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) | Doubt about the effectiveness of SBI | P(4): 75–131 DHP(2): 43–47 | FI(2) GB(2) US(2) | ||
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) | – | – | – | – | ||
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, 19–22, 24–26, 37, 38, 41, 48, 50–55, 57–63, 68, 69, 74–76, 82, 83, 86, 93] |
– | – | – | – | Causing management or logistic problems | P(4): 81–2377 N(1): 196DHP(1): 47 | GB(3) LK(1) US(1) | ||
– | – | – | – | 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) | ||
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) | 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) | ||
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) | Denial of alcohol misuse | P(5): 35–211 | DE(1) FI(1) FR(1) GB(1)US(2) | |||
Showing alcohol-related symptoms | P(3):13–1790 N(1): 2549 | FI(1) SE(2) | Dishonesty of alcohol consumption or unreliable patient alcohol use histories | P(2): 19 | AU(1) NZ(1) | |||
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) | 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) | |||
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) | |
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) | |
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) | – | – | – | – | ||
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) | Lack of staff, specialist support or multidisciplinary team | P(3): 41–2377 DHP(1): 43 | GB(2) US(1) ZA(1) | ||
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) | |
– | – | – | – | Doubt about the appropriateness of screening all patients | P(3): 24–40 | CA(1) NO(1) SE(1) | ||
Relative priority | Prioritization of alcohol issues | DHP(2): 18–214 | US(1) ZA(1) | 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) | ||
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) | 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) | ||
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) | – | – | – | – | ||
Providing early alcohol intervention recognized for quality assurance credits | P(3): 276–282 | GB(2), PO(1) | – | – | – | – | ||
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) | [13–15, 17, 22, 24, 45, 47, 50–53, 57, 60, 65–67, 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, 3950–52, 54–57, 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) | 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) | |||
– | – | – | – | Lack of space and in-patient facilities | P(1): 77 DHP(2): 32–47 | GB(1) US(1) ZA(1) | ||
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) | Lack of guidelines | P(2): 18–32 N(1): 19 | FI(1) SI(1) | ||
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) | – | – | – | – | ||
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) | 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) | ||
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) | ||
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) | 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) | |||
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) | ||
practical skills in interviewing or counselling technique | P(2): 68–1790 N(2): 193–2549 | NO(1) SE(2) | ||||||
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) | 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) | |||
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) | The belief that alcohol was not an important risk factor | P(2): 35–211 | DE(1) FI(1) | |||
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) | 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) | |||
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) | The belief that alcohol issue was not an important issue in general practice | P(3): 135–279 | GB(1) PO(1) TR(1) | |||
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) | ||
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) | ||
The belief in preventive function of screening | P(4): 65–1842 N(1): 141 | AU(1) PO(1) SE(1) US(1) | 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) | 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) | |||
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) | ||||||
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) | |
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) | 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) | |||
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) | 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) | ||
Younger physician age | P(2): 853–901 | NO(1) US(1) | 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) | Lack of motivation of physicians | P(1): 312 | US(1) | [39] | ||
Longer years of practice | P(2): 101–3611 | FI(1) US(1) | 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) | – | – | – | – | ||
Having a specialist licence in general practice or occupational health care | P(2): 1909–3611 | FI(2) | – | – | – | – | ||
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] | – | – | – | – |