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Int. J. Environ. Res. Public Health 2017, 14(4), 350; doi:10.3390/ijerph14040350

Are Brief Alcohol Interventions Adequately Embedded in UK Primary Care? A Qualitative Study Utilising Normalisation Process Theory

Institute of Health and Society, Newcastle University, Newcastle upon Tyne NE2 4AX, UK
Author to whom correspondence should be addressed.
Academic Editor: Icro Maremmani
Received: 30 January 2017 / Revised: 21 March 2017 / Accepted: 24 March 2017 / Published: 28 March 2017
(This article belongs to the Special Issue Alcohol and Health)
View Full-Text   |   Download PDF [939 KB, uploaded 31 March 2017]


Despite substantial evidence for their effectiveness, the adoption of alcohol screening and brief interventions (ASBI) in routine primary care remains inconsistent. Financial incentive schemes were introduced in England between 2008 and 2015 to encourage their delivery. We used Normalisation Process Theory-informed interviews to understand the barriers and facilitators experienced by 14 general practitioners (GPs) as they implemented ASBI during this period. We found multiple factors shaped provision. GPs were broadly cognisant and supportive of preventative alcohol interventions (coherence) but this did not necessarily translate into personal investment in their delivery (cognitive participation). This lack of investment shaped how GPs operationalised such “work” in day-to-day practice (collective action), with ASBI mostly delegated to nurses, and GPs reverting to “business as usual” in their management and treatment of problem drinking (reflexive monitoring). We conclude there has been limited progress towards the goal of an effectively embedded preventative alcohol care pathway in English primary care. Future policy should consider screening strategies that prioritise patients with conditions with a recognised link with excessive alcohol consumption, and which promote more efficient identification of the most problematic drinkers. Improved GP training to build skills and awareness of evidence-based ASBI tools could also help embed best practice over time. View Full-Text
Keywords: normalisation process theory; qualitative research; alcohol interventions; primary care normalisation process theory; qualitative research; alcohol interventions; primary care
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. (CC BY 4.0).

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O’Donnell, A.; Kaner, E. Are Brief Alcohol Interventions Adequately Embedded in UK Primary Care? A Qualitative Study Utilising Normalisation Process Theory. Int. J. Environ. Res. Public Health 2017, 14, 350.

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