Learning to talk about alcohol consumption
Prevention of heavy drinking in Latin America
Talking about their use of alcohol helps patients. But how can doctors and other health care providers be encouraged to bring up this topic with their patients, especially if they don’t usually do so? The SCALA project (Scale-up of Prevention and Management of Alcohol Use Disorders and Comorbid Depression in Latin America) is investigating whether scaling up an intervention programme for alcohol problems is more effective in the presence of municipal action and support. 'We want to teach health care providers how to screen, advise and refer patients.'
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- Promoting Health and Personalised care
Alcohol use can have serious adverse effects on both individuals and society as a whole. Although there are intervention programmes to prevent and control excessive drinking, their implementation often has little impact. The SCALA project is implementing and testing a screening and intervention programme that proved successful in the past and is now being scaled up. The Latin American cities taking part in the project are Mexico City, Mexico, and Lima, Peru, as well as three small cities near Bogotá, Colombia. The hypothesis is that the intervention will lead to more screenings by embedding primary health care activities into the local community through municipal support and training individual health care providers.
The intervention programme is expected to succeed because of two specific activities, explains Adriana Solovei, one of the coordinators of SCALA together with Daša Kokole. 'It will teach health care providers how to bring up the topic of alcohol consumption during patient interviews and how to subsequently advise or refer patients if necessary.' This currently doesn’t happen enough. 'Doctors think drinking alcohol isn’t harmful, avoid the subject or don’t have time to engage in prevention activities', explains Kokole. Solovei adds, 'We’re testing how we can make it easier for health care providers to implement this intervention more often.'
One hypothesis is that this won’t really work without another activity: the support of the local community. As Solovei explains, 'These interventions have to be supported by stakeholders such as municipal health services to, for example, facilitate communication campaigns to constantly remind health care providers of the fact that being open about alcohol use is very beneficial to patients.' To find out whether the involvement of the local community makes a difference, the researchers are comparing two districts in each city. One district receives municipal support of the training programmes and the other district doesn’t.
The SCALA implementation will last eighteen months. It’s a huge project: in each country, almost twenty health care institutions and about five hundred health care providers are participating. Each health care institution is expected to screen 800 to 4000 patients. According to the researchers, the project is special in that they are evaluating not just the effects of the implementation, but also the processes and costs involved. 'I focus on how the intervention is implemented and what changes are needed in the local context, for example', says Kokole. 'Adriana examines whether it’s worth the investment. Are there any (financial) barriers that prevent people from participating?'
The intervention is currently being introduced in the cities. It’s too early for results, but a first observation is that the participating health care providers are very motivated. 'According to the protocol, doctors only have to bring up the topic with patients who engage in risky alcohol use, but they bring it up with other patients as well', says Kokole. The implementation also appears to be more successful thanks to certain stakeholders who 'take ownership of the intervention', says Solovei. 'A hospital employee in Colombia did this. As a result, we were very successful in recruiting health care providers.'
National Institute of Psychiatry,
A consortium of several international universities in both Europe and Latin America are working together on SCALA. The Department of Health Promotion is coordinating the project. According to the researchers, a lot of knowledge about interventions and process evaluation is being exchanged. Newcastle University, for example, is specialised in tailored clinical interventions, Fundació Clínic Barcelona in developing training programmes and University Medical Centre Hamburg-Eppendorf in mental disorders. Alcohol problems and depression often go together. The project partners based in Latin America provide local expertise.
In addition to facilitating knowledge sharing, this international collaboration opened up the possibility of receiving European funding. SCALA already received funding from Horizon 2020. 'A project carried out by a consortium like this is more likely to receive funding', explains Kokole. 'One condition for these kinds of projects is that you have to know your partners, know they are reliable and know you can work together with them.'
SCALA is a wonderful example of a project in which global research is relevant at the local level. 'This shows from the way our project is organised', says Solovei. 'It was prepared through international cooperation and then implemented locally in city districts. But the lessons learnt locally can later be applied in different contexts.'
The social importance of SCALA is obvious. 'At its core, the project is about creating connections within a community', says Solovei. 'We want to gain insight into processes to involve the community in the interventions.' Ultimately, the goal of the project is to successfully scale up the interventions to a national level. Kokole adds, 'If this health care intervention succeeds - taking contextual, local and cultural adjustments into account - it should theoretically work anywhere'.
Text: Hans van Vinkeveen
The SCALA team