Barriers and facilitators to implementing screening and brief intervention for alcohol misuse: a systematic review of qualitative evidence
Abstract
BACKGROUND: This review aimed to synthesize qualitative evidence for barriers and facilitators to effective implementation of screening and brief intervention for alcohol misuse in adults and children over 10 years. METHODS: A search of medical and social science databases was carried out and augmented by hand-searching of reference lists and contents of key journals. Qualitative evidence was synthesized thematically. RESULTS: A total of 47 papers varying in design and quality were included in the review. Most evaluated implementation in primary care settings. Implementation was reported to be limited by lack of resources, training and support from management, as well as workload. The appropriateness of context in which discussions take place was reported as an acceptability factor for patients and practitioners. Health professionals require sufficient knowledge about alcohol guidelines and risk in order to implement screening and intervention to those most in need. CONCLUSIONS: Whilst brief screening and brief intervention have been shown to be effective in some settings, this review has identified a number of barriers and facilitators to implementation. Adequate resources, training and the identification of those at risk without stereotyping are the main facilitators in primary care. More research is needed to assess implementation in other settings.
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In a previous review, Johnson and colleagues identified barriers and facilitators to implementing alcohol screening and brief interventions.
“In a previous review, Johnson and colleagues identified barriers and facilitators to implementing alcohol screening and brief interventions [27].”
The presence of clear incentivisation structures drove adoption, including non-financial incentives such as public recognition and access to training.
“The presence of clear incentivisation structures was found to drive adoption: this included non-financial incentives such as public recognition [59] and access to training [60, 61].”
From Achieving change in primary care—causes of the evidence to practice gap: systematic reviews of reviews (2015) · cites this paper as [61]
Lack of training, support from management and resources, and workload pressures were main barriers to implementation of alcohol screening and brief interventions.
“Lack of training, support from management and resources, as well as workload pressures were identified as the main barriers to implementation; whilst adequate resources, training and the identification of those at risk without stereotyping were the main facilitators.”
Adequate resources, training, and identification of those at risk without stereotyping were main facilitators of alcohol screening and brief intervention implementation.
“Lack of training, support from management and resources, as well as workload pressures were identified as the main barriers to implementation; whilst adequate resources, training and the identification of those at risk without stereotyping were the main facilitators.”
A review of barriers and facilitators mediating implementation, and how they fit with theoretical understandings of behaviour change, to inform the design of implementation interventions is lacking.
“A review of the barriers and facilitators mediating implementation, and how they fit with theoretical understandings of behaviour change, to inform the design of implementation interventions is lacking.”
Johnson and colleagues' previous review included studies from settings other than PHC, reported only on studies published in English, and gave priority to studies judged most likely to inform UK practice.
“This review included studies from settings other than PHC, reported only on studies published in English, and gave priority to studies judged most likely to inform UK practice.”
The review's findings on bottlenecks are in keeping with results from a review of barriers and facilitators to implementing screening and brief intervention for alcohol misuse in high-income country settings.
“These findings are in keeping with results from a review of barriers and facilitators to implementing screening and brief intervention for alcohol misuse in high-income country settings (64).”
From Integration of Alcohol Use Disorder Interventions in General Health Care Settings in Sub-Saharan Africa: A Scoping Review (2022) · cites this paper as [64]
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- Authors
- Johnson, M., Jackson, R., Guillaume, L., Meier, P., & Goyder, E.
- Affiliations
- University of Sheffield (GB)
- Corresponding author
- Johnson, M.
- Venue
- Journal of Public Health
- Publisher
- Oxford University Press (OUP)
- Published
- 2010-12-17
- Volume
- 33
- Issue
- 3
- Pages
- 412-421
- ISSN
- 0943-1853 (ISSN-L)
- 1741-3842
- 1741-3850
- OpenAlex
- W2142664550
- Semantic Scholar
- 3ebf7670b0496b696c87255f170a301228402038
- Cited by
- 374
- References
- 52
- Citations by year
- 2026: 13 · 2025: 23 · 2024: 31 · 2023: 19 · 2022: 27 · 2021: 43 · 2020: 35 · 2019: 28 · 2018: 26 · 2017: 24 · 2016: 26 · 2015: 24 · 2014: 22 · 2013: 17 · 2012: 13
- FWCI
- 1.92
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Public Health (publishedVersion)
- PubMed (publishedVersion)
- ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (submittedVersion)
- Topics
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Pathology and Forensic Medicine › Alcohol Consumption and Health Effects
- Keywords
- screening and brief intervention, alcohol abuse, implementation barriers, implementation facilitators, primary care, health professions education, resource constraints, workload, acceptability, alcohol guidelines, children and adolescents
- MeSH terms
- Adult, Alcoholism, Child, Health Plan Implementation, Health Services Accessibility, Health Services Research, Humans, Quality Assurance, Health Care
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