World Health Organization Collaborative Project on Identification and Management of Alcohol-related Problems

 in Primary Health Care: Phase IV


Development of Country-wide Strategies for Implementing Early Identification and Brief Alcohol Intervention in Primary Health Care.

North-west Florence

[Customisation] [Communications] [Strategic Alliance] [Demonstration Project]


Collaborative Centre:

  • Istituto Fondazione A. Devoto, Florence

  • University of Florence, Research Centre for Alcohol Studies, University of Florence, Psychiatric Department

  • Eurocare Italy, Padua

  • National Institute of Health, Rome

  • Hospital Service, National Health Care System (NCHS), Florence

  • Addiction Department, NCHS, Florence

  • Epidemiological Office, Addiction Dep., NHCS, Florence

Chief Investigators:

 Valentino Patussi; Gloriana Bartoli; Scafato Emanuele

Collaborative Investigators: 

Bazzani Oreste (Research Centre for Alcohol Studies)

Cecchi Massimo (Addiction Dep., NHCS); Guidoni Guido (Addiction Dep., NHCS)

Polvani Stefania (Epidemiological Office, Addiction Dep., NHCS)

Geographical Area in which Implementation:

Strategy will be Applied: Florence area, Tuscany, Italy

Starting Date:

 February 1999

Completion Date: 

December 2003

Project Strands and Milestones:

Strand I: Customisation of early identification and brief intervention package, training (24months)

Strand II: Demonstration Project (26months)

Strand III: Evaluation and Outcome Measures (12months)

The strategic alliances will be developed from the beginning of the project and implemented during the process. The communication strategy should be linked to the demonstration project(s). The strands are not placed in a chronological order because they pursue overlapping objectives.

Proposed Funding Sources:

  • Local Health Authority

  • Ministry of Health - National Institution of Health

  • Social Affair Department, Presidenza del Consiglio

  • City Government of Florence and other North - West areas

  • Proposed Funding Sources Cont.:

  • Regional Centre for Volunteer Associations (CESVOT)

  • Banks; Local firms; National Association of City Government

Local Support:

  • City Government of Florence and other North-West areas

  • Municipal Health City Office

  • Volunteer Associations (ACAT, ARCAT, AA, Al-Anon, Al-Atheen)



GP's; Primary Health Care Professional Workers; Non Professional and NGOs workers


Focus Group; Structured questionnaire

It could be possible to revise the Questionnaire used for the Phase III, Strand I in a shorter form much more linked to the objectives of the present project. This questionnaire should include some questions about attitudes to early identification and brief intervention (EIBI) and willingness to take part in the project. The revised form of the questionnaire could constitute a baseline measure and a way to involve GP's in the project.

Brief Intervention Package, including delivery systems:

'Una guida per l'azione' (A guide for Action)

Alcoinforma (Alcohol Addresses)

Posters and leaflets on alcohol issues

Method of delivery:

GP's Association (SIMG)

Sensibilization meetings; Post + telephone +e-mail

Early Identification (Screening):

AUDIT; CAGE; CNR Alcohol Schedule (COALA); Health Survey Questionnaire (HSQ)

Brief Intervention Process:

Early identification and brief intervention (EIBI) should include different levels of action and it could be composed of three phases:

  • Screening (opportunistic early identification)
  • BI options: advice, informative materials and package, self-help groups, counselling, motivational interviewing
  • Follow-up

The different BI options should be clarified and defined considering level of alcohol related problems, indicators of physical, psychological and social factors, patient's 'stage of change'

Training of primary health care staff: Direct training; Training the trainers (SIMG, Hudolin Methodology and Devoto Model

We think we could offer post-graduate training on ARPP at the University of Florence

Data Analysis: 

Content Analysis; coding of categories; thematic analysis


Communication strategy is mainly based on the Educational Training Programme of the Clubs of Treated Alcoholics, Social Ecological Approach, Hudolin's Method. Additionally a mass media campaign could be delivered at later stages in the study. Finally, public conferences called 'Sensibilization Meetings' will be organised in local theatres, schools

General Public:

Sensibilization Course (ACAT); Territorial Alcohol Schools (3rd Module); Posters and leaflets on alcohol issues and health status

Health Professionals:

Sensibilization course (ACAT); Mono-thematic daily meeting on Alcohol Issue; Involvement of GP's Association (SIMG); Congress, Public presentation, Study papers

Other Stakeholders: 

Sensibilization course (ACAT); Territorial Alcohol Schools (3rd module); Involvement and alliance with local volunteer associations; Local schools

Media Advocacy: 

Create a link with the local mass media (radio, TV, newspapers) to persuade them to give information on alcohol issues

Control of Communications Strategy: 

Qualitative data on the response to the initiatives done pre and post questionnaire for the different sensibilization courses and meetings proposed.

Indicators of the effectiveness of the communication strategy such as diffusion of communication strategy; visibility of the project in the community; change in perception about ARPP in the local community and change in social response about ARPP


Lead organization(s): 

University of Florence, Research Centre for Alcohol Studies;

Eurocare Italy, Padua; Epidemiological Office of the Addiction Department (NCHS);

Foundation Istituto 'A Devoto', Florence

Building Strategic Alliances:

Local Municipalities; Municipal Health City Office; Health Cities Project; Addiction Service; GP's Associations; Regional Centre for Volunteer Association; Volunteer Associations; Tuscany Association for Self-Help Groups; National Association of City Government; Local & national media; Post-graduate training on ARPP, University of Florence; National Trade Unions; Ministry of Health; Ministry of Social Affairs; National Institution of Health; National Health Care System; ARCI


Involve local associations; create a network of "Alcohol Services"; establish a common territorial strategy; strengthen territorial alcohol centre; implement collaboration between public, private and NGO's; promote community action projects within the community.


Indicators of the effectiveness of the development of the strategic alliances such as: diffusion of the alliances and building of new spontaneous network within the community.



North West Florence area

Population base: 50,000 - 100,000. Representative and stable population with a high sense of responsibility and identity with the local community.

No of primary health care facilities: 50 primary health care workers

Projected Start Date: 

September 1999

Projected Completion Date: 

September 2002

Design of Project: 

Before - After study with baseline and outcome measures.

Outcome Measures: 

Baseline and follow-up measures on:

  • No of participants involved and trained
  • No information requested by other participants
  • No patients screened and No counselling performed
  • No request advice and help to primary health care services

Pre and post questionnaire about: Knowledge on alcohol issues, skills and attitude towards early identification and brief intervention (EIBI)

Qualitative analysis of patients responses to the EIBI

Process Measures: 

Structured or semi-structured questionnaire including process indicators with indexes convergence between primary health care workers and patients.

Economic Analysis: 

Health economist

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