Background: Addressing alcohol harm in prisons can potentially reduce the risk of re-offending, and costs to society, whilst tackling health inequalities. Health savings of £4.3 m and crime savings of £100 m per year can be a result of appropriate alcohol interventions. Prison therefore offers an opportunity for the identification, response and/or referral to treatment for those male remand prisoners who are consuming alcohol above recommended levels. There is however, limited evidence for the effectiveness, optimum timing of delivery, recommended length, content, implementation and economic benefit of Alcohol Brief Interventions (ABI) in the prison setting for male remand prisoners. As part of the PRISM-A study, we aimed to explore the 'elements' of an acceptable ABI for delivery, experiences of engagement with services/health professionals about alcohol use, alongside barriers and facilitators to implementation within the prison setting for male remand prisoners. Materials and methods: Twenty-four in-depth interviews were conducted with adult male remand prisoners at one Scottish prison (n = 12) and one English prison (n = 12). A focus group at each of the prison sites was held with key stakeholders (e.g. prison nurses, prison officers, voluntary alcohol/addiction services, health service managers and commissioners). Thematic analysis techniques utilizing NViVo 10 were employed. Results: A thematic content analysis of the interviews consistently highlighted that the majority of prisoners reflected about the connection between alcohol consumption and criminal offending, particularly in relation to offenses involving physical assaults. They also expressed motivation to change their alcohol consumption. Both prisoner interviews and focus groups with stakeholders (N = 2), indicated the value of continuous follow-up support outside of the prison system and also the need to address the lack of stable social environments, which is often associated with alcohol and drug consumption. Stakeholders further identified organizational barriers to the delivery of ABI, such as limited funding and manageable workloads. Conclusions: The importance of interpersonal trust indicated that intervention delivery by external organizations and nurses were favored in comparison to intervention delivery by prison staff and peer-prisoners. A2 Does perceived risk of harm mediate the effects of a primary care alcohol screening and brief advice intervention for adolescents?
The purpose of this study was to report the "Outcome Reporting in Brief Intervention Trials: Alcohol" (ORBITAL) recommended core outcome set (COS) to improve efficacy and effectiveness trials/evaluations for alcohol brief interventions (ABIs). Method: A systematic review identified 2,641 outcomes in 401 ABI articles measured by 1,560 different approaches. These outcomes were classified into outcome categories, and 150 participants from 19 countries participated in a two-round e-Delphi outcome prioritization exercise. This process prioritized 15 of 93 outcome categories for discussion at a consensus meeting of key stakeholders to decide the COS. A psychometric evaluation determined how to measure the outcomes. Results: Ten outcomes were voted into the COS at the consensus meeting: (a) typical frequency, (b) typical quantity, (c) frequency of heavy episodic drinking, (d) combined consumption measure summarizing alcohol use, (e) hazardous or harmful drinking (average consumption), (f) standard drinks consumed in the past week (recent, current consumption), (g) alcohol-related consequences, (h) alcohol-related injury, (i) use of emergency health care services (impact of alcohol use), and (j) quality of life. Conclusions: The ORBITAL COS is an international consensus standard for future ABI trials and evaluations. It can improve the synthesis of new findings, reduce redundant/selective reporting (i.e., reporting only some, usually significant outcomes), improve between-study comparisons, and enhance the relevance of trial and evaluation findings to decision makers. The COS is the recommended minimum and does not exclude other, additional outcomes.
BackgroundCapturing public opinion toward public health topics is important to ensure that services, policy, and research are aligned with the beliefs and priorities of the general public. A number of approaches can be used to capture public opinion.MethodsWe are conducting a program of work on the effectiveness and acceptability of health promoting financial incentive interventions. We have captured public opinion on financial incentive interventions using three methods: a systematic review, focus group study, and analysis of online user-generated comments to news media reports. In this short editorial-style piece, we compare and contrast our experiences with these three methods.ResultsEach of these methods had their advantages and disadvantages. Advantages include tailoring of the research question for systematic reviews, probing of answers during focus groups, and the ability to aggregate a large data set using online user-generated content. However, disadvantages include needing to update systematic reviews, participants conforming to a dominant perspective in focus groups, and being unable to collect respondent characteristics during analysis of user-generated online content. That said, analysis of user-generated online content offers additional time and resource advantages, and we found it elicited similar findings to those obtained via more traditional methods, such as systematic reviews and focus groups.ConclusionA number of methods for capturing public opinions on public health topics are available. Public health researchers, policy makers, and practitioners should choose methods appropriate to their aims. Analysis of user-generated online content, especially in the context of news media reports, may be a quicker and cheaper alternative to more traditional methods, without compromising on the breadth of opinions captured.
Objective: Outcomes used in alcohol brief intervention (ABI) trials vary considerably. Achieving consensus about key outcomes can enhance evidence synthesis and improve healthcare guidelines. This was an international, e-Delphi study to prioritize outcomes for ABI trials as one step in a larger effort to develop an ABI core outcome set (COS). Method: 150 registrants from 19 countries, and representing researchers, policymakers, and patients, participated in a two-round e-Delphi study. In Round 1, participants (n=137) rated 86 outcomes, derived from a review of the literature and a patient and public involvement panel, by importance. In Round 2, participants (n=114) received feedback on importance ratings for each outcome and a reminder of their personal rating before rating the outcomes for importance a second time. Seven additional outcomes suggested in Round 1 were added to the Round 2 questionnaire. We defined consensus a priori as 70% agreement across all stakeholder groups. Results: Seven consumption outcomes met inclusion criteria: typical frequency, typical quantity, frequency of heavy drinking, alcohol-related problems, and weekly drinks, at risk drinking, and combined consumption measures. Others meeting the threshold were: alcoholrelated injury; quality of life; readiness to change; and intervention fidelity. Conclusions: This is the first international e-Delphi study to identify and prioritize outcomes for use in ABI trials. The use and reporting of outcomes in future ABI trials should improve evidence synthesis in systematic reviews and meta-analyses. Further work is required to refine these outcomes into a COS that includes guidance for measurement of outcomes.
Forest management today often seeks to restore ecological integrity and enhance human well‐being by increasing forest complexity, resilience, and functionality. However, effective and financially expedient monitoring of forest complexity is challenging. In this study, we developed a practical and inexpensive technique to measure horizontal forest complexity. This monitoring method uses intuitively understandable data (imagery) and facilitates stakeholder participation in the adaptive management process within collaborative projects. We used this technique to determine if current restoration projects are successfully achieving their spatial restoration goals. We focused on the Colorado Front Range Landscape Restoration Initiative (CFRLRI) as a representative of the typical collaborative restoration projects underway in formerly fire‐dependent dry conifer forests. The developed monitoring method is practical and cost‐effective by using free aerial imagery to map, quantify, and analyze the distribution of canopy cover pre‐ and post‐treatment. We found the CFRLRI has successfully reduced canopy cover (from 44 to 26% on average) and increased some aspects of horizontal forest complexity. The application of these monitoring techniques has allowed the CFRLRI collaborative group to objectively quantify changes to horizontal forest complexity, and has facilitated stakeholder communication about forest spatial patterns. These methods could be adapted for use by other similar forest restoration projects around the world by utilizing increasingly available satellite or aerial imagery.
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