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Cited by 22Substance Abuse Treatment and OutcomesMental Health Treatment and AccessAlcohol Consumption and Health Effects

Perceived barriers by health care providers for screening and management of excessive alcohol use in an emergency department of a low-income country

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Staton, Catherine A., Vissoci, Joao Ricardo Nickenig, Wojcik, Rachel, Hirshon, Jon Mark, Mvungi, Mark, Mmbaga, Blandina T., Swahn, Monica·2018·Alcohol
DOI 10.1016/j.alcohol.2018.01.003PMC PMC6467255
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Abstract

Annually, alcohol causes 3.3 million deaths; countless more alcohol-related injury patients are treated in emergency departments (EDs) worldwide. Studies show that alcohol-related injury patients reduce their at-risk alcohol-use behavior with a brief negotiational interview (BNI) in the ED. This project aims to identify potential perceived barriers to implementing a BNI in Tanzania. A knowledge, attitude, and practice questionnaire was piloted and administered to all emergency department health care practitioners, including physicians, advanced medical officers, and nurses. The questionnaire included the Perceived Alcohol Stigma (PAS) Scale. The survey was self-administered in English, the language of health care instruction, with a Swahili translation available if preferred. Data were analyzed with relative and absolute frequencies and Spearman's correlation. Thirty-four (100%) health care practitioners completed the survey. Our results found positive attitudes toward addressing alcohol misuse (88%), but very poor knowledge of recommended alcohol-use limits (24%). Participants were willing to discuss alcohol use (88%) and to screen (71%) for alcohol-use disorders. Most health care practitioners report significant stigma against those with alcohol-use disorders (39% discrimination, 53% devaluation, 71% either). Counseling patients about high-risk alcohol use was directly and positively associated with at-risk alcohol and counseling education and believing it was common to ask patients about tobacco and alcohol use; it was negatively associated with believing it was 'not my role' or that knowing about alcohol use 'won't make a difference'. Stigma was negatively and indirectly associated with counseling patients. In conclusion, in an ED in Tanzania, health care practitioners have positive attitudes toward addressing at-risk alcohol use, and endorsed having training in alcohol misuse in school. Unfortunately, participants did not demonstrate knowledge of recommended alcohol limit guidelines. Similarly, among practitioners, there is a significant discrimination and devaluation stigma against those who misuse alcohol. These factors must be addressed prior to a successful implementation of an alcohol harm reduction intervention.

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  • Only 41.2% (n = 12) reported always asking about alcohol use as part of their practice.

    “most participants agreed that it is common to ask patients about alcohol use behaviors (91.2%, n = 21), but only 41.2% (n = 12) reported always asking as part of their practice.”

    From A scoping review of substance use brief interventions in Africa (2024) · cites this paper as [114]

  • Staton et al found that most participants felt comfortable asking patients (88.2%, n = 30) or counseling patients (94.1, n = 32) about their risk with drinking.

    “Staton et al. [114] found that most participants felt comfortable asking patients (88.2%, n = 30) or counseling patients (94.1, n = 32) about their risk with drinking;”

    From A scoping review of substance use brief interventions in Africa (2024) · cites this paper as [114]

  • Most participants agreed that it is common to ask patients about alcohol use behaviors (91.2%, n = 21).

    “most participants agreed that it is common to ask patients about alcohol use behaviors (91.2%, n = 21), but only 41.2% (n = 12) reported always asking as part of their practice.”

    From A scoping review of substance use brief interventions in Africa (2024) · cites this paper as [114]

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Authors
Staton, C. A., Vissoci, J. R. N., Wojcik, R., Hirshon, J. M., Mvungi, M., Mmbaga, B. T., & Swahn, M.
Affiliations
  • Duke University (US)
  • University of Colorado Anschutz (US)
  • University of Maryland, Baltimore (US)
  • Kilimanjaro Christian Medical Centre (TZ)
  • Georgia State University (US)
Corresponding author
Staton, Catherine A.
ORCID
Venue
Alcohol
Publisher
Elsevier BV
Published
2018-09
Volume
71
Pages
65-73
ISSN
0741-8329 (ISSN-L)
DOI
10.1016/j.alcohol.2018.01.003
PMC
PMC6467255
OpenAlex
W2783357623
Cited by
22
References
45
Citations by year
2026: 2 · 2025: 2 · 2024: 7 · 2023: 2 · 2022: 1 · 2021: 5 · 2020: 2 · 2019: 1
FWCI
1.56
Type
journal article
Language
en
Open access
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Alcohol (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
  • DigitalCommons - Kennesaw State University (Kennesaw State University) (submittedVersion)
Funders
National Institute of Health (K01TW010000)
Topics
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
  • Health Sciences › Medicine › Pathology and Forensic Medicine › Alcohol Consumption and Health Effects
Keywords
alcohol misuse screening, emergency department, clinician attitudes, alcohol stigma, perceived barriers, alcohol harm reduction, alcohol-related injuries, Tanzania, low-income countries
MeSH terms
Adult, Aged, Alcoholism, Developing Countries, Emergency Service, Hospital, Female, Health Personnel, Health Services Accessibility, Humans, Health Knowledge, Attitudes, Practice, Middle Aged, Tanzania, Young Adult, Social Stigma

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