How and when health-care practitioners in Aboriginal Community Controlled Health Services deliver alcohol screening and brief intervention, and why they don't: a qualitative study.

INTRODUCTION Indigenous Australians experience a disproportionately high burden of alcohol-related harm. Alcohol screening and brief intervention (SBI) offers the potential to reduce this harm if barriers to its delivery in Aboriginal Community Controlled Health Services (ACCHSs) can be optimally targeted. AIMS . Examine health-care practitioners' perceptions of, and practices in, alcohol SBI in ACCHSs. METHODS Semi-structured group interviews with 37 purposively selected health staff across five ACCHSs. RESULTS Alcohol screening independent of standard health assessments was generally selective. The provision of brief intervention was dependent upon factors related to the patient. Four key factors underlying health-care practitioners' perceptions of alcohol SBI were prominent: outcome expectancy; role congruence; utilisation of clinical systems and processes; and options for alcohol referral. Discussion. The influence of outcome expectancy and role congruence on health-care practitioners' alcohol SBI practices has been identified previously, as has to a lesser extent, their less than optimal use of clinical systems and processes. The influence of options for alcohol referral on health-care practitioners' willingness to deliver alcohol SBI primarily related to their misunderstanding of alcohol SBI and the lack of culturally appropriate alcohol referral options for their patients. CONCLUSION An intervention combining interactive, supportive and reinforcing evidence-based dissemination strategies is most likely required to enhance health-care practitioners' knowledge and skills in alcohol SBI delivery, positively orientate them to their role in its delivery, and facilitate integration of evidence-based alcohol SBI into routine clinical processes and locally available systems