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Table 1 Characteristics, facilitators, and barriers to implementing SBI of included studies

From: Using Consolidated Framework for Implementation Research to investigate facilitators and barriers of implementing alcohol screening and brief intervention among primary care health professionals: a systematic review

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
  1. Note: AUDIT Alcohol Use Disorder Identification Test, CME continuing medical education, GP general practitioner