3 years ago

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

Annually, alcohol causes 3.3 million deaths; countless more alcohol-related injury patients are treated in Emergency Departments (ED) 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 healthcare 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 healthcare instruction, with a Swahili translation available if preferred. Data were analyzed with relative and absolute frequencies and Spearman's correlation. 34 (100%) healthcare practitioners completed the survey. Our results found positive attitudes towards addressing alcohol misuse (88%), but very poor knowledge of recommended alcohol use limits (24%). Participants were willing to discuss alcohol use (88%) and screen (71%) for alcohol use disorders. Most healthcare 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 alcohol use ‘won't make a difference’. Stigma was negatively and indirectly associated with counseling patients. In conclusion, in an ED in Tanzania, healthcare practitioners have positive attitudes towards 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, amongst 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.

Publisher URL: www.sciencedirect.com/science

DOI: S0741832917308315

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