It may be effective to introduce targeted alcohol reduction interventions in health care centers to address individual risk practices and microenvironmental social norms.
In Vietnam where alcohol use is culturally normative and little treatment is available, persons living with HIV (PLWH) who consume alcohol at unhealthy levels are at greatly increased risk for negative health outcomes. We describe the first systematic adaptation of 2 evidence-based alcohol interventions for use in Vietnam: a combined motivational enhancement therapy/cognitive behavioral therapy and a brief alcohol intervention. Using the situated information, motivation and behavioral skills model, and systematic procedures for tailoring evidence-based treatments, we identified core intervention content to be preserved and key characteristics to be tailored for relevance to the clinical setting. We describe the use of in-depth interviews with antiretroviral treatment clients and providers, expert input, and counselor training procedures to develop tailored manuals for counselors and clients. Adapting evidence-based alcohol treatments for global settings is facilitated by the use of a model of behavior change and systematic procedures to operationalize the approach.
BackgroundWhile primary care medical clinics have been the most common setting for the delivery of advice about smoking cessation, the hospital emergency department (ED) is a valuable context for counseling medically underserved tobacco users. We conducted a secondary analysis based on a larger audio-recorded study of patient-provider communication about pain and analgesics in the ED. Within a sample of ED patients with back pain, the purpose of this mixed-methods study was to examine how physicians and nurse practitioners capitalize on “teachable moments” for health education to offer spontaneous smoking cessation counseling in the ED.MethodsPatients presenting to an academic ED with a primary complaint of back pain were invited to participate in a study of patient-provider communication. Audio-recorded encounters were transcribed verbatim. Two coders reviewed each transcript to determine whether smoking was discussed and to build a corpus of smoking-related discussions. We then developed inductively generated coding categories to characterize how providers responded when patients endorsed smoking behavior. Categories were refined iteratively to accommodate discrepancies.ResultsOf 52 patient-provider encounters during which smoking was discussed, two-thirds of the patients indicated that they were smokers. Providers missed opportunities for smoking cessation counseling 70% of the time. Eleven encounters contained teachable moments for smoking cessation. We identified four primary strategies for creating teachable moments: 1) positive reinforcement, 2) encouragement, 3) assessing readiness, and 4) offering concrete motivating reasons.ConclusionsMost providers missed opportunities to offer teachable moments for smoking cessation. In encounters that contained teachable moments, providers employed multiple strategies, combining general advice with motivation tailored to the patient’s particular circumstances. Creating motivational links to enhance smoking cessation efforts may be possible with a minimal investment of ED resources.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.