PIRE Programs NF, Pacific Institute for Research and Evaluation, Beltsville, MD, United States.
PIRE Programs NF, Pacific Institute for Research and Evaluation, Berkeley, CA, United States.
Front Public Health. 2024 Oct 23;12:1416190. doi: 10.3389/fpubh.2024.1416190. eCollection 2024.
Low- and middle-income countries bear disproportionate burdens from excessive alcohol consumption, yet have fewer resources to identify and intervene with risky drinkers. Low-cost screening and brief intervention (SBI) models offer a tool for addressing this health problem and reducing disparities.
In this mixed-methods study, trained pseudo-patients visited health clinics in Zacatecas, Mexico, where a novel SBI model was used with trained nonmedical health educators (HEs) conducting SBI in waiting areas. Pseudo-patients, who provided responses to the AUDIT-C screening items designed to trigger a brief intervention (BI), waited for HEs to engage them in an SBI encounter. Data on HEs' behaviors, SBI components provided, and contextual characteristics were coded from audio recordings of the encounters using an SBI checklist and from pseudo-patient interviews.
Quantitative analyses examined the consistency in pseudo-patients' targeted AUDIT-C scores and those documented by HEs as well as the frequency of delivery of SBI components. Across 71 interactions, kappas between HEs' scores and the targeted AUDIT-C scores ranged from 0.33 to 0.45 across AUDIT-C items; it was 0.16 for the total AUDIT-C. In 41% of interactions, the HEs recorded total AUDIT-C scores that accurately reflected the targeted scores, 45% were below, and 14% exceeded them. Analyses of checklist items and transcripts showed that HEs demonstrated desired interpersonal skills (attentive, empathetic, professional) and provided general information regarding risks and recommendations about reducing consumption. In contrast, personalized BI components (exploring pseudo-patients' personal challenges and concerns about reducing drinking; making a plan) occurred much less frequently. Pseudo-patient interviews revealed contextual factors (noise, lack of privacy) that may have negatively affected SBI interactions.
Using trained nonmedical persons to administer SBI holds promise to increase its reach. However, ongoing training and monitoring, prioritizing comprehensive BIs, eliminating contextual barriers, and electronic delivery of screening may help ensure high quality delivery.
中低收入国家承担着因过度饮酒而造成的不成比例的负担，但用于识别和干预风险饮酒者的资源较少。低成本的筛查和简短干预（SBI）模式为解决这一健康问题和减少差异提供了一种工具。
在这项混合方法研究中，经过培训的模拟患者访问了墨西哥萨卡特卡斯的诊所，那里使用了一种新的 SBI 模型，由经过培训的非医疗保健教育工作者（HEs）在候诊区进行 SBI。模拟患者对 AUDIT-C 筛查项目做出回应，这些回应旨在引发简短干预（BI），然后等待 HEs 与他们进行 SBI 接触。来自模拟患者访谈的数据，对会谈中 HEs 的行为、提供的 SBI 内容以及背景特征进行了编码，使用 SBI 清单和访谈记录对会谈进行了编码。
定量分析检查了模拟患者的目标 AUDIT-C 分数与 HEs 记录的分数之间的一致性，以及 SBI 内容的提供频率。在 71 次互动中，HEs 的分数与目标 AUDIT-C 分数之间的 Kappa 值在 AUDIT-C 项目中范围从 0.33 到 0.45；总 AUDIT-C 的 Kappa 值为 0.16。在 41%的互动中，HEs 记录的总 AUDIT-C 分数准确反映了目标分数，45%的分数低于目标分数，14%的分数高于目标分数。清单项目和访谈记录的分析表明，HEs 表现出了理想的人际交往技巧（专注、同理心、专业），并提供了有关风险和减少饮酒量的建议的一般信息。相比之下，个性化的 BI 内容（探讨模拟患者减少饮酒的个人挑战和关注；制定计划）发生的频率要低得多。模拟患者访谈揭示了可能对 SBI 互动产生负面影响的背景因素（噪音、缺乏隐私）。
使用经过培训的非医疗人员来进行 SBI 有望扩大其覆盖范围。然而，持续的培训和监测、优先考虑全面的 BI、消除背景障碍以及电子筛查的提供，可能有助于确保高质量的服务。
