Patient outcomes and experience of a task-shared screening and brief intervention service for problem substance use in South African emergency centres: a mixed methods study
Open accessAbstract
Background: Screening, brief intervention and referral to treatment (SBIRT) programmes have resulted in generally positive outcomes in healthcare settings, particularly for problem alcohol use, yet implementation is hampered by barriers such as concerns regarding the burden on healthcare professionals. In low-resourced settings, task-sharing approaches can reduce this burden by using non-professional healthcare workers, yet data are scarce regarding the outcomes and acceptability to patients within a SBIRT service. This study aims to evaluate patient-reported outcomes, patient acceptability, perceived benefits and recommendations for improving a task-shared SBIRT service in South African emergency centres (ECs). Methods: This mixed methods study incorporates quantitative substance use screening and patient satisfaction data collected routinely within the service at three hospitals, and qualitative semi-structured interviews with 18 EC patient beneficiaries of the programme exploring acceptability and perceived benefits of the programme, as well as recommendations to improve the service. Approximately three months after the acute EC visit, a sub-sample of patients were followed up telephonically to assess patient-reported satisfaction and substance use outcomes. Results: Of the 4847 patients eligible for the brief intervention, 3707 patients (76%) used alcohol as their primary substance and 794 (16%) used cannabis. At follow-up (n = 273), significant reductions in substance use frequency and severity were noted and over 95% of patients were satisfied with the service. In the semi-structured interviews, participants identified the non-judgemental caring approach of the counsellors, and the screening and psychoeducation components of the intervention as being the most valuable, motivating them to decrease substance use and make other positive lifestyle changes. Study participants made recommendations to include group sessions, market the programme in communities and extend the programme’s reach to include a broader age group and a variety of settings. Conclusions: This task-shared SBIRT service was found to be acceptable to patients, who reported several benefits of a single SBIRT contact session delivered during an acute EC visit. These findings add to the SBIRT literature by highlighting the role of non-professional healthcare workers in delivering a low-intensity SBIRT service feasible to implement in low-resourced settings.
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Sample sizes for the mixed methods studies ranged from 40 to 4,865.
“for the mixed methods studies from 40 [78] to 4,865 [79]”
From A scoping review of substance use brief interventions in Africa (2024) · cites this paper as [79]
The citation to this paper is attached to the upper end of the range, 4,865, not the lower end of 40. In Results, Table 1 gives the eligible patient group as n = 4,847, not 4,865; the paper separately reports 273 patients at follow-up and 18 qualitative interviewees. (LLM, conf=0.88)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredIn patients with moderate to high-risk substance use in South Africa, 97% said they would return for the service, 98% agreed that the program should be provided to other settings, and many participants found the program to be helpful.
“Patient satisfaction- 97% said they would return for the service; 98% agreed that program should be provided to other settings.Acceptability- many participants found the program to be helpful.”
From A scoping review of substance use brief interventions in Africa (2024) · cites this paper as [79]
The Results section on patient satisfaction reports that 97% of patients reached at three-month follow-up would return, and the Acceptability section says many interviewees found the intervention helpful. The reported 98% agreed it should be provided in all South African emergency centres—not in other types of settings generally. These percentages describe follow-up respondents, not all patients who received the service. (LLM, conf=0.88)
Experimental — accuracy not yet measuredIn patients with moderate to high-risk substance use in South Africa, for those with alcohol as primary substance, the number of alcohol use days were reduced significantly between baseline and 3 months (e.g., number of days with no alcohol use reduced from 11% at baseline to 59% at 3 month follow up); for other drugs, a similar pattern was observed with a drop in number of drug use days.
“For those with alcohol as primary substance, the number of alcohol use days were reduced significantly between baseline and 3 months. e.g. number of days with no alcohol use reduced from 11% at baseline to 59% at 3 month follow up. For other drugs, a similar pattern was observed with a drop in number of drug use days.”
From A scoping review of substance use brief interventions in Africa (2024) · cites this paper as [79]
The Results section (“Patient substance use outcomes at three-month follow-up”) reports significant decreases in alcohol-use and drug-use days. It also reports that the proportion of patients with no alcohol-use days increased from 11% at screening to 59% at three-month follow-up; the claim incorrectly says this measure was reduced and describes percentages of patients as a number of days. (LLM, conf=0.88)
Experimental — accuracy not yet measuredIn patients with moderate to high-risk substance use in South Africa, patients reported that counselors were non-judgmental and caring; perceived benefits included reduced substance use, improvement in health, improved interpersonal relationships, and ability to save money due to less substance use.
“Patients reported that the counselors were non-judgmental and caring;Perceived benefits included: reduced substance use, through implementing the strategies learnt; improvement in health e.g. less injuries; improved interpersonal relationships; ability to save money due to less substance use.”
From A scoping review of substance use brief interventions in Africa (2024) · cites this paper as [79]
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A reflection of the current status of the mental healthcare system in South Africa
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A scoping review of substance use brief interventions in Africa
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- Authors
- van der Westhuizen, C., Malan, M., Naledi, T., Roelofse, M., Myers, B., Stein, D. J., Lahri, S., & Sorsdahl, K.
- Affiliations
- University of Cape Town (ZA)
- Western Cape Department of Health (ZA)
- South African Medical Research Council (ZA)
- ORCID
- Venue
- Addiction Science & Clinical Practice
- Published
- 2021-05-12
- Volume
- 16
- Issue
- 1
- Pages
- 31-31
- ISSN
- 1940-0632 (ISSN-L)
- 1940-0640
- PMC
- PMC8117325
- OpenAlex
- W3163695280
- Cited by
- 13
- References
- 55
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 1 · 2023: 6 · 2022: 1
- FWCI
- 1.44
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Addiction Science & Clinical Practice (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- eSpace (Curtin University) (submittedVersion, cc-by)
- Open University of Cape Town (University of Cape Town) (submittedVersion)
- Funders
- Wellcome Trust (DEL-15-01)
- Topics
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Keywords
- task sharing, SBIRT, emergency department, problematic substance use, alcohol consumption, cannabis use, patient acceptability, patient satisfaction, substance use outcomes, South Africa
- MeSH terms
- Crisis Intervention, Emergency Service, Hospital, Humans, Mass Screening, Referral and Consultation, Substance-Related Disorders
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