We improved our life because I cut my drinking: Qualitative analysis of a brief intervention for people with alcohol use disorder in Ethiopian primary health care
BACKGROUND: Despite global recommendations that brief, task-shared interventions are effective for addressing problematic alcohol use in primary health care (PHC), low-income countries have made few attempts to implement and scale-up these interventions.
AIM: To explore perspectives and experiences of service users and providers on a brief intervention (BI) for alcohol use disorders (AUDs) delivered by nonspecialist health workers who are health officers and clinical nurses in PHC in a rural Ethiopian district.
METHODS: The study team conducted a qualitative study, comprising in-depth interviews with 26 purposively selected participants. The participants were 14 people who had been screened for probable AUD and were receiving the brief intervention; four caregivers without any intervention; and eight nonspecialist health workers who provided a single session brief intervention at four primary care health centers in Sodo district, south Ethiopia. The study used framework analysis. We grouped findings into five themes: acceptability, engagement in and barriers to care, implementation of the service, perceived impact of the BI, and unmet needs and expectations.
RESULTS: Participants perceived the intervention to be useful, and it was well-accepted by most service users and relatives. Participants reported reductions in alcohol consumption and benefits in terms of their capacity to work, increased earnings, less money wasted, and ability to provide for their families. However, most did not attend follow-up visits, often influenced by the belief that they did not have a serious problem and could handle it alone. Some did not believe AUDs to be treatable; others did not attend because of lack of money for transportation and stigma from peers. Providing BI did not affect PHC workers’ routine work. However, they noticed a reluctance from people with probable AUD to speak openly about their drinking, and they were constrained by a shortage of space. They recommended training and involvement from community members, leaders, and health extension workers to raise awareness, increase acceptability, refer cases, and reduce stigma.
CONCLUSION: The brief intervention that nonspecialist health workers in PHC delivered was acceptable, feasible, and perceived to have positive benefits. To extend the impact of the intervention, the community needs to be involved to address low awareness and to tackle stigma.
Zewdu, S., Hanlon, C., Fekadu, A., Medhin, G., & Teferra, S. (2022). "We improved our life because I cut my drinking": Qualitative analysis of a brief intervention for people with alcohol use disorder in Ethiopian primary health care. J Subst Abuse Treat, 132, 108636. doi:10.1016/j.jsat.2021.108636