Table 2.
Overall results of the findings using Consolidated Framework for Implementation Research
| 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, 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) | [50–52, 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) | [15–19, 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) | [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, 39,50–52, 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) | [15–17, 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, 21–24, 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, 50–52, 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, 51–53, 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, 60–64, 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] | – | – | – | – |
Note:
1. Abbreviations for populations: P physicians, N nurses, DHP different health professionals
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
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