin Graybill, Eilish Gilvarry, Kirsty Laing, Ruth McGovern, Paolo Deluca, Colin Drummond, Christine Harle, Paul McArdle, Les Tate, Eileen Kaner.
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Background: Approximately 33% of 15-16 year olds in England report alcohol intoxication in the past month. This present work builds on the evidence base by focusing on ASBI to reduce hazardous drinking in younger adolescents.
Setting: Seven schools across one geographical area in North-East of England.
Methods: Feasibility of trial processes, recruitment and retention and a qualitative evaluation examined facilitators and barriers to the use of ASBI approaches in the school setting in this age group. A three arm pilot cRCT (with randomisation at the school level) with qualitative evaluation to assess the feasibility of a future definitive cRCT of the effectiveness and cost-effectiveness of ASBI in a school setting with an integrated qualitative component. The trial ran in parallel with a repeated cross sectional survey which facilitated screening for the trial.
Participants: Year 10 school pupils (aged 14-15).
Interventions: Young people who screened positive on a single alcohol screening question and consented to take part were randomised to either feedback that they may be risky drinking and provision of an advice leaflet (control condition, n=two schools); a 30-minute brief interactive session which combined structured advice and motivational interviewing techniques delivered by the school learning mentor (Intervention 1, n=two schools); a 60-minute session involving family members delivered by the school learning mentor (Intervention 2, n=three schools). Young people were followed-up at 12-months.
Objectives: To explore the feasibility and acceptability of a future definitive cRCT of ASBI in a school setting to staff, young people and parents; To explore the fidelity of the interventions as delivered by school learning mentors; To estimate the parameters for the design of a definitive cRCT of brief alcohol intervention, including rates of eligibility, consent, participation and retention at 12-months; To pilot the collection of cost and resource use data to inform the cost-effectiveness/utility analysis in a definitive trial.
Main outcome measures: Feasibility and acceptability
Randomisation: Randomisation was carried out at the school level. Randomisation achieved balance on two school-level variables (numbers of pupils in school year and proportion receiving free school meals).
Blinding: School staff, young people and researchers were not blind to the intervention allocated.
Results: 229 young people were eligible for the trial. 182 (82%) were randomised (control n=53; Intervention 1 n=54; Intervention 2 n=75). Of the 75 randomised to Intervention 2, 67 received Intervention 1 (89%). Eight received both Intervention 1 and Intervention 2 (11%). 160/182 were successfully followed up at 12 months (88%). Interviews were carried out with six school lead liaisons; 13 learning mentors; 27 young people and seven parents (n=53). Analysis shows that the school setting is a feasible and acceptable place to carry out ASBI with learning mentors seen as suitable people to do this. Intervention 2 was not seen as feasible or acceptable by school staff, parents or young people.
Outcomes/conclusions: It is feasible and acceptable to carry out a trial of the effectiveness and cost-effectiveness of single session ASBI with young people in the school setting with learning mentors delivering the intervention. A definitive study should not include a parental arm
Trial registration: The trial is registered on the ISRCTN register as ISRCTN07073105
Source of funding: The SIPS JR-HIGH pilot feasibility study was funded under the NIHR Public Health Research Programme commissioned call 10/3002 Alcohol and Young People: Interventions to prevent hazardous drinking of alcohol by school aged children and young people.
[Show abstract][Hide abstract] ABSTRACT: Screening and brief interventions (BI) have been shown to be effective in the management of alcohol consumption for non-treatment-seeking heavy drinkers, who are at physical and social risk, but not yet dependent. The robust evidence base for the effectiveness of BI in primary health care suggests an implementation in other settings could be beneficial. Given the association between alcohol and social problems, social work has a long history of working with persons with alcohol-use disorders, and social workers are often the first service provider to come into contact with heavy-drinking individuals. This critical commentary summarises the existing literature on BI effectiveness in social services and criminal justice settings, and discusses to which extent the social work field might be a promising area for BI delivery.
British Journal of Social Work 09/2014; · 1.19 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Aims: To document the attitudes of general practitioners (GPs) from eight European countries to alcohol and alcohol problems and how these attitudes are associated with self-reported activity in managing patients with alcohol and alcohol problems.
Methods: A total of 2345 GPs were surveyed. The questionnaire included questions on the GP's demographics, reported education and training on alcohol, attitudes towards managing alcohol problems and self-reported estimates of numbers of patients managed for alcohol and alcohol problems during the previous year.
Results: The estimated mean number of patients managed for alcohol and alcohol problems during the previous year ranged from 5 to 21 across the eight countries. GPs who reported higher levels of education for alcohol problems and GPs who felt more secure in managing patients with such problems reported managing a higher number of patients. GPs who reported that doctors tended to have a disease model of alcohol problems and those who felt that drinking was a personal rather than a medical responsibility reported managing a lower number of patients.
Conclusion: The extent of alcohol education and GPs' attitudes towards alcohol were associated with the reported number of patients managed. Thus, it is worth exploring the extent to which improved education, using pharmacotherapy in primary health care and a shift to personalized health care in which individual patients are facilitated to undertake their own assessment and management (individual responsibility) might increase the number of heavy drinkers who receive feedback on their drinking and support to reduce their drinking.
Alcohol and Alcoholism 09/2014; 49(5):531-9. · 1.96 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background: Robust evidence supports the effectiveness of screening and brief alcohol interventions in primary healthcare. However, lack of understanding about their “active ingredients” and concerns over the extent to which current approaches remain faithful to their original theoretical roots has led some to demand a cautious approach to future roll-out pending further research. Against this background, this paper provides a timely overview of the development of the brief alcohol intervention evidence base to assess the extent to which it has achieved the four key levels of intervention research: efficacy, effectiveness, implementation, and demonstration.
Methods: Narrative overview based on (1) the results of a review of systematic reviews and meta-analyses of the effectiveness of brief alcohol intervention in primary healthcare and (2) synthesis of the findings of key additional primary studies on the improvement and evaluation of brief alcohol intervention implementation in routine primary healthcare.
Results: The brief intervention field seems to constitute an almost perfect example of the evaluation of a complex intervention. Early evaluations of screening and brief intervention approaches included more tightly controlled efficacy trials and have been followed by more pragmatic trials of effectiveness in routine clinical practice. Most recently, attention has shifted to dissemination, implementation, and wider-scale roll-out. However, delivery in routine primary health remains inconsistent, with an identified knowledge gap around how to successfully embed brief alcohol intervention approaches in mainstream care, and as yet unanswered questions concerning what specific intervention component prompt the positive changes in alcohol consumption.
Conclusion: Both the efficacy and effectiveness of brief alcohol interventions have been comprehensively demonstrated, and intervention effects seem replicable and stable over time, and across different study contexts. Thus, while unanswered questions remain, given the positive evidence amassed to date, research efforts should maintain a continued focus on promoting sustained implementation of screening and brief alcohol intervention approaches in primary care to ensure that those who might benefit from screening and brief alcohol interventions actually receive such support.
[Show abstract][Hide abstract] ABSTRACT: Aim: To evaluate the effectiveness of different brief intervention strategies at reducing hazardous or harmful drinking in the probation setting. Offender managers were randomized to three interventions, each of which built on the previous one: feedback on screening outcome and a client information leaflet control group, 5 min of structured brief advice and 20 min of brief lifestyle counselling. Methods: A pragmatic multicentre factorial cluster randomized controlled trial. The primary outcome was self-reported hazardous or harmful drinking status measured by Alcohol Use Disorders Identification Test (AUDIT) at 6 months (negative status was a score of <8). Secondary outcomes were AUDIT status at 12 months, experience of alcohol-related problems, health utility, service util-ization, readiness to change and reduction in conviction rates. Results: Follow-up rates were 68% at 6 months and 60% at 12 months. At both time points, there was no significant advantage of more intensive interventions compared with the control group in terms of AUDIT status. Those in the brief advice and brief lifestyle counselling intervention groups were statistically significantly less likely to reoffend (36 and 38%, respectively) than those in the client information leaflet group (50%) in the year following intervention. Conclusion: Brief advice or brief lifestyle counselling provided no additional benefit in reducing hazardous or harmful drinking compared with feedback on screening outcome and a client information leaflet. The impact of more intensive brief intervention on reoffending warrants further research.
Alcohol and Alcoholism 07/2014; · 1.96 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Alcohol misuse is common in people attending emergency departments (EDs) and there is some evidence of efficacy of alcohol screening and brief interventions (SBI). This study investigated the effectiveness of SBI approaches of different intensities delivered by ED staff in nine typical EDs in England: the SIPS ED trial.
PLoS ONE 06/2014; 9(6):e99463. · 3.53 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To identify shared patterns of views in young people relating to the influence of industry-driven alcohol marketing (price, promotion, product and place of purchase/consumption) on their reported drinking behaviour.
[Show abstract][Hide abstract] ABSTRACT: New clinical research findings may require clinicians to change their behaviour to provide high-quality care to people with type 2 diabetes, likely requiring them to change multiple different clinical behaviours. The present study builds on findings from a UK-wide study of theory-based behavioural and organisational factors associated with prescribing, advising, and examining consistent with high-quality diabetes care.Aim: To develop and evaluate the effectiveness and cost of an intervention to improve multiple behaviours in clinicians involved in delivering high-quality care for type 2 diabetes.Design/methods: We will conduct a two-armed cluster randomised controlled trial in 44 general practices in the North East of England to evaluate a theory-based behaviour change intervention. We will target improvement in six underperformed clinical behaviours highlighted in quality standards for type 2 diabetes: prescribing for hypertension; prescribing for glycaemic control; providing physical activity advice; providing nutrition advice; providing on-going education; and ensuring that feet have been examined. The primary outcome will be the proportion of patients appropriately prescribed (using anonymised computer records), advised, and examined (using anonymous patient surveys) at 12 months. We will use behaviour change techniques targeting motivational, volitional, and impulsive factors that we have previously demonstrated to be predictive of multiple health professional behaviours involved in high-quality type 2 diabetes care. We will also investigate whether the intervention was delivered as designed (fidelity) by coding audiotaped workshops and interventionist delivery reports, and operated as hypothesised (process evaluation) by analysing responses to theory-based postal questionnaires. In addition, we will conduct post-trial qualitative interviews with practice teams to further inform the process evaluation, and a post-trial economic analysis to estimate the costs of the intervention and cost of service use.
[Show abstract][Hide abstract] ABSTRACT: Objective: This article reviewed the literature and critically analysed the concept of preparation for parenthood. The analysis is mainly of a discursive nature with some theoretical underpinnings. Background: Preparation for parenthood is a concept that is generally used within psychology, sociology and health professional practice especially midwifery, in terms of preparation for birth and parenthood sessions. However, parents often report feeling unprepared during this period. In order to ensure appropriate delivery of support and education during this time it is important to fully understand what preparation for parenthood really means by unravelling its component elements and understanding its contemporary relevance. Methods: A number of sources were searched using the keywords ‘preparation’ and ‘parenthood’. The concept analysis framework put forward by Walker and Avant was used to develop appropriate cases to further illustrate and explore meaning. Results: The literature search confirmed limited evidence with regards to an in-depth exploration of the concept and the separate elements that are related to each other. This investigation is the first of its kind considering the full range of meanings with regards to the concept and the contemporary evidence available. Law, gender, culture and spirituality all influence the concept and thus antecedents and consequences cannot always be applied to contexts which are fundamentally different. Conclusion: Preparation for parenthood is multi-faceted and changing, thus further research with regards to this concept is warranted. This analysis provides the groundwork for the development of measures that may be used within clinical practice.
Journal of Reproductive and Infant Psychology 01/2014; 32(2). · 0.67 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aim of the study was to explore the evidence base on alcohol screening and brief intervention for adolescents to determine age appropriate screening tools, effective brief interventions and appropriate locations to undertake these activities.
A review of existing reviews (2003-2013) and a systematic review of recent research not included in earlier reviews.
The CRAFFT and AUDIT tools are recommended for identification of 'at risk' adolescents. Motivational interventions delivered over one or more sessions and based in health care or educational settings are effective at reducing levels of consumption and alcohol-related harm.
Further research to develop age appropriate screening tools needs to be undertaken. Screening and brief intervention activity should be undertaken in settings where young people are likely to present; further assessment at such venues as paediatric emergency departments, sexual health clinics and youth offending teams should be evaluated. The use of electronic (web/smart-phone based) screening and intervention shows promise and should also be the focus of future research.
Alcohol and Alcoholism 11/2013; · 1.96 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Aims: The aim of the study was to assess the cumulative evidence on the effectiveness of brief alcohol interventions in primary healthcare in order to highlight key knowledge gaps for further research. Methods: An overview of systematic reviews and meta-analyses of the effectiveness of brief alcohol intervention in primary healthcare published between 2002 and 2012. Findings: Twenty-four systematic reviews met the eligibility criteria (covering a total of 56 randomized controlled trials reported across 80 papers). Across the included studies, it was consistently reported that brief intervention was effective for addressing hazardous and harmful drinking in primary healthcare, particularly in middle-aged, male drinkers. Evidence gaps included: brief intervention effectiveness in key groups (women, older and younger drinkers, minority ethnic groups, dependent/co-morbid drinkers and those living in transitional and developing countries); and the optimum brief intervention length and frequency to maintain longer-term effectiveness. Conclusion: This overview highlights the large volume of primarily positive evidence supporting brief alcohol intervention effects as well as some unanswered questions with regards to the effectiveness of brief alcohol intervention across different cultural settings and in specific population groups, and in respect of the optimum content of brief interventions that might benefit from further research.
Alcohol and Alcoholism 11/2013; · 1.96 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: From International Network on Brief Interventions for Alcohol and Other Drugs (INEBRIA) Meeting 2013 Rome, Italy. 18-20 September 2013 Optimizing Delivery of Health care Interventions (ODHIN) is an ongoing European project (EC, FP7) invol-ving research institutions from 9 European countries using the implementation of Early Identification and Brief Inter-vention (EIBI) programmes for Hazardous and Harmful Alcohol Consumption (HHAC) in Primary Health Care (PHC) as a case study to better understand how to trans-late the results of clinical research into everyday practice. The Italian National Health Service (ISS) is the project leader of the Work Package 6 assessment tool. The aim of the ODHIN assessment tool is to formalise, operationalise and test the questionnaire developed under the PHEPA project in order to produce an update instrument to assess the extent of implementation of EIBIs for HHAC through-out PHC settings. The ODHIN assessment tool has been conceived as a semi-structured questionnaire for the iden-tification of the state of the art, gaps and areas in the country that need further work and strengthening; to monitor the adequacy of brief intervention programmes for HHAC in order to provide recommendations to improve and optimize delivery of health care interventions. It analyses 24 questions distributed across 7 key sections. Data have been collected from 9 ODHIN collaborating countries (