Implementation of a Multicomponent Responsible Beverage Service Programme in Sweden – A Qualitative Study of Promoting and Hindering Factors

Abstract

AIMS -The objective of this study was to identify factors that either promote or hinder implementation of a multicomponent Responsible Beverage Service programme in Swedish municipalities. DESIGN -Forty semi-structured interviews were conducted in six municipalities and directed content analysis, guided by the Consolidated Framework for Implementation Research (CFIR), was performed. RESULTS -The CFIR framework was useful as an underlying theoretical model in this study. Importance of the following factors, described in the five domains of CFIR, was empirically supported in this study: local needs, evidence strength and advantages of the intervention, costs and available resources, clear goals, evaluation and feedback, access to knowledge and information, clear role definitions and cooperation, and enthusiastic key persons with high confidence in the effectiveness of the intervention. Hindering factors listed by the informants were lack of enthusiasm and opportunities to specialise, low degree of self-efficacy, unengaged decision-makers, complexities of the programme, and a top-down approach. CONCLUSIONS -This study indicates that previously identified factors shown to promote and hinder implementation processes are also valid in the context of multicomponent community action programmes like RBS. Suggestions on how to elude some of the hindering factors are proposed, e.g. to develop long-time financial plans, to provide better information about the RBS program in full, and to stress the importance of collaboration between representatives from the municipalities, police authorities and owners of on-licenced premises.

Applying a complex systems perspective to alcohol consumption and the prevention of alcohol‐related harms in the 21st century: a scoping review

“…The studies we identified conceptualized, described or modelled systems of interest to alcohol-harm prevention research primarily in the United States (n = 38) [22,23,29,, Australia (n = 17) [28,31,[77][78][79][80][81][82][83][84][85][86][87][88][89][90][91] and the United Kingdom (n = 7) [26,[92][93][94][95][96][97]. We also found examples of generic alcohol systems (n = 16) [24,93,[98][99][100][101][102][103][104][105][106][107][108][109][110][111], as well as examples from Sweden (n = 2) [112,113], South Africa (n = 2) [114,115], Canada (n = 1) [116], Denmark (n = 1)…”

“…A system is made up of interconnected elements bounded in some way within a broader context. Systems theory emphasizes the relationships between elements and understanding how different parts of the system interact and influence one another [36,128] Argument for systems-thinking lens in prevention and treatment efforts [71,108,109] Development of specific systems-informed approaches to interventions and programmes [57,71,85,113,117] Systems approach to drug and alcohol work-force development [106] and practitioner guidelines [102] Systems theory used to inform analytical framework [80,112,117,118] Complex adaptive systems and complexity theory A complex adaptive system (CAS) is made up of elements who interact with each other over time, without a central organizing authority, to generate behaviour at the system level that cannot be reduced to the actions of individual actors. Relationships within a CAS are non-linear and may be unpredictable, as elements and the system adapt and co-evolve in response to internal and external stimuli; responses within the system may amplify or dampen system changes, depending on the system's capacity to absorb or respond to change [129][130][131][132].…”

“…those who work within the alcohol and drug work-force [57,85,86,94,106]. Other studies included alcohol retailers and the alcohol industry [24,82,93,95,103,112], as well as policy-makers and different types of organizations [80,82,121].…”

“…Some studies considered the impact of those consumption patterns, including acute and chronic health and social harms to individual drinkers and those in their communities [28,31,46,49,70,71,85,[87][88][89][90]108,109,111] including, for example, mental health outcomes [53,65,110], aggression [78,83,84], injuries and violence [42,45,57,87,97,112,116]. Other studies explored the influence of the environments in which alcohol is regulated, sold and consumed, including characteristics and density of alcohol retailing outlets [28,42,43,45,47,51,57,66,68,70,71,77,78,80,82,83,87,95,103,108,…”

“…Studies that considered only one system level primarily focused on the sublocal, often considering social influences on individuals' drinking behaviours [44,50,52,53,55,56,64,65,92,96,104,107,114,117,119]. We also identified examples that focused solely on local [51,57,70,71,79,86,100,108,109,[111][112][113]116], regional [47] and national [85,121] systems. Studies focusing on sublocal or local systems varied in their timeframes; for example, one study used an agent-based model (ABM) to generate an in-depth understanding of how drinking evolves over the course of a single evening in response to peer influences [64], whereas another ABM explored the impact of alcohol taxation policies and social connectedness interventions on depression and alcohol misuse among older adults over 5 years [46].…”