Aim: To explore the feasibility and cost effectiveness of screening and delivery of a brief intervention for hazardous drinking employees. Methods: A pilot randomised controlled trial of a brief intervention delivered by an Occupational Health nurse versus no delivery of brief intervention (control group) conducted in a Local Authority Council (LCA) in the United Kingdom. Changes in quality of life and economic indicators were measured by the EQ-5D. Results: 627 employees were screened of whom 163 (26.01%) fulfilled the inclusion criteria with a total of 57 (35%) agreeing to participate. No significant differences were found between the groups for baseline demographics or levels/patterns of alcohol consumption. A statistically significant effect was found in the mean AUDIT scores over time (F = 8.96, p = 0.004) but not for group (F=0.017, p = 0.896), and no significant interaction was found (F = 0.148, p = 0.702). The cost of each intervention was calculated at 12.48 pound, the difference in service costs was calculated at 344.50 pound per person; that is there was a net saving of health and other care costs in the intervention group compared to the control group. The QALYs fell in both intervention and control groups, the difference -0.002 (-0.010) yields a net advantage of the intervention of 0.008 QALYs. Conclusion: The main results from this pilot study suggest that alcohol brief interventions delivered in the workplace may offer the potential to reduce alcohol-related harm and save public sector resources. A fully powered multi-centre trial is warranted to contribute to the current evidence base and explore further the potential of alcohol brief interventions in the workplace. In a full trial the recruitment method may need to be re-considered. (C) 2014 Elsevier Ltd. All rights reserved.

BACKGROUND:Smoking in people with mental health problems (MHPs) is an important public health concern as rates are two to three times higher than in the general population. While a strong evidence base exists to encourage and support smoking cessation in the wider population, there is limited evidence to guide the tailoring of interventions for people with MHPs, including minimal understanding of their needs. This paper presents findings from theoretically-driven formative research which explored the barriers and facilitators to smoking cessation in people with MHPs. The aim, guided by the MRC Framework for the development and evaluation of complex interventions, was to gather evidence to inform the design and content of smoking cessation interventions for this client group.METHODS:Following a review of the empirical and theoretical literature, and taking a critical realist perspective, a qualitative approach was used to gather data from key stakeholders, including people with enduring MHPs (n = 27) and professionals who have regular contact with this client group (n = 54).RESULTS:There was a strong social norm for smoking in participants with MHPs and most were heavily addicted to nicotine. They acknowledged that their physical health would improve if they stopped smoking and their disposable income would increase; however, more important was the expectation that, if they attempted to stop smoking, their anxiety levels would increase, they would lose an important coping resource, they would have given up something they found pleasurable and, most importantly, their mental health would deteriorate. Barriers to smoking cessation therefore outweighed potential facilitators and, as a consequence, impacted negatively on levels of motivation and self-efficacy. The potential for professionals to encourage cessation attempts was apparent; however, they often failed to raise the issue of smoking/cessation as they believed it would damage their relationship with clients. The professionals' own smoking status also appeared to influence their health promoting role.CONCLUSIONS:Many opportunities to encourage and support smoking cessation in people with MHPs are currently missed. The increased understanding provided by our study findings and literature review have been used to shape recommendations for the content of tailored smoking cessation interventions for this client group.

BACKGROUND:Older people who smoke derive significant health benefits from stopping smoking in later life. Healthcare practitioners have an important role to play in raising the issue of smoking cessation with this client group; however, they often fail to do so.AIM:To assess the effectiveness of smoking cessation training for healthcare practitioners who have regular contact with older adults.METHODS:Mixed-methods were used to explore satisfaction with the training, the participants' learning and any resultant changes in behaviour. The effectiveness of the training was assessed using a two-group parallel design randomised controlled trial, followed by semistructured qualitative interviews. Participants (n = 57) were recruited from a cohort of community nurses and allied health professionals (e.g., occupational therapists) working in Scotland. The intervention was 1-day brief intervention smoking cessation training. Validated measures of knowledge, attitudes and practice, were used to assess learning and behaviour at baseline, 1 week and 3 months post training. Data were analysed using two-factor repeated measure analysis of variance, where the factors were "group" and "time." Qualitative data were gathered from members of the intervention group during semistructured interviews (n = 8) and were analysed thematically.RESULTS/FINDINGS:Levels of satisfaction with the training were high. There was a statistically significant improvement in the knowledge and attitudes of the intervention group following the training, with a noticeable, but nonsignificant, improvement in practice. The qualitative findings demonstrate how the training impacted positively on practice.CONCLUSIONS:Smoking cessation interventions in later life are important, as older smokers generally have long-term conditions caused or complicated by smoking. The delivery of brief smoking cessation interventions is known to be highly cost-effective; however, research demonstrates that practitioners often fail to raise the issue of smoking cessation with older adults. This study has demonstrated the effectiveness of a 1-day training course for practitioners. Further research is recommended.

BACKGROUND:Stroke is a major cause of disability and family disruption and carries a high risk of recurrence. Lifestyle factors that increase the risk of recurrence include smoking, unhealthy diet, excessive alcohol consumption and physical inactivity. Guidelines recommend that secondary prevention interventions, which include the active provision of lifestyle information, should be initiated in hospital, and continued by community-based healthcare professionals (HCPs) following discharge. However, stroke patients report receiving little/no lifestyle information.There is a limited evidence-base to guide the development and delivery of effective secondary prevention lifestyle interventions in the stroke field. This study, which was underpinned by the Theory of Planned Behaviour, sought to explore the beliefs and perceptions of patients and family members regarding the provision of lifestyle information following stroke. We also explored the influence of beliefs and attitudes on behaviour. We believe that an understanding of these issues is required to inform the content and delivery of effective secondary prevention lifestyle interventions.METHODS:We used purposive sampling to recruit participants through voluntary sector organizations (29 patients, including 7 with aphasia; 20 family members). Using focus group methods, data were collected in four regions of Scotland (8 group discussions) and were analysed thematically.RESULTS:Although many participants initially reported receiving no lifestyle information, further exploration revealed that most had received written information. However, it was often provided when people were not receptive, there was no verbal reinforcement, and family members were rarely involved, even when the patient had aphasia. Participants believed that information and advice regarding healthy lifestyle behaviour was often confusing and contradictory and that this influenced their behavioural intentions. Family members and peers exerted both positive and negative influences on behavioural patterns. The influence of HCPs was rarely mentioned. Participants' sense of control over lifestyle issues was influenced by the effects of stroke (e.g. depression, reduced mobility) and access to appropriate resources.CONCLUSIONS:For secondary prevention interventions to be effective, HCPs must understand psychological processes and influences, and use appropriate behaviour change theories to inform their content and delivery. Primary care professionals have a key role to play in the delivery of lifestyle interventions.

OBJECTIVE:To evaluate community pharmacists' readiness to provide brief interventions on alcohol and to use study findings to develop training to enable them to screen for hazardous or harmful drinking and intervene appropriately.SETTING:Community pharmacies in Scotland.METHOD:Eight community pharmacies in Greater Glasgow, Scotland were purposively selected on the basis of pharmacy (independent, multiple), population deprivation index, location (rural, urban, suburban), and local level of hospital admissions for alcohol misuse. Baseline pharmacist telephone interviews covered: current practice; attitudes towards a proactive role; and perceived training needs. A two-day course was designed focusing on: consequences of problem alcohol use; attitudes; sensible drinking; familiarity with client screening using the Fast Alcohol Screening Tool; brief interventions and motivational interviewing.MAIN OUTCOME MEASURES:Knowledge of problem alcohol use and brief interventions; attitudes; competence. Results Participants felt it was feasible for trained pharmacists to provide brief interventions. Core training needs centred on communication and alcohol related knowledge. The training course was positively evaluated and led to increases in knowledge, attitudinal scores and self related competence.CONCLUSION:A training programme for pharmacists to deliver brief interventions to problem drinkers was successfully delivered resulting in enhanced knowledge, attitudinal scores and self related competence.

Nurses have an important role to play in providing information and advice on lifestyle risk factors for recurrent stroke. However, patients report receiving little or no lifestyle information. Aim: This study aimed to explore stroke nurses' knowledge and practice in relation to the provision of secondary prevention lifestyle information following stroke. Design: Cross-sectional survey methods were used. Participants were members of the Scottish Stroke Nurse Forum (n=97). Methods: A self-completed questionnaire was used to collect the data, with descriptive statistics summarizing the results. Results: Respondents stated that they assessed lifestyle risk factors following stroke; however, they focused on some but not all risk factors. While written and verbal information and advice was provided, knowledge of guidelines and health-related recommendations was limited. Conclusions: Stroke nurses require improved access to continuing professional development with regard to secondary prevention of stroke. They also require easy access to information resources which support evidence-based practice.

Background: Stroke is a major cause of mortality, disability and family disruption; yet prevalence continues to rise despite advances in prevention and treatment. Many risk factors for stroke are modifiable, including life style behaviours, i.e. tobacco and alcohol use, diet and physical activity. Patterns that influence lifestyle behaviour are believed to be embedded in family life. Primary and secondary prevention of stroke are important health promotion issues. Objective: To summarize government recommendations and contemporary evidence-based guidelines regarding four lifestyle risk factors for recurrent stroke. Methods: Structured review methods were used. Conclusions: Modifiable lifestyle risk factors for stroke and recurrent stroke have been identified and brief interventions are known to be cost effective health promotion tools. However, very few studies have tested the effectiveness of behavioural interventions designed to address lifestyle risk factors for recurrent stroke and none have tested the effectiveness of family-centred behavioural interventions. Recommendations for education, practice and research are presented.

Abstract Objective The aim was to evaluate the feasibility and acceptability of the provision of brief interventions on alcohol misuse in community pharmacies. The objectives were to: train community pharmacists to initiate discussion of alcohol consumption with targeted pharmacy clients and screen, intervene or refer as appropriate; and to explore with pharmacists and clients the feasibility, acceptability and perceived value of screening and delivering the intervention. Setting Eight community pharmacies in Greater Glasgow. Method After a two-day training course for pharmacists (n = 9) and one day for pharmacy assistants (n = 13), the eight pharmacies recruited clients over 3 months. Standardised protocols were prepared to screen clients for hazardous or harmful drinking using the Fast Alcohol Screening Tool (FAST) and to guide the intervention. Clients were recruited from specific target groups and via posters highlighting the service. Following completion of the recruitment phase, pharmacists and clients were followed up by the research team, using a combination of focus groups and semi-structured telephone interviews. Key findings During the study period 70 clients were recruited, 30 screened as drinking hazardously (42.9%) and 7 (10%) screened positive for harmful drinking. Interventions commonly included explanation of sensible drinking and units in clients' preferred drinks (n = 33), feedback on screening and risks to health (n = 27) and discussion of pros and cons of current drinking pattern and link with presenting issue (n = 23). Of the 40 clients agreeing to be followed up, 19 could be contacted and most were generally positive about the experience. On follow-up the pharmacists were positive and felt the project worthwhile and, importantly, noted no strong negative reactions from clients. Conclusion This project has been successful in training community pharmacists to discuss alcohol with 70 clients. Further work is required to test the generalisability of our findings and to measure the impact on alcohol consumption.

AIMS:(i) To evaluate the effect of receiving one of two brief interventions in reducing alcohol consumption among general hospital patients compared with usual care. (ii) To assess whether a brief intervention of self-efficacy enhancement was superior to a self-help booklet in reducing alcohol consumption.DESIGN:A three-arm cluster randomized controlled trial.SETTING:Seven general medical, six general surgical, one dermatology and two otolaryngology wards of a large teaching hospital covering a large urban and rural area.PARTICIPANTS:A total of 215 of 789 in-patients aged 18-75 years, who screened positive for alcohol consumption in excess of national recommended limits according to a 7-day retrospective drinking diary.INTERVENTIONS:Participants were allocated to receive one of three interventions: (i) face-to-face self-efficacy enhancement; (ii) a self-help booklet; or (iii) usual care.MEASUREMENTS:The primary outcome measure was change in reported alcohol consumption at 6-month follow-up as measured by a 7-day retrospective drinking diary. Secondary outcomes were change in: number of alcohol drinking days in last week; the maximum units of alcohol consumed on any one day in last week; and Drinking Refusal Self-efficacy Expectancy Questionnaire score.FINDINGS:Compared to the usual care group the self-efficacy enhancement group (-10.1 units 95% CI -16.1 to -4.1) and the self-help booklet group (-10.0 units 95% CI -16.0 to -3.9) had greater reductions in self-reported weekly alcohol consumption. There was no evidence that self-efficacy enhancement was superior to the self-help booklet (P = 0.96).CONCLUSIONS:Brief interventions delivered in hospital offer simple means of helping heavy drinkers to reduce their alcohol consumption.

AIM:To evaluate the psychometric properties of an adaptation of the Alcohol and Alcohol Problems Perceptions Questionnaire to measure the attitudes of staff to working with drug users (the DDPPQ).DESIGN:Postal survey: a questionnaire was mailed to participants on two occasions.SETTING:A large urban National Health Service (NHS) mental health service.PARTICIPANTS:A stratified random sample of medical staff, clinical psychologists, occupational therapists and nurses (n = 672) who work within generic mental health, adolescent psychiatry, forensic psychiatry and alcohol and drug services. Response rate at Time 1 was 56% and 68% at Time 2.MEASUREMENTS:A structured demographic questionnaire; individual item and total scores for the DDPPQ administered on two occasions 4 weeks apart; data relating to the content validity of the instrument.FINDINGS:A principal component analysis confirmed the DDPPQ's construct validity and participants confirmed its content validity. Following analysis of the instrument's test-retest reliability and its principal component structure it was reduced to a 20-item scale. Its five subscales related to role adequacy, role support, job satisfaction, role-specific self-esteem and role legitimacy.CONCLUSION:The refined DDPPQ was shown to be a valid and reliable tool which can be used to measure attitudes of people in relation to working with drug users.

Smokers aged 65 and over have been identified as a priority group for smoking-cessation interventions. However, despite confirmation of the benefits of cessation in later life and compelling evidence that interventions can be effective, studies have shown that members of the primary care team often fail to target this population. If these professionals are to be encouraged to broach the subject of smoking cessation with older people, it is important that barriers to the effective provision of interventions are uncovered. This article reports findings from a qualitative study that sought to do this by exploring the knowledge, attitudes and practice of members of the primary care team in relation to smoking/smoking cessation in later life. A purposive sample of health visitors, district nurses, practice nurses and general practitioners (n = 41) working in the west of Scotland was recruited. Data were collected during face-to-face interviews using a semi-structured interview schedule. The interviews were transcribed and then analysed using content analysis procedures. While the participants were generally convinced of the benefits of cessation many believed that few older people manage to stop smoking successfully. A pessimistic view of the success rate of older smokers appeared to negatively influence practice. In addition, a number of the participants lacked confidence in their own counselling skills and/or had limited awareness of smoking cessation resources and specialist services. These factors also appeared to preclude the provision of effective smoking-cessation interventions. Finally, there was little awareness of the content of the UK Smoking Cessation Guidelines. The findings from this study, and a parallel study that explored the health beliefs of older smokers, have been used to develop smoking cessation training designed specifically for members of the primary care team who have contact with older people who smoke. The efficacy of the training is currently being evaluated.

Background: Substance misuse can trigger or be causally associated with mental health problems. Therapeutic attitude is important in predicting effective engagement with people with alcohol and drug problems but health professionals' attitudes towards this client group are often negative. Education regarding substance misuse has often been neglected and nurses may lack knowledge to provide appropriate care.Objectives: To test the impact of training for staff who work with people who have co-existing mental health and substance use problems.Design: A randomised controlled trial.Setting: An NHS Primary Care Division in the West of Scotland.Participants: Forty-nine mental health nurses.Methods: Intervention. A four-day training programme. Measurements: (a) therapeutic attitudes measured by the comorbidity problems perceptions questionnaire; (b) knowledge of alcohol, drugs and co-morbidity measured by a structured questionnaire.Results: Significant effects for group (F = 30.42, p < 0.001) were found in therapeutic attitude scores and also over time (F = 10.66, p < 0.001). A significant interaction was also found (p < 0.001). Post-hoc testing revealed that the mean pre-training attitude score was significantly different from post-training (p = 0.001; 95% CI 5.53, 25.38) and from six-months follow-up (p < 0.001; 95% CI 11.26, 32.49) but that post-training and follow-up mean scores were not significantly different (p = 0.358; 95% CI -4.71, 17.55). For knowledge, a significant group effect was found (F = 10.32, p = 0.002), and also a significant time effect (F = 3.35, p = 0.039) but no significant interaction effect was present (p = 0.169). The post-hoc testing revealed that only a pre-training to six-month follow-up time effect was statistically significant (p = 0.005; 95% CI 1.37, 9.29).Conclusions: The training programme was effective in improving the therapeutic attitudes of participants to working with clients who have co-existing mental health and substance use problems, both immediately after the training was delivered, and at six-months follow-up. It was also effective in improving participants' overall knowledge of alcohol, drugs and co-morbidity. (C) 2006 Elsevier Ltd. All rights reserved.

AIM:This paper reports a study exploring nurses' provision of opportunistic health education on smoking for hospital patients. BACKGROUND:Smoking cessation guidelines recommend assessment of patients' smoking habits and provision of smoking cessation advice when possible, and highlight the importance of the role of nurses in health promotion and health education. In the past, nurses have been criticized for lack of knowledge, skills and confidence in relation to health education and the perception that it is additional to, rather than integrated with, nursing care. METHODS:A qualitative case study design was selected to explore the health education practice of 12 nurses working in acute wards in three general hospitals in Scotland. Data were collected in 2000 through non-participant observation, semi-structured interviews and the use of a radio-microphone to record nurse-patient interactions. The data analysis was guided by four key elements of health education practice: 'the teachable moment', 'readiness to learn', 'the provision of health information' and 'oral communication'. FINDINGS:Smoking was part of the nurses' agenda, as most recognized opportunities to introduce health education on smoking during nursing care, suggesting a tentative move towards the integration of health education with nursing care. Evidence from patients' interactions indicated ample opportunity for nurses to provide smoking-related health information. However, the content of nurses' interactions on smoking was variable, with some limited by poor communication skills and inadequate knowledge of smoking and smoking cessation. The context of the interactions was also important in understanding some of the restrictions on conversational progress. CONCLUSIONS:Nurses require the knowledge and skills to perform a health education role, and the inclusion of smoking cessation guidelines in nursing curricula would contribute to this. Where patients are in hospitals for short periods of time, opportunistic health education on smoking needs to be introduced as the basis for more specialist intervention.