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Addressing Alcohol: Alcohol Prevention in Swedish Primary and Maternity Health Care and Occupational Health Services
Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
2009 (English)Doctoral thesis, comprehensive summary (Other academic)Alternative title
Att tala om alkohol (Swedish)
Abstract [en]

Alcohol consumption in Sweden has reached its highest levels of the past 100 years in the wake of the country’s entry into the European Union in 1995. Increased alcohol prevention efforts in Swedish health care settings have been given high priority by the authorities. The Swedish parliament’s national action plan up to 2010 emphasises that public health must be protected by achieving reductions in alcohol consumption and limiting the negative physical, psychological, and social effects of alcohol.

This thesis aims to investigate various aspects related to the current alcoholpreventive activity in 2006 among health care professionals in three important health care settings: primary health care (PHC), occupational health services (OHS), and maternity health care (MHC). The thesis includes four studies based on a total population mail questionnaire survey.

Results from the studies show that alcohol issues in both PHC and OHS were addressed less frequently than all other lifestyle issues, i.e. smoking, physical activity, overweight, and stress. Important barriers to alcohol-preventive activity in these settings were perceived lack of time, scepticism regarding the effectiveness of addressing the issue of alcohol, fear of potentially negative patient responses, uncertainty about how to ask, uncertainty about how to give advice regarding alcohol, and uncertainty concerning where to refer the patient.

OHS professionals generally considered themselves more skilful than their PHC counterparts in achieving change in patients’ alcohol habits and more knowledgeable about providing advice to patients with risky alcohol consumption. The overall frequency of initiating discussions about alcohol with patients in PHC and OHS was positively associated with self-assessed skills, knowledge, and education for all professional categories.

Slightly more than one-third of the MHC midwives used a questionnaire to assess the woman’s alcohol intake before the pregnancy; AUDIT was the most commonly used questionnaire. Their perceived knowledge concerning alcohol and pregnancy matters was generally high, but the midwives considered themselves less proficient at detecting pregnant women with risky alcohol consumption before the pregnancy.

MHC midwives had participated in more continuing professional education in handling risky drinking than all other categories investigated. PHC nurses was the category that had the highest proportion of professionals who lacked education in handling risky drinking. Professionals in PHC, OHS, and MHC to a large extent believed that provision of more knowledge about counselling techniques to use when alcohol-related symptoms are evident could facilitate increased alcohol intervention activity.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press , 2009. , 97 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1094
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-16815ISBN: 978-91-7393-714-6 (print)OAI: oai:DiVA.org:liu-16815DiVA: diva2:174207
Public defence
2009-03-06, Hälsans hus, ingång 16, Campus US, Linköpings Universitet , Linköping, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2009-02-19 Created: 2009-02-19 Last updated: 2009-04-17Bibliographically approved
List of papers
1. Asking patients about their drinking: A national survey among primary health care physicians and nurses in Sweden
Open this publication in new window or tab >>Asking patients about their drinking: A national survey among primary health care physicians and nurses in Sweden
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2008 (English)In: Addictive Behaviors, ISSN 0306-4603, Vol. 33, no 2, 301-314 p.Article in journal (Refereed) Published
Abstract [en]

Aims: To investigate the extent to which Swedish primary health care (PHC) general practitioners (GPs) and nurses discuss alcohol issues with their patients, their reasons for and against addressing alcohol issues, their perceived importance of these issues, and factors that could facilitate increased alcohol intervention activity among the PHC professionals.

Methods: All Swedish GPs and nurses who have the authority to issue prescriptions were surveyed with a postal questionnaire. The questionnaire was returned by 1821 GPs (47% response rate) and 3125 nurses (55% response rate).

Results: Fifty percent of the GPs and 28% of the nurses stated that they “frequently” discussed alcohol with their patients. The two most common reasons for asking patients about their drinking were that the GPs and nurses considered it part of their routines and the belief that the patient had alcohol-related symptoms. GPs said that improved opportunities for referral to specialists and provision of more knowledge about counselling techniques for use when alcohol-related symptoms are evident were the most important facilitators to increased intervention activity. Concerning the nurses, 93% stated that more time devoted to health-oriented work could facilitate increased alcohol intervention activity.

Conclusions: The findings highlight a considerable gap between the recognition of the significance of the alcohol problem and Swedish PHC intervention activity.

Keyword
Primary health care; Alcohol intervention; Risk consumption
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-16799 (URN)10.1016/j.addbeh.2007.09.021 (DOI)18029104 (PubMedID)
Available from: 2009-02-19 Created: 2009-02-19 Last updated: 2009-08-18Bibliographically approved
2. Towards increased alcohol intervention activity in Swedish occupational health services.
Open this publication in new window or tab >>Towards increased alcohol intervention activity in Swedish occupational health services.
2008 (English)In: International journal of occupational medicine and environmental health, ISSN 1232-1087, Vol. 21, no 2, 179-187 p.Article in journal (Refereed) Published
Abstract [en]

Objectives: To investigate the extent to which Swedish occupational physicians and nurses discuss alcohol issues with their patients, their reasons for and against addressing these issues, their amount of education in handling risky drinking, and factors that they believe could facilitate increased alcohol intervention activity in OHS.

Methods: All Swedish physicians and nurses in OHS were surveyed with a postal questionnaire. The questionnaire was returned by 313 physicians (response rate 54%) and 759 nurses (response rate 69%).

Results: As much as 70% of the physicians and 85% of the nurses reported that they "frequently" discussed alcohol problems with their patients. The majority of both physicians (81%) and nurses (69%) admitted participating in a maximum of a half-day training in handling risky drinking. Among the physicians, the most common reason for asking patients about their alcohol consumption was the clinical relevance (57%). Seventy-three per cent of the nurses initiated discussions about alcohol on the basis of questionnaire responses. Both the physicians (72%) and nurses (90%) said that the knowledge about counselling techniques to use when alcohol-related symptoms are evident was the most important facilitator to increased intervention activity.

Conclusions: OHS professionals usually discuss alcohol-related issues with their patients. Nonetheless, they are interested in gaining further education and knowledge in this respect. The study results indicate that OHS is an important setting for alcohol prevention.

Keyword
Occupational health care, Alcohol intervention, Risky consumption
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-16802 (URN)10.2478/v10001-008-0012-1 (DOI)18715842 (PubMedID)
Available from: 2009-02-19 Created: 2009-02-19 Last updated: 2009-04-30Bibliographically approved
3. Alcohol prevention activity in Swedish primary health care and occupational health services: Asking patients about their drinking
Open this publication in new window or tab >>Alcohol prevention activity in Swedish primary health care and occupational health services: Asking patients about their drinking
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2008 (English)In: Nordic Studies on Alcohol and Drugs, Vol. 25, no 6, 489-504 p.Article in journal (Refereed) Published
Abstract [en]

Aims

To investigate the alcohol preventive activity in Swedish Occupational health services (OHS) and Primary health care (PHC) in relation to education in handling risky drinking, perceived skills in achieving change in patients’ alcohol habits, and knowledge in alcohol issues among the physicians and nurses in these two settings.

Design and Methods

All Swedish physicians and nurses in OHS and PHC having the authority to issue prescriptions were surveyed with a postal questionnaire. The questionnaire was returned by 313 OHS physicians (response rate 54%), 759 OHS nurses (69%), 1821 PHC physicians (47%), and 3125 PHC nurses (55%). Regression analyses were used to assess the independent and interacting effects of skills, knowledge, education, sex, age, and years in practice, patient encounters per week, and location of unit.

Results

OHS professionals were more active in initiating discussions about alcohol with their patients than their colleagues in PHC. OHS professionals considered themselves more skilful and knowledgeable than PHC professionals. OHS nurses and PHC physicians were the professional categories that had received most education in handling risky drinking. Skills were positively associated with activity for all categories except OHS physicians. Knowledge and education were positively associated with activity for all categories except OHS nurses.

Conclusions

OHS professionals were more active than the PHC professionals in addressing alcohol issues with their patients. Education, knowledge, and skills were positively associated with activity for most professional categories in the two settings.

 

Keyword
Occupational health care, primary health care, alcohol intervention, risk consumption, Sweden
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-16804 (URN)
Available from: 2009-02-19 Created: 2009-02-19 Last updated: 2009-03-02Bibliographically approved
4. Approaches to assessment of alcohol intake during pregnancy in Swedish maternity care-a national-based investigation into midwives' alcohol-related education, knowledge and practice
Open this publication in new window or tab >>Approaches to assessment of alcohol intake during pregnancy in Swedish maternity care-a national-based investigation into midwives' alcohol-related education, knowledge and practice
2010 (English)In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 26, no 4, 430-434 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: to evaluate how much education midwives in Sweden have undertaken to help them assess alcohol intake during pregnancy, and what tools they use to identify women who may be at risk of drinking during pregnancy. DESIGN: a national survey was conducted in March 2006, using a questionnaire constructed by a Swedish team of researchers and clinicians. SETTING: maternity health-care centres in Sweden. PARTICIPANT: 2106 midwives. FINDINGS: nearly all midwives stated that they had excellent or good knowledge concerning the risks associated with drinking during pregnancy. They considered themselves less knowledgeable about detecting pregnant women with risky alcohol consumption before pregnancy. The majority of the midwives had participated in some education in handling risky drinking. Almost half of the midwives assessed women's alcohol intake before pregnancy. Important facilitators for increased activity concerned recommendations and decisions at different levels (national, local and management) on how to address alcohol with expectant parents and work with risky drinkers. KEY CONCLUSIONS: more education was associated with more common use of a questionnaire for assessment of women's alcohol intake before pregnancy, and more frequent counselling when identifying a pregnant woman whose pre-pregnancy consumption was risky.

Keyword
Maternity health care; Risk consumption; Alcohol intervention; Addressing alcohol
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-16813 (URN)10.1016/j.midw.2008.10.009 (DOI)000279742400009 ()19185397 (PubMedID)
Available from: 2009-02-19 Created: 2009-02-19 Last updated: 2017-12-13Bibliographically approved

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