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

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