Table 1 Characteristics, facilitators, and barriers to implementing SBI of included studies
Study (first author) and country | Study method and population | Facilitators coded by the CFIR | Barriers coded by the CFIR |
|---|---|---|---|
Aalto (2001) [13] Finland | Survey, 84 physicians, 167 nurses | Outer setting Patient needs and resources: patient’s willingness to be asked about alcohol consumption Inner setting Available resources: practical training; lectures Access to knowledge and information: information about brief intervention studies Characteristics of individuals Knowledge and beliefs: positive attitudes towards discussing alcohol with patients; belief that it was worth asking about patients’ alcohol consumption; belief that detection and treatment of early phase alcohol use disorder was appropriate for their work Self-efficacy: self-efficacy | Inner setting Available resources: lack of training Characteristics of individuals Knowledge and beliefs: lack of knowledge in screening tools; lack of knowledge about the definition of heavy drinking; lack of knowledge about brief intervention |
Aalto (2003) [35] Finland | Survey, 64 physicians | Inner setting Available resources: brief intervention tools were available Characteristics of individuals Knowledge and beliefs: belief that having the responsibility to ask about patient’s alcohol consumption Other personal attributes: male GPs | N.A. |
Aalto (2003) a[20] Finland | Focus groups, 18 physicians, 19 nurses | N.A. | Intervention characteristics Cost: lack of time for carrying out brief intervention Inner setting Access to knowledge and information: lack of guidelines for brief intervention Characteristics of individuals Knowledge and beliefs: confusion regarding the definition of or difficulty in identifying early-phase heavy drinking; uncertainty about the justification for initiating discussion on alcohol issues with patients Self-efficacy: lack of self-efficacy |
Aalto (2006) [36] Finland | Survey, 1909 physicians | Characteristics of individuals Other personal attributes: having a specialist licence in general practice or occupational health care | N.A. |
Aira (2003) [21] Finland | Semi-structured interviews, 35 physicians | Outer setting Patient needs and resources: clear reason for consultation of the patient; patients’ specific characteristics, such as shabbiness | Intervention characteristics Evidence strength and quality: doubt about the effectiveness of intervention Cost: lack of time Inner setting Available resources: low availability of intervention tools Characteristics of individuals Knowledge and beliefs: fear of harming patient-physician relationship: low awareness of patients’ alcohol problems |
Aira (2004) [23] Finland | Semi-structured interviews, 35 physicians | N.A. | Intervention characteristics Evidence strength and quality: doubt about the effectiveness of counselling Outer setting Patient needs and resources: patient’s denial Inner setting Available resources: lack of intervention tools Characteristics of individuals Knowledge and beliefs: belief that alcohol was not an important risk factor; belief that moderate use of alcohol was acceptable |
Akvardar (2010) [37] Turkey | Survey, 135 physicians | N.A. | Intervention characteristics Cost: lack of time Outer setting Patient needs and resources: patients’ unwillingness to take advice Characteristics of individuals Knowledge and beliefs: lack of knowledge about screening tools; lack of knowledge in identifying problem drinkers; belief that alcohol issue was not an important issue in general practice; fear of harming patient-physician relationship |
Amaral (2010) [38] Brazil | Focus groups, 79 different health professionals (e.g. physicians, social workers, psychologists) | Intervention characteristics Design quality and packaging: simplicity of SBI technique Inner setting Structural characteristics: the collaborative way the project was planned (teamwork) | Intervention characteristics Cost: lack of time Outer setting Cosmopolitanism: difficulty in patients’ referral Inner setting Culture: organizational culture about alcohol use Relative priority: competing priorities Leadership engagement: the variability of the institutional support due to changes in leadership Characteristics of individuals Self-efficacy: discomfort in dealing with alcohol issues |
Anderson (1985) [39] UK | Survey, 312 physicians | Characteristics of individuals Knowledge and beliefs: belief that they had the right to ask patients about their alcohol drinking | Inner setting Available resources: lack of training Characteristics of individuals Knowledge and beliefs: belief that it was unrewarding Other personal attributes: lack of motivation |
Anderson (2003) [40] Australia, Belgium, Canada, the UK, France, Italy, New Zealand, Norway, and Portugal | Survey, 1300 physicians | Inner setting Access to knowledge and information: support calls responding to questions or problems that arose during SBI implementation Characteristics of individuals Knowledge and beliefs: higher education level on alcohol; greater therapeutic commitment to working with alcohol problems Self-efficacy: higher role security (e.g. confidence in giving advice) in working with alcohol problems | N.A. |
Anderson (2004) [14] Australia, Belgium, Canada, the UK | RCT, 632 physicians | Inner setting Available resources: training Access to knowledge and information: support calls responding to questions or problems that arose during SBI implementation Characteristics of individuals Knowledge and beliefs: therapeutic commitment to work with problem drinkers Self-efficacy: role security (e.g. confidence in giving advice appropriately) | N.A. |
Anderson (2014) [17] Catalonia, Czech Republic, Italy, Netherlands, Poland, Portugal, Slovenia, and the UK | Survey, 2345 physicians | Inner setting Organizational incentives and rewards: financial incentives Available resources: screening and advice materials were available; training; Characteristics of individuals Knowledge and beliefs: higher levels of education for alcohol problems Self-efficacy: higher role security in working with alcohol problems (e.g. confidence in giving advice appropriately) | Characteristics of individuals Knowledge and beliefs: having their own disease model rather than prevention model of alcohol problems; belief that drinking was a personal rather than a medical responsibility |
Arborelius (1995) [25] Sweden | Semi-structured interview, 13 physicians | Inner setting Available resources: concrete SBI materials | Intervention characteristics Cost: lack of time Characteristics of individuals Knowledge and beliefs: fear of harming the patient-physician relationship |
Barry (2004) [41] USA | Survey, 41 physician managers | N.A. | Intervention characteristics Cost: lack of time for screening and brief intervention Outer setting Patient needs and resources: patient defensiveness for screening and brief intervention Inner setting Structural characteristics: lack of specialty staff to conduct brief intervention Characteristics of individuals Knowledge and beliefs: lack of knowledge and skills to conduct brief intervention |
Beich (2002) [42] Denmark | Focus groups, 24 physicians | N.A. | Intervention characteristics Cost: considerable resources needed Inner setting Compatibility: interruptions of the natural course of consultations Characteristics of individuals Knowledge and beliefs: questioned the rationale of screening in young drinkers who may grow out of excessive drinking behaviour; Self-efficacy: lack of confidence in their ability to counsel patients effectively on lifestyle issues; difficulty in establishing rapport with patients |
Bendtsen (2015) [43] Netherlands, Poland, Spain, Sweden, the UK | Survey, 746 different health professionals (e.g. nurses, and other staff) | Characteristics of individuals Self-efficacy: role security (e.g. confidence in giving advice appropriately) | N.A. |
Berner (2007) [44] Germany | Survey, 58 physicians | Characteristics of individuals Other personal attributes: male patients; female physicians | N.A. |
Brennan (2013) [45] Australia | Survey, 15 physicians | Inner setting Available resources: training Characteristics of individuals Knowledge and beliefs: knowledge of SBI Self-efficacy: self-efficacy | N.A. |
Clement (1986) [46] UK | Survey, 71 physicians | Outer setting Cosmopolitanism: easy to refer Characteristics of individuals Knowledge and beliefs: knowledge of alcohol; belief that having the right to ask patients about their drinking Other personal attributes: physician’s interest in alcohol issues | Characteristics of individuals Knowledge and beliefs: belief that drinking problems would persist for a long time; belief that it was not rewarding to work with drinkers Self-efficacy: lack of self-efficacy in counselling patients |
Clifford (2011) [47] Australia | Survey, 47 different health professionals (e.g. allied health workers, administrative staff, physicians) | Outer setting Patient needs and resources: patient’s willingness for screening Inner setting Available resources: training Access to knowledge and information: clear guidelines | Outer setting Patient needs and resources: patient’s resistance to referral |
Coloma-Carmona (2017) [48] Spain | Survey, 60 physicians, 47 nurses | N.A. | Intervention characteristics Cost: lack of time Outer setting Patient needs and resources: patients’ dishonesty of alcohol consumption; patients’ neglect of negative consequences of alcohol consumption; patients’ unwillingness to participate in brief intervention; patients’ denial of alcohol use disorder Inner setting Available resources: lack of training |
Costa (2019) [49] France | Survey, 101 physicians | Outer setting Cosmopolitanism: available referral services from community alcohol teams Inner setting Available resources: training Characteristics of individuals Knowledge and beliefs: physicians’ acceptance of controlled drinking as a therapeutic goal of treating alcohol use disorder | N.A. |
Deehan (1997) [50] UK | Survey, 81 physicians | Characteristics of individuals Self-efficacy: self-efficacy | Intervention characteristics Cost: workload or lack of time; causing management problems Characteristics of individuals Knowledge and beliefs: belief that it was not a rewarding task |
Deehan (1998) [51] UK | Survey, 2377 physicians | Outer setting Patient needs and resources: self-motivation of patient Inner setting Available resources: adequate training in detection of alcohol misue Characteristics of individuals Knowledge and beliefs: belief that general practice is an appropriate setting | Intervention characteristics Cost: workload or lack of time; alcohol misusers presented major management problems Inner setting Structural characteristics: lack of specialist support (teamwork) Available resources: lack of training in the treatment of alcohol misuse Characteristics of individuals Knowledge and beliefs: belief that alcohol misusers were unrewarding to treat Self-efficacy: not confident in the ability to treat alcohol misusers |
Deehan (1999) [52] UK | Survey, 264 physicians, 196 nurses | Outer setting Cosmopolitanism: referral services Inner setting Available resources: training Characteristics of individuals Knowledge and beliefs: belief that general practice was an appropriate setting Self-efficacy: self-efficacy in working with alcohol misusers | Intervention characteristics Cost: workload or lack of time; causing management problems Inner setting Available resources: lack of training Characteristics of individuals Knowledge and beliefs: belief that it was not a rewarding task in physicians Self-efficacy: lack of self-efficacy in working with alcohol misusers |
Farmer (2001) [53] UK | Semi-structured interview, 50 physicians | Inner setting Available resources: training Characteristics of individuals Knowledge and beliefs: knowledge of alcohol services; belief that general practice was an appropriate place to treat problem drinkers; belief that having the right to ask about patient’s drinking | Intervention characteristics Cost: lack of time Characteristics of individuals Knowledge and beliefs: belief that alcohol misuse was a social rather than health problem; pessimistic attitudes of physicians towards alcohol patients; unwilling to work with problem drinkers |
Ferguson (2003) [54] USA | Survey, 42 physicians | N.A. | Intervention characteristics Cost: lack of time Outer setting Patient needs and resources: patients’ denial; lack of motivation to change Cosmopolitanism: lack of referral services; lack of community resources Inner setting Available resources: lack of training |
Friedmann (2000) [55] USA | Survey, 853 physicians | Characteristics of individuals Knowledge and beliefs: familiarity with expert guidelines Self-efficacy: greater confidence in alcohol history taking Other personal attributes: younger physician age; female physician | Intervention characteristics Cost: lack of time Outer setting Patient needs and resources: patients' refusal to be diagnosed Cosmopolitanism: long wait for treatment referral Inner setting Available resources: lack of training |
Geirsson (2005) [24] Sweden | Survey, 68 physicians, 193 nurses | Outer setting Cosmopolitanism: support services were readily available to refer patients to or better co-operation with the local community alcohol service Inner setting Available resources: quick and easy screening questionnaires and counselling materials were available; training programs for early intervention Characteristics of individuals Knowledge and beliefs: better practical skills in suitable interview technique | Intervention characteristics Cost: lack of time Inner setting Available resources: lack of training in counselling for reducing alcohol consumption; lack of counselling materials; lack of screening tools Characteristics of individuals Knowledge and beliefs: did not know how to identify problem drinkers |
Gordon (2011) [56] USA | Survey, focus groups, 47 different health professionals (e.g. physicians and other staff) | Intervention characteristics Adaptability: computer-based methods for screening Characteristics of individuals Knowledge and beliefs: education | Intervention characteristics Evidence strength and quality: treatment did not work Cost: logistic problem Outer setting Cosmopolitanism: difficulty in patients’ referral Inner setting Available resources: lack of training; lack of alcohol screening tools |
Gurugama (2003) [57] Sri Lanka | Survey, 105 physicians | Outer setting Cosmopolitanism: support from local services Inner setting Available resources: training Characteristics of individuals Knowledge and beliefs: rewarding to treat persons who misused alcohol Self-efficacy: confident in the ability to treat persons who misused alcohol | Intervention characteristics Cost: persons who misused alcohol presented major management problems; persons who misused alcohol were time-consuming to deal with Inner setting Available resources: lack of training to alcohol misuse Characteristics of individuals Knowledge and beliefs: lack of knowledge; negative attitudes towards persons misusing alcohol |
Hanschmidt (2017) [58] France, Germany, Italy, Spain, and the UK | Survey, 2468 different health professionals (e.g. physicians, other staff) | N.A. | Intervention characteristics Cost: lack of time; too much effort needed Inner setting Relative priority: the low rating of importance of alcohol screening Characteristics of individuals Knowledge and beliefs: insufficient knowledge of screening tools; belief that regular screening was unnecessary |
Holmqvist (2008) [59] Sweden | Survey, 1790 physicians, 2549 nurses | Outer setting Patient needs and resources: the patient had alcohol-related symptoms Cosmopolitanism: improved opportunities for referral Inner setting Structural characteristics: professional teamwork on problem drinkers Access to knowledge and information: improved greater supply of information materials Characteristics of individuals Knowledge and beliefs: improved knowledge about screening instruments; more knowledge about counselling techniques; more knowledge about how alcohol influences health; belief that asking patient’s alcohol consumption was their routine; the clear role of dealing with problem drinkers | Intervention characteristics Cost: lack of time Characteristics of individuals Knowledge and beliefs: uncertain how to ask; uncertain how to give advice; uncertain where to refer the patients |
Hutchings (2006) [26] UK | Focus groups, 43 different health professionals (e.g. practice managers, receptionists, physicians) | Intervention characteristics Adaptability: targeted rather than universal screening, such as new patient registrations, general health checks, and particular types of consultations | Intervention characteristics Evidence strength and quality: uncertainty about the effectiveness of brief alcohol interventions Cost: workload or lack of time Inner setting Structural characteristics: lack of specialty staff Organizational incentives and rewards: lack of incentives Available resources: lack of space Characteristics of individuals Knowledge and beliefs: fear of harming the patient-physician relationship |
Jakubczyk (2015) [60] Poland | Survey, 276 physicians | Intervention characteristics Evidence strength and quality: proven efficacy on early alcohol intervention Outer setting Patient needs and resources: patients’ requests for advice on alcohol consumption; patient’s willingness to pay for alcohol counselling Cosmopolitanism: provision of referral services External policy and incentives: public health education campaigns Inner setting Organizational incentives and rewards: quality assurance credits for providing early intervention; improving salary and working conditions Available resources: training was available; quick and easy screening questionnaire and counselling materials Characteristics of individuals Knowledge and beliefs: having a disease prevention model Other personal attributes: smaller number of patients seen by GP in an average week | Intervention characteristics Cost: lack of time Outer setting Patient needs and resources: patients’ refusal to change; no private insurance coverage for patients receiving alcohol counselling External policy and incentives: lack of government policy to support preventive medicine Inner setting Organizational incentives and rewards: lack of financial incentive Available resources: lack of screening tools; lack of counselling materials; lack of training Characteristics of individuals Knowledge and beliefs: having their own disease model rather than prevention model of alcohol problems; difficulty in identifying problem drinkers; belief that alcohol issue was not an important issue in general practice; belief that preventive health should be the patient’s responsibility but not theirs; having a liberal attitude to alcohol Self-efficacy: discomfort in dealing with alcohol issues Other personal attributes: physicians having alcohol problems |
Johansson (2002) [61] Sweden | Survey, 65 physicians, 141 nurses | Characteristics of individuals Knowledge and beliefs: belief that health status was influenced by alcohol; perceived knowledge; perceived skills; belief that having the responsibility to help problem drinkers with early detection and brief intervention; belief that early detection was important; belief that working with alcohol-related problems worth the cost and effort; belief that anyone could develop alcohol problems | Intervention characteristics Cost: lack of time Outer setting Patient needs and resources: patient’s refusal for help Characteristics of individuals Knowledge and beliefs: belief that more tiring to take care of patients with drinking problems than other patients Self-efficacy: low self-efficacy in reducing patient’s alcohol consumption Other personal attributes: lower self-efficacy in nurses than physicians; nurses worried more about patients might react negatively to questions about alcohol |
Johansson (2005) [62] Sweden | Focus groups, 13 physicians | Outer setting Patient needs and resources: patients had alcohol-related symptoms | Outer setting Cost: lack of time Inner setting Compatibility: doubt about the appropriateness of screening all patients Characteristics of individuals Knowledge and beliefs: fear of harming their relationship with the patient Self-efficacy: lack of self-efficacy |
Johansson (2005) a[63] Sweden | Focus groups, 26 nurses | N.A. | Intervention characteristics Cost: lack of time Characteristics of individuals Knowledge and beliefs: fear of harming their relationship with the patient Self-efficacy: lack of self-efficacy |
Kaariainen (2001) [64] Finland | Survey, 37 physicians, 32 nurses | Characteristics of individuals Knowledge and beliefs: belief that it was appropriate setting for early recognition and treatment | Characteristics of individuals Knowledge and beliefs: poor motivational skills; belief that discussing alcohol consumption was unacceptable Self-efficacy: low self-efficacy |
Kaner (1999) [15] UK | Survey, 279 physicians | Intervention characteristics Evidence strength and quality: proven efficacy of SBI Outer setting Patient needs and resources: patients’ requests for health advice about alcohol consumption Cosmopolitanism: availability of appropriate support services to refer patients to External policy and incentives: public health campaigns make society more concerned about alcohol Inner setting Organizational incentives and rewards: salary conditions improved; training for early alcohol intervention recognized for CME; providing early alcohol intervention recognized for quality assurance credits Available resources: quick and easy counselling materials were available; training | Intervention characteristics Cost: lack of time Outer setting Patient needs and resources: patients’ unwillingness to receive help; no private insurance coverage for patients receiving alcohol counselling External policy and incentives: lack of government policy to support preventive medicine Inner setting Organizational incentives and rewards: lack of financial incentives Available resources: lack of training; lack of counselling materials Characteristics of individuals Knowledge and beliefs: having their own disease model rather than prevention model of alcohol problems; not sure how to identify problem drinkers; belief that preventive health should be the patient’s responsibility but not theirs; belief that general practice was not organized to do preventive counselling; belief that alcohol issue was not an important issue in general practice Self-efficacy: low self-efficacy |
Kaner (2001) [65] Australia, Belgium, Bulgaria, Canada, France, Hungary, Italy, New Zealand, Norway, Poland, Portugal, Thailand, the UK | Survey, 2139 physicians | Characteristics of individuals Knowledge and beliefs: higher levels of alcohol-related education | N.A. |
Kaner (2001) a[66] UK | Survey, 84 physicians, 12814 completed AUDIT screening questionnaires | Outer setting Patient needs and resources: more likely to give brief intervention when patients’ risk drinking status measured by total AUDIT score Inner setting Available resources: provision of training on brief intervention Characteristics of individuals Other personal attributes: patients were males, unemployed, and technically trained; GPs had longer average practice consultations; GPs in solo practice | Characteristics of individuals Other personal attributes: old patients (60-69 years old); students; university educated; unskilled workers |
Kaner (2003) [67] UK | RCT, nurses in 156 general practices | Inner setting Available resources: provision of training | N.A. |
Kersnik (2009) [19] Slovenia | Focus groups, 32 physicians | Outer setting Cosmopolitanism: professional institution, e.g., providing treatment suggestions External policy and incentives: SBI should be part of a national strategy or plan Inner setting Organizational incentives and rewards: financial support Access to knowledge and information: telephone support for questions regarding SBI implementation Characteristics of individuals Knowledge and beliefs: adequate knowledge and skills Other personal attributes: physician’s motivation | Intervention characteristics Cost: workload |
Koopman (2008) [22] South Africa | Survey, 50 physicians | Inner setting Available resources: adequate training | Intervention characteristics Cost: lack of time Outer setting Patient needs and resources: patients’ refusal to take advice External policy and incentives: lack of support of government policy Inner setting Organizational incentives and rewards: difficulties in getting reimbursed for treating patients with alcohol problems Available resources: lack of training; lack of screening and counselling tools Characteristics of individuals Knowledge and beliefs: having their own disease model rather than prevention model of alcohol problems; didn’t know to identify problem drinkers; belief that general practice was not organized for preventive medicine Self-efficacy: low self-efficacy in helping patients reduce alcohol consumption; discomfort in asking patients’ alcohol drinking; belief that preventive health was patient’s responsibility |
Kraus (2017) [68] Germany | Survey, 211 physicians | N.A. | Intervention characteristics Cost: lack of time Outer setting Patient needs and resources: patients’ denial Characteristics of individuals Knowledge and beliefs: lack of knowledge of appropriate alcohol screening instruments; alcohol was not an important risk factor |
Le (2015) [69] USA | Survey, 210 physicians | N.A. | Intervention characteristics Cost: lack of time Inner setting Organizational incentives and rewards: lack of reimbursement Available resources: lack of adequate training Characteristics of individuals Self-efficacy: did not feel confident in helping at-risk drinkers |
Lock (2002) [70] UK | Semi-structured interviews, 24 nurses | Characteristics of individuals Knowledge and beliefs: role legitimacy (belief that having the right to ask about patients’ drinking | Characteristics of individuals Knowledge and beliefs: confusion about the recommended sensible drinking limits; belief that drinking had social and coping functions |
Lock (2004) [71] UK | 128 nurses’ and patients’ data were collected and analysed | Outer setting Patient needs and resources: patients’ risk status as measured by AUDIT score was the most influential predictor for brief intervention Other personal attributes: male patients | N.A. |
Marcell (2002) [72] USA | Survey, 1842 physicians | Outer setting Cosmopolitanism: physicians had places to refer patients Characteristics of individuals Knowledge and beliefs: positive beliefs about the importance of prevention; approved of early alcohol screening Self-efficacy: comfortable to manage alcohol patients Other personal attributes: female physician | N.A. |
May (2006) [73] UK | Semi-structured interviews, 43 physicians | Characteristics of individuals Knowledge and beliefs: physicians already had their own strategies to ask about alcohol use using approaches incorporated over long-standing practice | N.A. |
McAvoy (2001) [16] Australia, Canada, Denmark, France, Hungary, Italy, New Zealand, Norway, Poland, Russia UK | Semi-structured interview, 126 physicians | Intervention characteristics Evidence strength and quality: proven efficacy of early intervention Outer setting Patient needs and resources: patients’ requests for advice about alcohol consumption External policy and incentives: more societal concern about alcohol; government policy favoured preventive medicine; professional recognition of early intervention by medical bodies; policy making preventive medicine a higher status in the medical profession Inner setting Organizational incentives and rewards: financial reimbursement for training in early intervention; health scheme reimbursements; training in early intervention for hazardous alcohol consumption was recognized for continuing medical education credits; providing early intervention for hazardous alcohol consumption was recognized for quality assurance credits Available resources: quick and easy counselling techniques were available; quick and easy diagnostic questionnaires were available Characteristics of individuals Knowledge and beliefs: gained knowledge on alcohol in medical school | Intervention characteristics Cost: lack of time Outer setting Patient needs and resources: private health insurance did not reimburse patients for alcohol counselling; patient’s unwillingness to be asked; patient’s unwillingness for alcohol counselling Cosmopolitanism: lack of referral services External policy and incentives: lack of government policy support Inner setting Organizational incentives and rewards: lack of financial reimbursement or incentives in the contract Available resources: lack of training and education for early intervention in medical schools Characteristics of individuals Knowledge and beliefs: lack of counselling skills for reducing alcohol consumption |
Miller (2006) [74] USA | Focus group, 18 different health professionals (e.g. medical assistants, nurses) | Intervention characteristics Adaptability: computer-based method for screening Inner setting Structural characteristics: teamwork Relative priority: prioritization | Intervention characteristics Cost: lack of time Characteristics of individuals Knowledge and beliefs: lack of knowledge of screening tools; fear of harming patient-physician relationship |
Miquel (2018) [75] Spain | Survey, 867 physicians | Characteristics of individuals Knowledge and beliefs: higher levels of graduate education and postgraduate education in alcohol were more likely to provide screening | Intervention characteristics Cost: lack of time |
Mules (2012) [76] New Zealand | Semi-structured interviews, 19 physicians | N.A. | Intervention characteristics Cost: lack of time Outer setting Patient needs and resources: patient dishonesty |
Nevin (2002) [77] Canada | Survey, 75 physicians | N.A. | Characteristics of individuals Self-efficacy: lack of self-efficacy in counselling |
Nygaard (2010) [18] Norway | Survey, 901 physicians | Outer setting Cosmopolitanism: access to specialized treatment for alcohol problems Inner setting Organizational incentives and rewards: reimbursement Characteristics of individuals Knowledge and beliefs: knowledge; better counselling skills Other personal attributes: male patients; young physicians | Characteristics of individuals Knowledge and beliefs: fear of harming their relationship with the patient Self-efficacy: low self-efficacy |
Nygaard (2011) [78] Norway | Focus groups, 40 physicians | Outer setting Cosmopolitanism: referral services Characteristics of individuals Knowledge and beliefs: clear role of GPs in detecting alcohol problems | Inner setting Compatibility: doubt about the appropriateness to screen all patients; interruptions of the natural course of consultations Characteristics of individuals Knowledge and beliefs: difficulty in defining what is healthy drinking; fear of harming the physician-patient relationship |
Owens (2000) [79] UK | Survey 101 nurses | N.A. | Inner setting Available resources: lack of training Characteristics of individuals Knowledge and beliefs: lack of knowledge and skills |
Payne (2005) [80] Australia | Survey, 170 physicians | Outer setting Patient needs and resources: materials for patients Cosmopolitanism: referral services Inner setting Available resources: diagnosis materials for health professionals; availability of screening tools Characteristics of individuals Knowledge and beliefs: belief in preventive function of screening | N.A. |
Peltzer (2008) [81] South Africa | Survey, semi-structured interviews, 214 different health professionals (i.e. clinic managers, nurses) | Inner setting Structural characteristics: teamwork Relative priority: less prioritized other health goals Learning climate: more chances to try and observe how to perform SBI Available resources: training Characteristics of individuals Knowledge and beliefs: belief that health status was influenced by alcohol Process Reflecting and evaluating: the feedback provided by the SBI trainers during their visits at the clinics | Intervention characteristics Complexity: perceived complexity Cost: workload Characteristics of individuals Knowledge and beliefs: belief that some people used alcohol for traditional purpose; belief that asking elderly about their drinking was a sign of disrepect |
Poplas Susic (2010) [82] Slovenia | Focus groups, 32 physicians | N.A. | Intervention characteristics Cost: lack of time Outer setting Patient needs and resources: patients’ unwillingness to participate in SBI External policy and incentives: lack of government policy Inner setting Compatibility: interruptions of the natural course of consultations Organizational incentives and rewards: lack of funding; Access to knowledge and information: lack of guidelines Characteristics of individuals Knowledge and beliefs: lack of knowledge; inadequate counselling skills; disagreement over the recommended limits to the number of alcohol units per day/week; different interpretations regarding definitions of what constitutes an alcoholic beverage; fear of harming their relationship with the patient Other personal attributes: GPs’ alcohol drinking habits |
Rapley (2006) [83] UK | Semi-structured interview, 43 physicians | Outer setting Patient needs and resources: patients actively seeking help Characteristics of individuals Self-efficacy: confidence in asking patients about their drinking | Intervention characteristics Cost: lack of time Outer setting Cosmopolitanism: lack of referral services Inner setting Relative priority: multiple problems of patients |
Romero-Rodriguez (2019) [84] Spain | Survey, 1532 physicians and 220 nurses | Characteristics of individuals Other personal attributes: providers more likely to give advice: a nurse, female healthcare providers, providers aged 46–55 years | N.A. |
Rush (1994) [85] Canada | Survey, 1235 physicians | Characteristics of individuals Knowledge and beliefs: belief that having the right to ask patients about their drinking; knowledge about drinking problems Self-efficacy: self-efficacy in giving advice | Characteristics of individuals Knowledge and beliefs: pessimistic attitudes towards problem drinkers; unwilling to work with problem drinkers; not feeling proud to work with problem drinkers; belief that it was unrewarding to work with problem drinkers |
Rush (1995) [86] Canada | Focus groups, semi-structured interviews, 24 physicians | Outer setting Cosmopolitanism: available referral service Characteristics of individuals Knowledge and beliefs: belief that health status was influenced by health; belief that having the right to ask their patients about alcohol drinking; belief that having the responsibility to ask about patients’ alcohol consumption; belief that alcohol issue was an important issue in general practice | Intervention characteristics Cost: lack of time Inner setting Compatibility: doubt about the appropriateness of asking all patients Available resources: lack of screening materials Characteristics of individuals Self-efficacy: lack of confidence in helping patients reduce alcohol consumption Other personal attributes: female physicians Process Executing: lack of a systematic strategy |
Seppanen (2012) [87] Finland | Survey, 2001 physicians (2002), 1610 physicians (2007) | Characteristics of individuals Other personal attributes: having a specialist’s licence in general practice or occupational health care; long experience as a GP | N.A. |
Sharp (2011) [88] USA | Survey, 101 physicians | Characteristics of individuals Self-efficacy: self-efficacy in alcohol management skills Other personal attributes: long years of practice | N.A. |
Slaunwhite (2015) [89] Canada | Survey, 67 physicians | Characteristics of individuals Knowledge and beliefs: belief that health status was influenced by alcohol | Outer setting Cosmopolitanism: lack of referral services |
Spandorfer (1999) [90] USA | Survey, 131 physicians | N.A. | Intervention characteristics Evidence strength and quality: doubt about the effectiveness of treatment Outer setting Cosmopolitanism: lack of treatment resources |
Tam (2013) [91] Australia | Focus group, 19 physicians | N.A. | Outer setting Patient needs and resources: unreliable patient alcohol use histories Characteristics of individuals Knowledge and beliefs: fear of harming their relationship with the patient |
Van (2013) [92] South Africa | Survey, 77 physicians | N.A. | Outer setting Cosmopolitanism: lack of referral services Inner setting Structural characteristics: lack of multidisciplinary teams Organizational incentives and rewards: lack of medical funding Available resources: lack of in-patient facilities |
Williams (2016) [27] USA | Semi-structured interviews, 32 different health professionals (e.g. clinical staff, providers, administrative staff) | Characteristics of individuals Knowledge and beliefs: belief that health status was influenced by alcohol; belief that alcohol issue was an important issue in general practice | Outer setting Patient needs and resources: patients’ discomfort; low interest of patients in seeking help Cosmopolitanism: limited treatment referral resources Inner setting Goals and feedback: lack of understanding of the goals of SBI Available resources: lack of training |
Wilson (2011) [93] The UK | Survey, 282 physicians | Intervention characteristics Evidence strength and quality: proven efficacy Patient needs and resources: patients’ requests for advice Outer setting Cosmopolitanism: referral services were available External policy: public health campaigns Inner setting Organizational incentives and rewards: improving salary and working conditions Available resources: availability of easy and quick screening questionnaires and counselling materials; training; providing early invention recognized in quality assessment | Outer setting Patient needs and resources: patients’ refusal to take advice Cost: workload Inner setting Organizational incentives and rewards: lack of contractual incentives Available resources: lack of training; lack of counselling materials Characteristics of individuals Knowledge and beliefs: lack of knowledge to identify problem drinkers |