Barriers to Alcohol Screening Among Hypertensive Patients and the Role of Stigma: Lessons for the Implementation of Screening and Brief Interventions in European Primary Care Settings
Abstract
AIMS: 1. To quantify barriers to alcohol screening among hypertensive patients reported by primary healthcare professionals. 2. To examine whether education and screening frequency measures are associated with stigma-related barriers. METHODS: A web survey was conducted among 3081 primary healthcare professionals from France, Germany, Italy, Spain and the UK. Participants were asked about perceived barriers to alcohol screening as free-text response. The replies were independently categorized by two raters. Stigma-related barriers were predicted by logistic regressions with education, knowledge on alcohol as risk factor and frequency of alcohol screening. RESULTS: In France and Italy, almost half of the reported barriers were stigma-related, whereas time constraints were cited most commonly in Spain and the UK. In Germany, nearly half of respondents rated the importance of alcohol screening for hypertension as low. Perception that regular screening is inappropriate or associated with too much effort, beliefs that screening is unnecessary, and insufficient knowledge of screening tools were cited as further barriers. Professional education on alcohol use was consistently rated to be poorer than the equivalent education on hypertension, and only a minority of respondents perceived alcohol as important risk factor for hypertension. Stigma-related barriers could not be significantly predicted by education, knowledge or screening frequency in most models. CONCLUSIONS: Overall, regular alcohol screening among hypertensive patients seems to be widely accepted, but further education (Germany) and structural support (Spain, UK) could contribute to increase screening rates. In France and Italy, screening uptake could be improved by addressing stigma. SHORT SUMMARY: Alcohol screening among hypertensive patients was largely accepted among general practitioners from five different European countries. Reported screening barriers varied between countries and included time constraints, stigma and underrated importance of alcohol. Results did not indicate a positive impact of education and screening frequency on perception of stigma as barrier to screening.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
A survey study conducted in the five largest European Union countries found that the most frequently cited barriers to implementing alcohol screening among patients with hypertension varied substantially from country to country.
“One recently published survey study conducted in the largest five European Union countries found that the most frequently cited barriers to implementing alcohol screening among patients with hypertension varied substantially from country to country [119].”
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Diagnostic and Statistical Manual of Mental Disorders
American Psychiatric Association (2013) · doi:10.1176/appi.books.9780890425596 · Cited by 116,369 · see citing works
Diagnostic and Statistical Manual of Mental Disorders
Williams, J. B. W., & First, M. B. (2013) · Oxford University Press eBooks · doi:10.1093/acrefore/9780199975839.013.104 · Cited by 109,841 · see citing works
Link, B. G., & Phelan, J. C. (2001) · Annual Review of Sociology · doi:10.1146/annurev.soc.27.1.363 · Cited by 8,848 · see citing works
Forouzanfar, M. H., Afshin, A., Alexander, L. T., Anderson, H. R., Bhutta, Z. A., Biryukov, S., Brauer, M., Burnett, R., Cercy, K., Charlson, F. J., et al. (2016) · The Lancet · doi:10.1016/s0140-6736(16)31679-8 · Cited by 7,698 · see citing works
Self-citationUsing Bayes to get the most out of non-significant results
Dienes, Z. (2014) · Frontiers in Psychology · doi:10.3389/fpsyg.2014.00781 · Cited by 1,998 · see citing works
Challenging the public stigma of mental illness: a meta-analysis of outcome studies
Corrigan, P. W., Morris, S. B., Michaels, P. J., Rafacz, J. D., & Rüsch, N. (2012) · Psychiatric Services · doi:10.1176/appi.ps.201100529 · Cited by 1,680 · see citing works
Tackling Harmful Alcohol Use: Economics and Public Health Policy
OECD (2015) · doi:10.1787/9789264181069-en · Cited by 991 · see citing works
Livingston, J. D., Milne, T., Fang, M. L., & Amari, E. (2012) · Addiction · doi:10.1111/j.1360-0443.2011.03601.x · Cited by 927 · see citing works
Global strategy to reduce the harmful use of alcohol
Ray, R., & Anish, P. K. (2012) · The Indian Journal of Medical Research · Cited by 900 · see citing works
Stigma, social inequality and alcohol and drug use
ROOM, R. (2005) · Drug and Alcohol Review · doi:10.1080/09595230500102434 · Cited by 891 · see citing works
Schomerus, G., Lucht, M., Holzinger, A., Matschinger, H., Carta, M. G., & Angermeyer, M. C. (2011) · Alcohol and Alcoholism · doi:10.1093/alcalc/agq089 · Cited by 744 · see citing works
The impact of brief alcohol interventions in primary healthcare: a systematic review of reviews
O'Donnell, A., Anderson, P., Newbury-Birch, D., Schulte, B., Schmidt, C., Reimer, J., & Kaner, E. (2014) · Alcohol and Alcoholism · doi:10.1093/alcalc/agt170 · Cited by 613 · see citing works
Stigma and Treatment for Alcohol Disorders in the United States
Keyes, K. M., Hatzenbuehler, M. L., McLaughlin, K. A., Link, B. G., Olfson, M., Grant, B. F., & Hasin, D. S. (2010) · American Journal of Epidemiology · doi:10.1093/aje/kwq304 · Cited by 436 · see citing works
Johnson, M., Jackson, R., Guillaume, L., Meier, P., & Goyder, E. (2011) · Journal of Public Health · doi:10.1093/pubmed/fdq095 · Cited by 374 · see citing works
Taylor, B., Irving, H. M., Baliunas, D., Roerecke, M., Patra, J., Mohapatra, S., & Rehm, J. (2009) · Addiction · doi:10.1111/j.1360-0443.2009.02694.x · Cited by 346 · see citing works
Self-citationAlcohol measurement methodology in epidemiology: recent advances and opportunities
Greenfield, T. K., & Kerr, W. C. (2008) · Addiction · doi:10.1111/j.1360-0443.2008.02197.x · Cited by 339 · see citing works
Defining substance use disorders: do we really need more than heavy use?
Rehm, J., Marmet, S., Anderson, P., Gual, A., Kraus, L., Nutt, D. J., Room, R., Samokhvalov, A. V., Scafato, E., Trapencieris, M., et al. (2013) · Alcohol and Alcoholism · doi:10.1093/alcalc/agt127 · Cited by 242 · see citing works
Self-citationBerner, M. M., Kriston, L., Bentele, M., & Härter, M. C. (2007) · Journal of Studies on Alcohol and Drugs · doi:10.15288/jsad.2007.68.461 · Cited by 164 · see citing works
Aira, M., Kauhanen, J., Larivaara, P., & Rautio, P. (2003) · Family Practice · doi:10.1093/fampra/cmg307 · Cited by 164 · see citing works
Corrigan, P. W., Schomerus, G., Shuman, V., Kraus, D. J., Perlick, D., Harnish, A., Kulesza, M., Kane-Willis, K., Qin, S., & Smelson, D. A. (2016) · American Journal on Addictions · doi:10.1111/ajad.12436 · Cited by 151 · see citing works
Corrigan, P. W., Schomerus, G., Shuman, V., Kraus, D. J., Perlick, D., Harnish, A., Kulesza, M., Kane-Willis, K., Qin, S., & Smelson, D. A. (2016) · American Journal on Addictions · doi:10.1111/ajad.12458 · Cited by 136 · see citing works
Still a difficult business? Negotiating alcohol-related problems in general practice consultations
Rapley, T., May, C., & Frances Kaner, E. (2006) · Social Science & Medicine · doi:10.1016/j.socscimed.2006.05.025 · Cited by 95 · cited 2× · see citing works
“The observed pattern may be partially explained by contextual differences in social norms regarding tolerable levels of alcohol consumption, which may impact on the perceived acceptability of screening about alcohol use among GPs (Rapley et al., 2006; Lid et al., 2015).”
BackgroundAlcohol policy in Europe: evidence from AMPHORA.
Anderson, P., Braddick, F., Reynolds, J. P., & Gual, A. (2012) · Cited by 86 · see citing works
Self-citationNygaard, P., & Aasland, O. G. (2011) · Alcohol and Alcoholism · doi:10.1093/alcalc/agq073 · Cited by 77 · see citing works
Nilsen, P., Kaner, E., & Babor, T. F. (2008) · Nordic Studies on Alcohol and Drugs · doi:10.1177/145507250802500608 · Cited by 64 · see citing works
Kaner, E. (2006) · Family Practice · doi:10.1093/fampra/cml015 · Cited by 58 · see citing works
Addressing patient alcohol use: a view from general practice
Mules, T., Taylor, J., Price, R., Walker, L., Singh, B., Newsam, P., Palaniyappan, T., Snook, T., Ruselan, M., Ryan, J., et al. (2012) · The Journal of Primary Health Care · doi:10.1071/hc12217 · Cited by 51 · see citing works
McCormick, R., Docherty, B., Segura, L., Colom, J., Gual, A., Cassidy, P., Kaner, E., & Heather, N. (2010) · Drugs: Education, Prevention and Policy · doi:10.3109/09687630903286800 · Cited by 38 · see citing works
Self-citationJohansson, K., Bendtsen, P., & Åkerlind, I. (2005) · Public Health · doi:10.1016/j.puhe.2004.12.006 · Cited by 33 · see citing works
Brief Interventions Implementation on Alcohol from the European Health Systems Perspective
Colom, J., Scafato, E., Segura, L., Gandin, C., & Struzzo, P. (2014) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2014.00161 · Cited by 31 · see citing works
Self-citationRehm, J. T., Prieto, J. A. A., Beier, M., Duhot, D., Rossi, A., Schulte, B., Zarco, J., Aubin, H., Bachmann, M., Grimm, C. J., et al. (2016) · BMC Family Practice · doi:10.1186/s12875-016-0529-5 · Cited by 30 · see citing works
Self-citationlid, T. G., Nesvåg, S., & Meland, E. (2015) · Scandinavian Journal of Public Health · doi:10.1177/1403494814565129 · Cited by 29 · cited 1× · see citing works
“The observed pattern may be partially explained by contextual differences in social norms regarding tolerable levels of alcohol consumption, which may impact on the perceived acceptability of screening about alcohol use among GPs (Rapley et al., 2006; Lid et al., 2015).”
BackgroundIdentification of smokers, drinkers and risky drinkers by general practitioners
Manthey, J., Probst, C., Hanschmidt, F., & Rehm, J. T. (2015) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2015.06.017 · Cited by 19 · see citing works
Self-citationGeirsson, M., Hensing, G. K. E., & Spak, F. (2009) · Alcohol and Alcoholism · doi:10.1093/alcalc/agp071 · Cited by 16 · see citing works
Kraus, L., Schulte, B., Manthey, J., & Rehm, J. T. (2016) · Addiction Research & Theory · doi:10.1080/16066359.2016.1263728 · Cited by 14 · see citing works
Self-citationAlcoholic Beverages, Gender and European Cultures
Allamani, A. (2008) · Substance Use & Misuse · doi:10.1080/10826080801913438 · Cited by 9 · see citing works
Schulte, B., Schmidt, C., Milin, S., et al. (2013) · Suchttherapie · doi:10.1055/s-0033-1349863 · Cited by 8 · see citing works
Miller, P. M., Stockdell, R., Nemeth, L., Feifer, C., Jenkins, R. G., Liszka, H., Ornstein, S., Nietert, P. J., & Wessell, A. (2006) · Substance Abuse · doi:10.1300/j465v27n01_08 · Cited by 1 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Rosário, F., Santos, M. I., Angus, K., Pas, L., Ribeiro, C., & Fitzgerald, N. (2021) · Implementation Science · doi:10.1186/s13012-020-01073-0 · Cited by 141 · see citing works
- Authors
- Hanschmidt, F., Manthey, J., Kraus, L., Scafato, E., Gual, A., Grimm, C., & Rehm, J.
- Affiliations
- Leipzig University (DE)
- Technische Universität Dresden (DE)
- Stockholm University (SE)
- Instituto de Salud Carlos III (ES)
- Royal College of General Practitioners (GB)
- Centre for Addiction and Mental Health (CA)
- Corresponding author
- Hanschmidt, Franz
- Venue
- Alcohol and Alcoholism
- Publisher
- Oxford University Press (OUP)
- Published
- 2017-06-13
- Volume
- 52
- Issue
- 5
- Pages
- 572-579
- ISSN
- 0735-0414 (ISSN-L)
- 1464-3502
- OpenAlex
- W2619770773
- Cited by
- 34
- References
- 39
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 7 · 2023: 4 · 2022: 5 · 2021: 8 · 2020: 2 · 2019: 3 · 2018: 1
- FWCI
- 1.29
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Alcohol and Alcoholism (publishedVersion)
- PubMed (publishedVersion)
- Funders
- H. Lundbeck A/S
- Topics
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
- Health Sciences › Medicine › Pathology and Forensic Medicine › Alcohol Consumption and Health Effects
- Keywords
- alcohol screening, hypertension, stigma, barriers to screening, screening and brief intervention, primary care, general practitioners, professional education, alcohol as risk factor, screening frequency, time constraints, cross-national comparison
- MeSH terms
- Alcohol Drinking, Attitude of Health Personnel, Europe, Health Services Accessibility, Humans, Hypertension, Health Knowledge, Attitudes, Practice, Primary Health Care, Substance Abuse Detection, Social Stigma
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
