1 Injury Prevention Research Unit, Department of Preventive and Social Medicine, University of Otago Medical School, Dunedin, New Zealand and 2 Centre for Drug and Alcohol Studies, Department of Psychiatry, School of Medicine, University of Queensland, Brisbane, Queensland, Australia
(Received 18 June 2003; first review notified 24 July 2003; in revised from 25 July 2003; accepted 30 July 2003)
* Author to whom correspondence should be addressed at: Injury Prevention Research Unit, Department of Preventive and Social Medicine, University of Otago Medical School, PO Box 913, Dunedin, New Zealand. Tel.: +64 3 479 8048; Fax: +64 3 479 8337; E-mail: kkypri{at}ipru.otago.ac.nz
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ABSTRACT |
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INTRODUCTION |
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A promising response to this public health problem is the use of screening and brief intervention (SBI), delivered in the context of primary care. This refers to the systematic identification of people with health risk behaviours and the provision of brief advice on how to reduce or avoid these. There is now compelling evidence for the efficacy of SBI in reducing hazardous drinking in a wide variety of settings. The most recent meta-analysis showed significant reductions in consumption and in alcohol-related problems for non-treatment-seeking individuals which lasted for at least 12 months (Moyer et al., 2002).
Evidence on SBI for younger people, while promising, is more meagre (Saunders et al., in press). Questions remain as to the effectiveness of SBI when it is provided under conditions of normal healthcare delivery, as distinct from researcher-driven programmes primarily designed and executed by researchers. Some studies reveal obstacles to the implementation of SBI. For example, Beich et al. (2002) reported that many general practitioners (GPs) object to initiating discussion about alcohol with their patients, while Lock et al. (2000)
found that many medical receptionists do not see screening as a legitimate part of their role. The state of evidence with respect to the implementation of SBI is a matter of ongoing debate (see a series of letters at bmj.com/cgi/eletters/325/7369/870).
A key consideration is whether healthcare professionals would actually deliver such interventions and whether they would be acceptable to patients, especially if hazardous alcohol use were not the primary reason for the consultation. Focus group studies conducted at a New Zealand university suggested that student hazardous drinkers would be unwilling to discuss their drinking with a doctor, nurse, counsellor or psychologist, unless the discussion was self-initiated (Kypri, 2002). Students were interested in receiving personalized assessment of their drinking, but were highly sensitive to being judged by a health professional. Web-based alcohol risk assessment and feedback, also known as electronic screening and brief intervention (e-SBI), was considered by the investigators to be a practicable option, given the concerns about practitioner-delivered SBI and this population's familiarity with computers. The approach has the added appeal of reducing demands on professional time, and of being deliverable without limitations of distance.
Given the cost of developing, implementing and evaluating a web-based intervention approach, it was important to know whether members of the wider student population would be willing to utilize this form of intervention. Our aim was thus to determine the acceptability of various modes of delivering brief intervention.
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SUBJECTS AND METHODS |
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Respondents were asked the following questions concerning the acceptability of alcohol related services: For the following services concerning alcohol, which do you think (A) should be available to students; and (B) you would use if you had a drinking problem?: (1) reading materials/leaflets about alcohol and its effects, (2) health education seminars on alcohol, (3) anonymous web-based alcohol risk assessment and personalized feedback, (4) alcohol risk assessment and advice from a nurse, counsellor, or psychologist, (5) alcohol risk assessment and advice from a doctor.
Respondents gave a yes/no answer for parts A and B relating to each of the five items (i.e. a total of 10 answers). Items 1 and 2 are not forms of brief intervention but they are commonly used in university campus health promotion in New Zealand and elsewhere. The inclusion of items 1 and 2 served to provide a gradient in the intensity of the intervention, from minimal and inexpensive to more intensive and costly (item 5).
There were 980 (62.7%) respondents to the Alcohol Use Survey who were classified as hazardous drinkers (i.e. they attained a score of 8 or higher on the AUDIT). Of these, 950 completed the questions concerning brief intervention services. Given that brief intervention efforts would be focused on hazardous drinkers, responses to the above questions were examined separately for this group.
Responses were analysed statistically by using the McNemar test, a non-parametric test for two related dichotomous variables, which tests for changes in responses using the binomial distribution (Everitt, 1977).
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RESULTS |
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DISCUSSION |
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The finding of a preference for electronic methods is consistent with results of research conducted in the general population. Of 1257 current drinkers in a telephone survey of Ontario residents, 16% reported interest in receiving a telephone call from a therapist to help them evaluate their drinking, 26% in receiving a self-help book, and 39% in a computerized summary comparing their drinking to that of other Canadians (Koski-Jannes and Cunningham, 2001, p. 91).
The standard SBI paradigm in which a medical or other health practitioner counsels the client appears to be less suitable for student health services, where few of the clients have the kind of established trust relationship with medical staff, on which the success of SBI may depend. e-SBI may be a more acceptable way of addressing hazardous drinking among tertiary students. However, it should be noted that, to date, there are no published studies on the efficacy of e-SBI in reducing hazardous drinking in tertiary students.
The results of this study supported the development and implementation of e-SBI at the university's Student Health Service in 2002. Its efficacy was assessed in a randomized controlled trial, the subject of a paper currently in preparation. Baseline recruitment data in that trial showed that 94% of students who screened positive for hazardous drinking consented to receiving the intervention and follow-up assessments. This approach shows considerable promise as an intervention for reducing hazardous drinking among university students, and may be worthy of investigation in other groups of drinkers.
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Acknowledgements |
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REFERENCES |
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