I presented this abstract (PDF, 344 KB) as an oral presentation at the 2015 Primary Health Care Research Conference, held at the Adelaide Convention Centre, 29-31 July 2015.
A recorded version of the presentation is available on YouTube:
Title: How acceptable is it for GPs to ask about drinking? What patients think – a mixed methods study.
Authors: Chun Wah Michael Tam, Louis Leong, Nicholas Zwar, Charlotte Hespe
Aims and rationale
The successful implementation of alcohol screening in routine general practice (GP) remains elusive. Relatively little is known about patient perspectives – consultation contexts are probably important but these have not been well explored. We sought to answer three questions regarding patient acceptability of alcohol enquiry: (i) is it improved by asking within SNAP (smoking, nutrition, alcohol, physical activity)? (ii) how does it vary with the reason of encounter? and (iii) what is the explanation for these phenomena.
We used quantitative and qualitative methods. All adult patients presenting to a GP clinic in a week in May 2014 were randomised to receive one of two postal questionnaires in a survey experiment. The number of vignettes (20 presentation scenarios) where alcohol enquiry was rated as “acceptable” was the primary outcome measure. The intervention group rated the acceptability of SNAP enquiry, while the control group only rated alcohol enquiry. Acceptability scores between groups were analysed. Individual scenario acceptability was explored descriptively.
Survey respondents were further recruited for semi-structured interviews. We used grounded theory method – purposive and theoretical sampling, data coding, and the construction of an explanatory model.
There were 144 survey respondents (33% response rate). Alcohol enquiry was rated as more acceptable (mean difference 2.1 vignettes, p = 0.016, independent samples t-test) when presented in SNAP, and this was a small-moderate effect (Cohen’s d = 0.40). There were large variations between scenarios – 46% of participants rated GP alcohol enquiry to have been acceptable in the back pain vignette compared to 90% in the diabetes vignette.
The influences on patient acceptability appeared to be explained using a three factor model – patient perception of the “relevance” of the alcohol dialogue, the “construction” of the dialogue within the consultation, and the perceived “challenge” to moral identity.
Patient acceptance of alcohol screening should not be assumed – contexts matter. Early detection strategies might be better implemented by respecting and making use of patient perspectives. For instance, establishing the reason for enquiry within the context of the presentation, screening for risky drinking within broader lifestyle factor assessment, a collaborative approach to alcohol discussions, and recognising the delicate nature of the dialogue may improve acceptability. Alcohol enquiry in certain consultations (such as the management of diabetes) seem highly acceptable to patients and could be seen as screening opportunities.