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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 to collect information about a patient’s risk for alcohol-related problems and how much confidence they had in recommending low-risk consumption limits. Response options consisted of “no confidence”, “very little confidence”, “moderate degree of confidence” and “quite a lot of confidence”. Internal consistency reliability (Cronbach’s alpha) was .88 for these items. The remaining measures were based on Likert scale ratings of a series of belief statements, each with five response options ranging from strongly agree to strongly disagree. The scales were developed by Babor et al. (2004) and the item content was informed by the alcohol health services literature, including Project NEADA (Church & Babor 1995) and the World Health Organization Study of General Practitioners (Gomel et al. 1998). The scales used in this study were: 1) Self-Efficacy to conduct SBI (5-items, Cronbach’s alpha = .73);. 2). Perceived obstacles to screening (8-items, Cronbach’s alpha = .70). 3) Perceived obstacles to Brief Intervention (10-items, Cronbach’s alpha = .60); 4) High Expectations for Brief Intervention, (5-items, Cronbach’s alpha = .48). Finally, interviews were conducted with the key informants who provided qualitative data that were used to provide contextual information about the effects of the training on the practice of SBI and its longterm sustainability (Bardin 2006). With this method of analysis it was possible to explore emerging themes related to their attitudes and beliefs about the SBI implementation and to explore how the training affected clinical practices. 532 NORDIC STUDIES ON ALCOHOL AND DRUGS V O L . 2 5. 2 0 0 8 . 6 � Statistical Analysis Analysis of variance (ANOVA), followed by Post hoc Tukey tests, were used to compare the scale means in the pre- and posttraining across the four groupings. Results As shown in Figure 1, the PHC professionals in all categories demonstrated a significant increase in the level of technical knowledge about SBI after the training (p

Score Means 40 33.8 31.4 30 20 10 Pre Post * 31 # 31 31.8 28.8 28.7 26.9 * 0 GP Nur AUX+CHW Psy+SW Professional Categories * p< 0,05 pre and post (t test paired) # p < 0,05 in Tukey Test with GP (pre) Figure 2. Confidence to conduct SBI at baseline (pre-training) and follow up (post training) Score Means 2 5 19.3 20.2 2 0 1 5 1 0 5 * # 18.3 17.9 17.3 15.6 Pre Post 18.3 18.2 0 GP Nur AUX+CHW Psy+SW Professional Categories * p< 0,05 pre and post (t test paired) # p < 0,05 in Tukey Test with Psy+SW (pre) Figure 3. Self-efficacy to conduct SBI at baseline (pre-training) and follow up (post training) As shown in Figure 3, at baseline self- efficacy to do SBI was lower among the AUX/CHW group compared to other professional categories. Comparing pre- and post-training scores, there was a significant increase in self-efficacy to do SBI among the AUX/CHW group. Similarly, there was a significant increase in the scores of this group on the scale measuring high expectations about brief intervention (see Figure 4). Evaluation of a training program to implement alcohol screening, brief intervention and referral to treatment in primary health care in Minas Gerais, Brazil Score Means 2 1 Pre Post 2 0 19,9 19,6 1 9 1 8 18,9 18,6 * 17,7 18,5 18,3 1 7 1 6 16,7 1 5 GP N u r AU X+C H W Ps y+SW Professional Categories * p< 0,05 pre and post (t test paired) Figure 4. High expectations about brief intervention at baseline (pre training) and follow up (post-training) Score Means 25 20 15 10 5 0 * 19 16.6 20.3 18.5 Pre Post # 21.8* 19.7 19 17.6 GP Nur AUX+CHW Psy+SW Professional Categories * p< 0,05 pre and post (t test paired) # p < 0,05 in Tukey Test with Psy+SW (pre) Figure 5. Perceived obstacles to screening at baseline (pre-training) and follow up (post training) Figure 5 shows that in general, the SBI training program decreased the PHC professionals’ perceptions of difficulties to conduct screening. In the pre-training measure, the AUX/CHW group had the highest perception of difficulties, compared to the PSY/SW group (p

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