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Table 2 Overall results of the findings using Consolidated Framework for Implementation Research

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

Domain/constructs

Facilitators of implementation

Population and range of sample size among different studies (see the note below this table)

Country (see the note below this table)

Reference

Barriers of implementation

Population and range of sample size among different studies (see the note below this table)

Country (see the note below this table)

Reference

Intervention characteristics

 Intervention source

 Evidence strength and quality

Proven efficacy of SBI

P(4): 126-282

AU(1) CA(1) DK(1) FR(1) GB(3) HU(1) IT(1) NO(1) NZ(1) PO(1) RU(1)

[15, 16, 60, 93]

Doubt about the effectiveness of SBI

P(4): 75–131

DHP(2): 43–47

FI(2) GB(2) US(2)

[21, 23, 26, 46, 56, 90]

 Relative advantage

 Adaptability

Targeted rather than universal screening, such as new patient registrations, general health checks, and particular types of consultations

DHP(1): 43

GB(1)

[26]

Computer-based methods for screening

DHP(2): 18-47

US(2)

[56, 74]

 Trialability

 Complexity

Perceiving SBI as a complex intervention

DHP(1): 214

ZA(1)

[81]

 Design quality and packaging

Simplicity of SBI techniques

DHP(1): 79

BR(1)

[38]

 Cost

Workload or lack of time

P(32):13–2377

N(6):19–2549

DPH(4):18–2468

AU(1) BR(1) CA(2) DE(2) DK(1) ES(3) FI(2) FR(2) GB(9) HU(1) IT(2) LK(1) NO(1) NZ(2) PO(2) RU(1) SE(6) SI(2) TR(1) US(5) ZA(1)

[15, 16, 1922, 2426, 37, 38, 41, 48, 5055, 5763, 68, 69, 7476, 82, 83, 86, 93]

Causing management or logistic problems

P(4): 81–2377

N(1): 196DHP(1): 47

GB(3) LK(1) US(1)

[5052, 56, 57]

Considerable resources or too much effort needed

P(1): 24

DHP(1): 2468

DE(1) DK(1) ES(1) FR(1) GB(1) IT(1)

[42, 58]

Outer setting

 Patient needs and resources

Willingness to be asked about their drinking consumption, receive adv, or pay for alcohol counselling

P(2): 84–276

N(1): 167

DHP(1): 47

AU(1) FI(1) PO(1)

[13, 47, 60]

Refusal, unwilling, or low interest to take advice or receive help

P(11): 32–853

N(2): 47–141

DHP(2): 32–47

AU(2) CA(1) DK(1) ES(1) FR(1) GB(3) HU(1) IT(1) NZ(1) NO(1) PO(2) RU(1) SE(1) SI(1) TR(1) US(3) ZA(1)

[15, 16, 22, 37, 47, 48, 54, 55, 60, 61, 82, 27, 93]

Request for health advice on alcohol consumption or self-motivation for seeking help

P(6): 43–2377

AU(1) CA(1) DK(1) FR(1) GB(4) HU(1) IT(1) NZ(1) NO(1) PO(2) RU(1)

[15, 16, 51, 60, 83, 93]

Denial of alcohol misuse

P(5): 35–211

DE(1) FI(1) FR(1) GB(1)US(2)

[23, 41, 49, 54, 68]

Showing alcohol-related symptoms

P(3):13–1790

N(1): 2549

FI(1) SE(2)

[21, 59, 63]

Dishonesty of alcohol consumption or unreliable patient alcohol use histories

P(2): 19

AU(1) NZ(1)

[76, 91]

Clear reason for consultation of patients

P(1): 35

FI(1)

[21]

Neglect of negative consequences caused by excessive alcohol consumption

P(1): 60

N(1): 47

ES(1)

[48]

Risk status as measured by AUDIT score

P(1): 84

N(1): 128

GB(2)

[66, 71]

Private health insurance did not reimburse patients for alcohol counselling

P(3): 126–279

AU(1) CA(1) DK(1) FR(1) GB(2) HU(1) IT(1) NZ(1)

NO(1) PO(2) RU(1)

[15, 16, 60]

Materials for patients

P(1): 170

AU(1)

[80]

Discomfort when talking about alcohol issues

DHP(1): 32

US(1)

[27]

 Cosmopolitanism

Referral services were available, such as provision of addiction care, specialized treatment for alcohol problems, access to local community alcohol teams, general support services (e.g. self-help or counselling)

P(15): 24–1842

N(2): 193–2549

AU(1) CA(1) GB(5) LK(1) NO(2) PO(1) SE(2) SI(1) US(1)

[15, 18, 19, 24, 46, 50, 52, 57, 59, 60, 72, 78, 80, 86, 93]

Lack of referral services or difficulty in patients’ referral

P(7): 42–853

DHP(4): 32–79

AU(1) BR(1) CA(2) DK(1) FR(1) GB(2) HU(1) IT(1) NL(1) NZ(1) O(1) PO(1) RU(1) US(5) ZA(1)

[16, 38, 55, 56, 83, 89, 90, 92, 27]

 Peer pressure

 External policy and incentives

Implementation of SBI using a national alcohol strategy;

P(1): 32

SI(1)

[19]

Lack of government policy to support preventive medicine

P(5): 32–279

AU(1) BR(1) CA(1) DK(1) FR(1) GB(2) HU(1) IT(1) NZ(1) NO(1) PO(2) RU(1) SI(1) ZA(1)

[15, 16, 22, 60, 82]

Public health education campaigns make society more concerned about alcohol;

P(5\4): 126–282

AU(1) CA(1) DK(1) FR(1) GB(3) HU(1) IT(1) NZ(1) NO(1) PO(2) RU(1)

[15, 16, 60, 93]

Policy making preventive medicine a higher status in the medical profession;

P(1): 126

AU(1) CA(1) DK(1) FR(1) GB(3) HU(1)

IT(1) NL(1) NZ(1) NO(1) PO(1) RU(1)

[16]

Professional recognition of early intervention by medical bodies

P(1): 126

AU(1), CA(1) DK(1) FR(1) GB(1) HU(1) IT(1) NL(1) NZ(1) NO(1) PO(1) RU(1)

[16]

Inner setting

 Structural characteristics

Teamwork or interprofessional cooperation in the delivery of SBI

P(1): 1790

N(1): 2549

DHP(3): 18–214

BR(1) SE(1) US(1) ZA(1)

[38, 59, 74, 81]

Lack of staff, specialist support or multidisciplinary team

P(3): 41–2377

DHP(1): 43

GB(2) US(1) ZA(1)

[26, 41, 51, 92]

 Networks and communications

 Culture

Organizational culture about alcohol use

DHP(1): 79

BR(1)

[38]

 Tension for change

 Compatibility

Interruptions of the natural course of consultations

P(3): 24–40

DK(1) NO(1) SI(1)

[42, 78, 82]

Doubt about the appropriateness of screening all patients

P(3): 24–40

CA(1) NO(1) SE(1)

[62, 78, 86]

 Relative priority

Prioritization of alcohol issues

DHP(2): 18–214

US(1) ZA(1)

[74, 81]

Low rating of importance of alcohol screening, patients with multiple problems or other competing priorities

P(1): 43

DHP(2): 79–2468

BR(1) DE(1) ES(1) GB(2) IT(1)

[38, 58, 83]

 Organizational incentives and rewards

Financial support/ incentives/reimbursements, such as improving salary conditions, health scheme reimbursements

P(8): 32–2345

AU(1) CA(1) CZ(1) DK(1) ES(1) FR(1) GB(4) HU(1) IT(2) NL(1) NO(2) NZ(1) PO(3) PT(1) RU(1) SI(2)

[1519, 60, 93]

Lack of financial support, incentives, reimbursement, funding, such as

Contractual incentives, time spent on treating alcohol patients

P(8): 32–282

DHP(1): 43

AU(1) CA(1) K(1) FR(1) GB(4) HU(1) IT(1) NO(1) NZ(1) PO(2) RU(1) SI(1) US(1) ZA(2)

[15, 16, 22, 26, 60, 69, 82, 92, 93]

Training in early alcohol intervention recognized for continuing medical education credits

P(2): 126–279

AU(1), CA(1) DK(1), FR(1) GB(2) HU(1) IT(1) NZ(1) NO(1) PO(1) RU(1)

[15, 16]

Providing early alcohol intervention recognized for quality assurance credits

P(3): 276–282

GB(2), PO(1)

[15, 60, 93]

 Goals and feedback

Lack of understanding of the goals of SBI

DHP(1): 32

US(1)

[27]

 Learning climate

More chances to try and observe SBI

DHP(1): 214

ZA(1)

[81]

 Leadership engagement

Variability of the institutional support due to changes in leadership

DHP(1): 79

BR(1)

[38]

 Available resources

Training

P(15): 15–2377

N(3): 167–196

DHP(2): 47–214

AU(5) BE(2) BG(1) CA(2) CZ(1) ES(1) FI(1) FR(1) GB(11) U(1) IT(2) LK(1) NL(1) NO(1) NZ(1) PO(3) PT(2) SE(1) SI(1) TH(1) ZA(2)

[1315, 17, 22, 24, 45, 47, 5053, 57, 60, 6567, 80, 81, 93]

Lack of training in detection in alcohol misuse, counselling in reducing alcohol consumption

P(17): 42–2377

N(4): 47–196

DHP(2): 32–47

AU(2) BE(1) BG(1) CA(2) DK(1) ES(1) FI(1) FR(2) GB(7) HU(2) IT(2) LK(1) NZ(2) NO(2) PO(3) PT(1) RU(1) SE(1) TH(1) US(6) ZA(1)

[13, 15, 16, 22, 24, 395052, 5457, 60, 65, 69, 79, 27, 93]

Screening and counselling materials were available

P(9): 13–2345

N(1): 193

AU(3) CA(1) CZ(1) DK(1) ES(1) FI(1) FR(1) GB(4) HU(1) IT(2) NL(1) NO(1) NZ(1) PO(3) PT(1) RU(1) SE(2) SI(1)

[1517, 24, 25, 35, 60, 80, 93]

Lack of screening devices or counselling materials

P(8): 24–282

N(1): 193

DHP(1): 47

CA(1) FI(2) GB(2) SE(1) PO(1) US(1) ZA(1)

[15, 2124, 56, 60, 86, 93]

Lack of space and in-patient facilities

P(1): 77

DHP(2): 32–47

GB(1) US(1)

ZA(1)

[26, 92]

 Access to knowledge and information

Easy access to clear guidelines or information related to implementing SBI

P(2): 84–1790

N(2): 167–2549

DHP(1): 47

AU(1) FI(1) SE(1)

[13, 47, 59]

Lack of guidelines

P(2): 18–32

N(1): 19

FI(1) SI(1)

[20, 82]

Support calls responding to questions or problems that arose during SBI

P(2): 632–1300

AU(2) BE(2) CA(2) FR(1) GB(2) IT(1) NO(1) NZ(1) PT(1)

[14, 40]

Characteristics of individuals

 

 Knowledge and beliefs about the intervention

Knowledge: knowledge, qualification, or education level of alcohol medicine

P(8): 50–2345

DHP(1): 47

AU(2) BE(1) CA(3) CZ(1) DK(1) ES(2) FR(2) GB(5) HU(1) IT(3) NL(1) NZ(2) NO(2) PO(2) PT(2) RU(1) SE(1) SI(1) US(1)

[16, 17, 40, 46, 53, 56, 59, 75, 85]

Knowledge: confusion regarding the definition of early-phase heavy drinking and problem drinkers, the recommended sensible drinking limits, or what is health drinking

P(12): 18–282

N(5): 19–193

AU(1) CA(1) DK(1) FI(2) FR(1) GB(5) HU(1) IT(1) LK(1) NO(2) NZ(1) PO(2) RU(1) SE(1) SI(1) TR(1) ZA(1)

[13, 15, 16, 20, 22, 24, 37, 57, 60, 70, 78, 79, 82, 93]

Familiarity with expert guidelines

P(1): 853

US(1)

[55]

Insufficient knowledge of screening tools, intervention techniques, counselling skills

P(10): 19–1790

N(3): 32–2549

DHP(2): 18–2468

AU(2) CA(1) DE(2) DK(1) FI(2) ES(1) FR(2) GB(2) HU(1) IT(2) NZ(1) NO(1) PO(1) RU(1) SE(1) SI(1) TR(1) US(2) ZA(1)

[13, 16, 22, 37, 41, 58, 59, 64, 68, 74, 82, 91]

knowledge of alcohol screening or brief intervention;

P(6): 15–1790

N(2): 28–2549

AU(1) ES(1) NL(1) NO(1) PO(1) SE(3) SI(1)

[18, 19, 45, 59, 61]

Having their own disease model rather than prevention model of alcohol problems

P(4): 50–2345

ES(1) CZ(1) GB(2) IT(1) NL(1) PO(2) PT(1) SI(1) ZA(1)

[15, 17, 22, 60]

already had their own strategies in asking patients about their alcohol drinking;

P(1): 43

GB(1)

[73]

Low awareness of alcohol problems

P(2): 35–170

DHP(1): 43

AU(1) FI(1) GB(1)

[21, 26, 80]

practical skills in interviewing or counselling technique

P(2): 68–1790

N(2): 193–2549

NO(1) SE(2)

[18, 24, 59]

    

Beliefs: the belief that having the responsibility to ask about patient's alcohol consumption

P(5): 24–1790

N(2): 141–2549

CA(1) FI(1) NO(2) SE(2)

[35, 59, 61, 78, 86]

Beliefs: the belief that discussion about alcohol issues might harm the patient-physician relationship

P(8): 13–901

N(1): 26

DHP(2): 18–43

AU(1) FI(1) GB(1) NO(2) SE(3) SI(1) TR(1) US(1)

[18, 21, 25, 26, 37, 62, 63, 74, 78, 82, 91]

The belief that having the right to ask patients about their drinking

P(4): 24–1235

N(1): 24

CA(2) GB(3) US(1)

[39, 46, 53, 70, 85, 86]

The belief that alcohol was not an important risk factor

P(2): 35–211

DE(1) FI(1)

[23, 68]

Greater therapeutic commitment to working with alcohol problems

P(3): 101–1300

AU(2) BE(2) CA(2) FR(2) GB(2) IT(1) NZ(1) NO(1) PT(1)

[14, 40, 49]

The belief that drinking was a personal rather than a medical responsibility

P(5): 50–2345

CZ(1) ES(1) GB(3) IT(1) NL(1) PO(3) PT(1) SI(1) ZA(1)

[15, 17, 22, 53, 60]

The belief that health status was influenced by alcohol

P(3): 24–67

N(1): 141

DHP(1): 214

CA(2) SE(1) US(1) ZA(1)

[61, 81, 86, 89, 27]

The belief that alcohol issue was not an important issue in general practice

P(3): 135–279

GB(1) PO(1) TR(1)

[15, 60, 37]

The belief that it was rewarding to treat patients with alcohol use disorder

P(1): 105

LK(1)

[57]

The belief that general practice was not organized for preventive medicine

P(2): 50–279

GB(1) ZA(1)

[15, 22]

The belief that it was rewarding to treat patients with alcohol use disorder

P(1): 105

LK(1)

[57]

The belief that it was not rewarding to work with drinkers

P(6): 71–2377

CA(1) GB(4) US(1)

[39, 46, 5052, 85]

The belief in preventive function of screening

P(4): 65–1842

N(1): 141

AU(1) PO(1) SE(1) US(1)

[60, 61, 72, 80]

The belief that discussing alcohol consumption was unacceptable

P(1): 37

N(1): 32

FI(1)

[64]

The belief that anyone could develop alcohol problems

P(1): 65

N(1): 141

SE(1)

[61]

The belief that regular screening was unnecessary

DHP(1) 2468

DE(1) ES(1) FR(1) GB(1) IT(1)

[58]

The belief that general practice was an appropriate setting or alcohol issue was an important issue in general practice

P(6): 24–2377

N(3): 32–196

DHP(1): 32

CA(1) FI(2) GB(3) US(1)

[13, 5153, 64, 86, 27]

The belief that moderate use of alcohol was acceptable or it had social or coping function

P(2): 35–276

N(1): 14

FI(1) GB(1) PO(1)

[23, 60, 70]

    

Doubt about the rationale in screening in young people

P(1): 24

DK(1)

[42]

    

The belief that some people used for traditional purpose

DHP(1): 214

ZA(1)

[81]

    

The belief that asking elderly about their drinking was a sign of disrespect

DHP(1): 214

ZA(1)

[81]

    

Other negative/pessimistic attituded towards alcohol patients such as not feeling proud, unwilling to work with drinkers, more tiring to take care of Patients with alcohol problem than other patients

P(4): 50–1235 N(1): 141

CA(1) GB(1) LK(1) SE(1)

[53, 57, 61, 85]

 Self-efficacy

Self-efficacy in alcohol history taking;

N(1): 196

US (1)

[55]

Low self-efficacy in inquiring about patients’ alcohol drinking, giving advice, counselling patients

P(4): 24–75

CA(1) DK(1) GB(1) ZA(1)

[22, 42, 46, 77]

Confident in alcohol management skills or in asking, giving advice, motivating or influencing patients’ drinking

P(12): 15–2345

N(1): 167

DHP(1): 746

AU(2) BE(1) CA(2) ES(1) FI(1) FR(1) GB(4) IT(1) LK(1) NL(1) NO(1) NZ(1) PO(2) PT(1) SE(1) US(2)

[13, 40, 43, 45, 50, 57, 60, 72, 83, 85, 88]

Not confident or discomfort in working in alcohol issues (e.g. Establishing rapport with patients) or in helping patients reduce alcohol consumption

P(13): 15–2377

N(3): 19–141

DHP(1): 79

BR(1) CA(1) DK(1) FI(2) GB(3) NO(1) PO(1) SE(3) US(1) ZA(1)

[15, 18, 20, 22, 38, 42, 51, 52, 6064, 69, 86]

 Individual stage of change

 Individual identification with the organization

 Other personal attributes

Male patients

P(3): 58–901

N(1): 128

DE(1) GB(2) NO(1)

[18, 44, 66, 71]

University educated or old patients (60–69 years old)

P(1): 84

GB(1)

[66]

Unemployed patients

P(1): 84

GB(1)

[66]

Physicians had alcohol drinking habits or problems

P(2): 32–276

PO(1) SI(1)

[60, 82]

Younger physician age

P(2): 853–901

NO(1) US(1)

[18, 55]

Some nurses worried more or had lower self-efficacy than physicians

P(1): 65

N(1): 141

SI(1)

[61]

Female healthcare providers

P(4): 58–1842

N(1): 228

DE(1) ES(1) US(2)

[44, 55, 72, 84]

Lack of motivation of physicians

P(1): 312

US(1)

[39]

Longer years of practice

P(2): 101–3611

FI(1) US(1)

[87, 88]

Female physicians

P(1): 24

CA(1)

[86]

Physicians (asking about alcohol use)

P(1): 65

N(1): 141

SE(1)

[61]

Nurses (provided advice for reducing alcohol use)

P(1): 1543

N(1): 228

ES(1)

[84]

Smaller number of patients seen by GP in an average week

P(1): 276

PO(1)

[60]

Longer average practice consultations

P(1): 84

GB(1)

[66]

Solo practice

P(1): 84

GB(1)

[66]

Physician’s motivation or interest in alcohol issues

P(2): 32–71

GB(1) SI(1)

[19, 46]

Having a specialist licence in general practice or occupational health care

P(2): 1909–3611

FI(2)

[36, 87]

Process

 

 Planning

 Engaging

 Executing

Lack of a systematic strategy

P(1): 24

CA(1)

[86]

 Reflecting and evaluating

The feedback provided by the SBI trainers during their visits at the clinics

DHP(1): 214

ZA(1)

[81]

  1. Note:
  2. 1. Abbreviations for populations: P physicians, N nurses, DHP different health professionals
  3. 2. The number in the bracket in Population and Country indicated the number of studies, and the number on the right-hand side in Population indicated the range of numbers of participants
  4. 3. Abbreviations for country names: AU Australia, BE Belgium, BG Bulgaria, BR Brazil, CA Canada, CZ Czech Republic, DE Germany, DK Denmark, ES Spain, FI Finland, FR France, GB United Kingdom of Great Britain and Northern Ireland, HU Hungary, IT Italy, LK Sri Lanka, NL Netherlands, NZ New Zealand, NO Norway, PO Poland, PT Portugal, RU Russia, SE Sweden, SI Slovenia, TH Thailand, TR Turkey, US the United States of America, ZA South Africa