Quirk Alan, MacNeil Virginia, Dhital Ranjita, Whittlesea Cate, Norman Ian, McCambridge Jim
Centre for Quality Improvement, Royal College of Psychiatrists, London, UK.
Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, UK.
Drug Alcohol Depend. 2016 Apr 1;161:36-41. doi: 10.1016/j.drugalcdep.2016.01.023. Epub 2016 Feb 2.
This qualitative process study, nested within a randomised controlled trial evaluating community pharmacist brief alcohol intervention delivery, aims to explore participants' engagement with the trial, so as to identify whether research participation effects may explain why the brief intervention was not found to be effective.
Qualitative interviews were conducted with 24 randomly selected participants approximately one month after the end of the trial. Semi structured Interviews were conducted by telephone in which participants were asked to give a chronological account of their trial participation, leading to a discussion of possible impacts. These were digitally recorded, transcribed verbatim, and analysed using the Framework method.
A range of motivations for taking part in the trial were identified, including pharmacy visitors wanting to obtain an assessment of their drinking. Participants in both arms of the trial spoke of the potent effect that screening had on them. All participants were exposed to discussions about alcohol with empathic pharmacists and, as this is an integral intervention component, this constitutes contamination. Participants' pre-existing ideas about the nature of alcohol problems had an important bearing on how relevant they thought the intervention was to them.
A detailed appreciation of participant engagement with the trial can provide a strong basis for interpretation of trial outcome data, and in this instance does help explain the null finding. Other findings also indicate the need for dedicated studies of public understanding of the nature of alcohol problems, and their implications for receptivity to brief interventions.
本定性过程研究嵌套于一项评估社区药剂师简短酒精干预实施效果的随机对照试验中,旨在探究参与者对该试验的参与情况,以确定研究参与效应是否可以解释为何未发现简短干预有效。
在试验结束约一个月后,对24名随机选取的参与者进行了定性访谈。通过电话进行半结构化访谈,要求参与者按时间顺序讲述他们参与试验的情况,进而讨论可能产生的影响。访谈内容进行了数字录音、逐字转录,并采用框架法进行分析。
确定了一系列参与试验的动机,包括药房访客希望对自己的饮酒情况进行评估。试验两组的参与者都谈到了筛查对他们产生的强烈影响。所有参与者都与富有同理心的药剂师进行了关于酒精的讨论,而这是干预的一个重要组成部分,这构成了污染。参与者对酒精问题本质的既有观念对他们认为该干预与自身的相关性有重要影响。
对参与者参与试验情况的详细了解可为解释试验结果数据提供有力依据,在这种情况下确实有助于解释零结果。其他研究结果还表明,需要专门研究公众对酒精问题本质的理解及其对接受简短干预的影响。