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.
Valentino Patussi; Gloriana Bartoli; Scafato Emanuele
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
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:
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:
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
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
Sensibilization Course (ACAT); Territorial Alcohol Schools (3rd Module); Posters and leaflets on alcohol issues and health status
Sensibilization course (ACAT); Mono-thematic daily meeting on Alcohol Issue; Involvement of GP's Association (SIMG); Congress, Public presentation, Study papers
Sensibilization course (ACAT); Territorial Alcohol Schools (3rd module); Involvement and alliance with local volunteer associations; Local schools
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
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:
Projected Completion Date:
Design of Project:
Before - After study with baseline and outcome measures.
Baseline and follow-up measures on:
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
Structured or semi-structured questionnaire including process indicators with indexes convergence between primary health care workers and patients.