Community involvement facilitating the discussion of alcohol use in primary care: A nominal group study

Figures & data

Figure 1. Overview of recruitment strategy (*) recruitment included flyers and social media, increasing the total amount reached.

Table 1. Demographics and nominal group compositions.

	Group 1	Group 2	Group 3	Group 4
Men	50%	25%	25%	57%
Women	50%	75%	75%	43%
Composition
General population	2	3	3	3
General practitioner	1	2	1
Psychologist	1	1
Prevention worker	1		1	1
Emergency doctor		1	1
Communication expert	1		1
Mental health worker	1
Social worker	1
Dietitian				1
Pharmacist		1		1
Law enforcement			1
Health insurance company				1
Attendance		Pharmacist and 1 GP left early

GP: general practitioner.

Table 2. Stakeholders approved master list with community-oriented strategies to facilitate the delivery of alcohol-related EIBI in general practice from a stakeholder point of view.

Idea / Strategy	Overarching relative score^a
Awareness campaign directed to the general population highlighting the pro-active role of the GP concerning alcohol use, alcohol-related questions and health promotion	1151
Media campaign (e.g. posters, flyers, videos) related to alcohol in the waiting room of GPs to spike the patient’s interest; possible conversation starter	579
Formal (the news, talk shows) and informal (soaps) media attention focussing on the effects of harmful alcohol use with a link regarding the GP as a reliable source of information	554
Initiating conversations on alcohol use in community specific settings, stepping outside the areas of healthcare and general practice	453
Informative campaign towards the general population concerning the effects of (harmful) alcohol use	426
Social norm campaign in the community	393
Mobile or web-based self-awareness tool to assess one’s own consumption pattern	338
A ‘silent alarm’ (e.g. a notification) for community members to inform their GP about the need to discuss alcohol related topics	138
Structural interventions to highlight the current social norm on alcohol	113

^aGroup-specific scores were divided by the participant count of that group. Summation of the relative scores from the four groups resulted in the overarching relative score. GP: general practitioner.

Table

Stakeholder group	Purpose for inclusion
General practitioner	As the aim of this study is to create consensus on community-oriented strategies to support GPs in de delivery of EIBI it is essential to incorporate their point of view and their needs or concerns.
Lay people	They represent the population of interest to address with the community-oriented strategies. The Lay people provide insights in community perspective.
Social worker	Social workers have a strong connection with the community, especially with a proportion that is generally more difficult to reach (ethnicity, social economic status, et cetera).
Prevention worker	They are part of a governmental organisation responsible for local preventive work in the community. Prevention workers have a good idea of the possibilities in the municipality. They can give more insight in what might work at municipal level.
Psychologist	Psychologists provide a scientific point of view on behaviour change techniques.
Communication expert	They have a better understanding on the scientific perspective on how to communicate sensitive topics like alcohol to the general population. Furthermore, they provide insight in how to facilitate behavioural change trough communication.
Pharmacist	They come in contact with a large part of the general population. They also have an increasing potential to be involved in prevention approaches, especially when it related to alcohol use.
Dietitian	Has a unique position to ask about alcohol use and health. Furthermore, dietitians are increasingly involved in health promotion and prevention.
Mental health worker	Mental health workers bring the other spectrum of alcohol use to the discussion. They allow to address the seriousness of harmful alcohol use to the less experienced participants. In addition, they are able to address the topic from another angle.
Health insurance company	Besides providing the population with health insurances, health insurance companies also undertake a significant amount of health promotion and prevention activities. They provide insight from another perspective.
Law enforcement	The police has a strong connection with the local community. Their role in prevention is often undervalued. However, they come in contact with a large proportion of the population and experience the local necessities first-hand.
Emergency doctor	The emergency department comes in contact with a lot of harmful and hazardous alcohol use. They have the opportunity and willingness to participate in prevention work, especially when it is alcohol related.

Table

Idea/strategy	Overarching relative score^a
Awareness campaign directed to the general population highlighting the pro-active role of the GP concerning alcohol use, alcohol-related questions and health promotion	1151
Media campaign (e.g. posters, flyers, videos) related to alcohol in the waiting room of GPs to spike the patient’s interest; possible conversation starter	579
Formal (the news, talk shows) and informal (soaps) media attention focussing on the effects of harmful alcohol use with a link regarding the GP as a reliable source of information	554
Initiating conversations on alcohol use in community specific settings, stepping outside the areas of healthcare and general practice	453
Skills training for GPs regarding behaviour change strategies and communication skills	435
Informative campaign towards the general population concerning the effects of (harmful) alcohol use	426
Social norm campaign in the community	393
Mobile or web-based self-awareness tool to assess one’s own consumption pattern	338
More initiative should come from the GPs to start the conversation on alcohol	175
Integrating other healthcare professionals besides GPs into the early identification process, stepping outside of general practice	162
A ‘silent alarm’ (e.g. a notification) for community members to inform their GP about the need to discuss alcohol related topics	138
Initiating free alcohol-consults to discuss alcohol with the GP	114
Structural interventions to highlight the current social norm on alcohol	113
Introducing a financial model which stimulates GPs to do more pro-active work	92
Integrating more psychologists in general practice, thus, reducing waiting lists and stimulating collaboration for a better follow-up	88
Government support for educating the population on the dangers of alcohol use	86
Establishing a database containing patient information related to alcohol for use by all healthcare professionals, thus increasing the likelihood of early identification	71
Introducing standard yearly screenings for alcohol by the GP	67
A recognition for GPs with a specialisation to guide people with alcohol related questions and issues	63
Reorienting the focus to the underlying issues responsible for causing the harmful use of alcohol (mental health focus); integrating mental health workers	50
Mandatory ‘alcohol-consultations’ with a GP after repeated encounters with law enforcement related to alcohol use	50

^aGroup-specific scores divided by the participant count of that group. Summation of the relative scores from the four groups resulted in the overarching relative score. GP: General Practitioner.