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5 years ago

NAT 6/08 - THL

NAT 6/08 - THL

Evaluation of a training

Evaluation of a training program to implement alcohol screening, brief intervention and referral to treatment in primary health care in Minas Gerais, Brazil were reduced after the training. Three months after the training, SBI was more likely to be performed by health workers who had higher levels of pretraining self-efficacy and positive expectances, and who perceived fewer obstacles prior to training. Community Health workers were the professional group with the best performance in a number of areas. DISCUSSION Considering the technical knowledge acquired and the attitudinal change observed among these professionals, it is reasonable to conclude that the training program had an important impact on the readiness of health professionals to implement SBI in these clinics, especially among auxiliary nurses and community health workers. KEywORDS Screening, BI, SBIRT, alcohol, hazardous drinking, early intervention, primary health care 530 NORDIC STUDIES ON ALCOHOL AND DRUGS VOL. 25. 2008 . 6 Disorders Identification Test (AUDIT, Babor & Higgins-Biddle 2001) and ASSIST (Humeniuk et al. 2007) in addition to standardized brief intervention methods (World Health Organization 2006) that are considered effective when applied under ideal clinical research conditions. Nevertheless, evidence suggests that many difficulties emerge in the translation of theory to practice, as when these techniques are implemented in the routine conditions of most of the health care services (Babor et al. 2006; Heather 2007; Anderson et al. 2003; Kaner et al. 2007). The aim of this article is to describe the implementation of a Brazilian Screening, Brief Intervention and Referral to Treatment (SBIRT) training program in PHC centers in the state of Minas Gerais, Brazil. A description of the first phase of this study has been reported in Ronzani et al. (2005). In this article attention is given to the impact of SBI training on attitudes and knowledge, and to identify predictors of screening and brief intervention practices following the training. Methods The project was implemented in five cities of the Zona da Mata Region, State of Minas Gerais, Brazil. About 600,000 people live in these cities. The PHC services cover about 293,000 inhabitants. The main population center is Juiz de Fora, a city with a population of 515,000 inhabitants, whose health system is organized into three levels (primary, secondary and tertiary care). Juiz de Fora is also the reference point for health care and education services in this region. � Research Design The study used a before-and-after repeated measures group design to test changes in the attitudes of four types of Primary Health Care (PHC) professionals who received eight hours of training about alcohol screening and brief intervention. The project trained 334 PHC professionals: 293 from 32 PHC sites, 30 from four organizational health services, seven from two alcohol and other drugs (AOD) treatment services and four from a Sexually Transmitted Disease/AIDS treatment service. The evaluation focused on short-term changes in providers’ knowledge about SBI, perceived obstacles to practicing it, expectations about its effectiveness, and self-efficacy or confidence in performing SBI. Baseline predictors

of SBI performance three months after the training were also computed. � Study Samples Of the 334 PHC professionals trained, 195 (58%) completed at least one questionnaire in the baseline assessment. The other professionals were trained but did not complete the instruments. The followup rate of this study it was 60%. The lowest rates of follow-ups were among nurses (45.7%) and the highest among psychologists (85.7%). A comparison of those who were and were not contacted at follow-up found no baseline differences in the scales studied (p>0.20). The main reason for nonresponse rates was that many professionals changed their jobs or positions, which is very common in PHC services in Brazil. The final study group consisted of 25 physicians, 35 nurses, 25 auxiliary nurses, 29 social workers, 7 psychologists and 74 community health workers. The majority of professionals were female (82.4%). The mean age of the participants was 38.2 years. The professionals were categorized into four groupings: general practitioners (GPs, (n= 25), nurses (n=35), auxiliary nurses and community health workers (AUX/CHW) (n= 99), and psychologists and social workers (PSY/SW) (n= 36), based on the functional and educational differences among these professional groups. Ten local health center administrators and service co-ordinators were also included in the study. They participated as key informants during the evaluation process, giving in-depth interviews three months before and three months after the training. They were considered as key informants because of their important positions in the local health system, their authority to make policy decisions and their Evaluation of a training program to implement alcohol screening, brief intervention and referral to treatment in primary health care in Minas Gerais, Brazil capacity to manage the PHC services. All indepth interviews made with the key informants were submitted to content analysis. To evaluate the levels of risky alcohol use among patients, the AUDIT was recommended for use by PHC professionals in their services. Three months following the training, the PHC professionals were asked how often they applied the AUDIT and if they did, whether positive cases were given a brief intervention. � Data Collection Procedures Approximately one week prior to the training, the PHC professionals were asked to complete a 123-item questionnaire that included questions on beliefs, practices and self-efficacy related to preventive medicine, including at-risk drinking and alcoholism. Immediately before the training session and again at the end of the training, participants completed a 9-item knowledge test about alcohol SBI. The complete questionnaire was re-administered three months after training. Knowledge essential to conducting SBI was measured by nine objective questions. For example, trainees were asked to define moderate drinking in terms of the recommended upper limit of number of drinks per day for men and women. Preand post-training knowledge items were scored according to the number of correct responses. Confidence in SBI was measured with ten items translated from a questionnaire developed by Babor et al. (2004). Participants were instructed to “indicate the amount of confidence you have in your ability to perform each of the activities.” For instance, respondents were asked how confident they were in asking questions NORDIC STUDIES ON ALCOHOL AND DRUGS V O L . 25. 2008 . 6 531