Instituto de Medicina Preventiva e Saúde Pública, Faculty of Medicine, Lisbon University, Avenida Professor Egas Moniz, 1649-028, Lisbon, Portugal.
Agrupamento de Centros de Saúde Dão Lafões, Av. António José de Almeida - Edíficio MAS, 3514-511, Viseu, Portugal.
Implement Sci. 2021 Jan 7;16(1):6. doi: 10.1186/s13012-020-01073-0.
Alcohol is a leading risk factor contributing to the global burden of disease. Several national and international agencies recommend that screening and brief interventions (SBI) should be routinely delivered in primary care settings to reducing patients' alcohol consumption. However, evidence shows that such activities are seldom implemented in practice. A review of the barriers and facilitators mediating implementation, and how they fit with theoretical understandings of behaviour change, to inform the design of implementation interventions is lacking. This study aimed to conduct a theory-informed review of the factors influencing general practitioners' and primary care nurses' routine delivery of alcohol SBI in adults.
A systematic literature search was carried out in four electronic databases (Medline, CINAHL, CENTRAL, PsycINFO) using comprehensive search strategies. Both qualitative and quantitative studies were included. Two authors independently abstracted and thematically grouped the data extracted. The barriers and facilitators identified were mapped to the domains of the Capability-Opportunity-Motivation-Behaviour system/Theoretical Domains Framework (TDF).
Eighty-four out of the 258 studies identified met the selection criteria. The majority of the studies reported data on the views of general practitioners (n = 60) and used a quantitative design (n = 49). A total of 660 data items pertaining to barriers and 253 data items pertaining to facilitators were extracted and thematically grouped into 46 themes. The themes mapped to at least one of the 14 domains of the TDF. The three TDF domains with the highest number of data units coded were 'Environmental Context and Resources' (n = 158, e.g. lack of time), 'Beliefs about Capabilities' (n = 134, e.g. beliefs about the ability to deliver screening and brief advice and in helping patients to cut down) and 'Skills' (n = 99, e.g. lack of training).
This study identified a range of potential barriers and facilitators to the implementation of alcohol SBI delivery in primary care and adds to the scarce body of literature that identifies the barriers and facilitators from a theoretical perspective. Given that alcohol SBI is seldom implemented, this review provides researchers with a tool for designing novel theory-oriented interventions to support the implementation of such activity.
PROSPERO CRD42016052681.
酒精是导致全球疾病负担的主要风险因素之一。一些国家和国际机构建议，在初级保健环境中应常规提供筛查和简短干预（SBI），以减少患者的饮酒量。然而，有证据表明，这些活动在实践中很少实施。缺乏对影响全科医生和初级保健护士常规提供成人酒精 SBI 的障碍和促进因素的审查，以及它们如何与行为改变的理论理解相契合，以提供实施干预措施的信息。本研究旨在对影响全科医生和初级保健护士常规提供成人酒精 SBI 的因素进行理论导向的审查。
使用全面的搜索策略，在四个电子数据库（Medline、CINAHL、CENTRAL、PsycINFO）中进行了系统文献检索。纳入了定性和定量研究。两位作者独立提取和主题分组提取的数据。将确定的障碍和促进因素映射到能力-机会-动机-行为系统/理论领域框架（TDF）的各个领域。
从 258 项研究中选出 84 项符合选择标准。大多数研究报告了全科医生的观点（n=60）和使用定量设计（n=49）的数据。共提取了 660 个与障碍相关的数据项和 253 个与促进因素相关的数据项，并将其分为 46 个主题。这些主题映射到 TDF 的至少 14 个领域之一。编码数据项最多的三个 TDF 领域是“环境背景和资源”（n=158，例如缺乏时间）、“能力信念”（n=134，例如对提供筛查和简短建议以及帮助患者减少饮酒的能力的信念）和“技能”（n=99，例如缺乏培训）。
本研究确定了在初级保健中实施酒精 SBI 提供的一系列潜在障碍和促进因素，并从理论角度增加了很少从理论角度识别障碍和促进因素的文献。鉴于酒精 SBI 很少实施，本综述为研究人员提供了一种设计新颖的理论导向干预措施的工具，以支持此类活动的实施。
PROSPERO CRD42016052681。
