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IBA for alcohol… and diet…and physical activity…and smoking….and…

19 Jun

I have just had the pleasure of writing and delivering a one-day training course entitled ‘Brief Advice for Health Behaviour Change’ that aimed to enable practitioners to deliver brief interventions using a motivational approach on the four issues of alcohol, smoking, diet and physical activity. The target audience was frontline staff, not just in healthcare (hospital staff and those delivering NHS Health Checks) but also prisons and workplaces. It is not the first time we have written training on IBA for topics other than alcohol (try IBA for alcohol and drugs for youth workers, or for alcohol and sexual risk-taking) but combining four topics into one process for IBA is not easy.

Firstly, there are basic practical difficulties of how you build the knowledge and understanding of practitioners and address any prejudices or myths that may exist about not one but four issues, in a single day. This is by no means easy, but pre-course work helps.

Even more tricky is how to describe and teach the process of ‘IBA’ for such a broad range of ‘lifestyle’ issues.  Finally, the challenge is to design a process that can realistically be implemented in a 10 minute (max) conversation.

While the basic IBA skills remain the same, we designed a completely new framework or IBA process in which to present and teach them. The course included discussion not only of how and when to raise the issue of ‘lifestyle’ generally, but also how to narrow the conversation down to one or two topics which the individual is ready to discuss. We discussed stages of change in terms of just three stages to simplify thinking and decision-making. And the ‘Identification’ or ‘Screening’ process inherent in IBA was simplified to exploring the individual’s current behaviour and comparing it to national guidelines rather than using a formal screening tool.

The pilot went well, and I am confident that the challenges described can be met – but perhaps not for all of the people all of the time!  And one key question remains – are some issues harder to raise than others?  If you try to cover them all together, will practitioners avoid the issue they find most sensitive? And if so, which issue will be left out? In Scotland, I know that when Keep Well practitioners offering cardiovascular check ups (similar to NHS Health Checks in England) were trained on generic health behaviour change approaches, it was found that they avoided alcohol as an issue and separate training specifically on alcohol was provided. Was this a one-off? Or could we expect that diet and weight issues would be just as sensitive?

We will soon be training 18 people to roll out the Brief Advice for Health Behaviour Change course to others via a two-day training for trainers course… watch this space!

How to decide what to do, whatever the evidence.

7 Jun

At the recent Cyrenian’s conference on the potential for delivery of alcohol brief interventions in untested or unproven community settings, Dr. Andrew Tannahill’s presentation with the above title, may be of interest. Rather than an ‘evidence rules’ approach decision-making, his thesis (part of his work for NHS Health Scotland) advocates 10 principles to underpin an ethics-based approach to deciding how to improve population health and reduce health inequalities. The alternative motto of this approach, he claims is ‘ethics rule: evidence serves’.

Importantly, evidence remains an important part of the decision-making framework, but so does logic and theory about the probable and possible impact of any decision or intervention made. The 10 principles can be organised into 3 categories:

1. Four principles fundamental to main health outcomes and how the organisation goes about its
business: Do good, Do not harm, Fairness, Sustainability
2. Five principles to do with other outcomes and/or how the organisation goes about its business:
Respect, Empowerment, Social responsibility, Participation, Openness
3. Principle of Accountability – for consequences of decisions and actions, use of resources, value for
money, etc

Dr. Tannahill’s presentation goes through each of the principles and considers how it might be applied to the rollout of IBA in new or untested settings and is well worth a look.  You can also read his journal paper on the framework.

Personally, I find it offers an answer to concerns I have had about how to balance the need for evidence with the great need to do something effective about alcohol consumption.  A solely evidence based approach is not always possible – many, many aspects of what we do are not evidence-based, and it seems to me unlikely that we will ever have really robust, hard evidence for many ‘interventions’ by many practitioners.  Dr. Tannahil’s approach offers part of the answer.  A shorter answer may be that – if we choose to do new things – we have a responsibility to contribute to knowledge about them – by clearly describing why and how and what happened – and to be honest with ourselves and others about exactly what the level of evidence is.

INEBRIA Conference 2012

28 May

9th Conference of INEBRIA: International Network on Brief Interventions for Alcohol and Other Drugs

Conference theme: From Clinical practice to Public Health: The two dimensions of brief interventions.

Dates: 27th – 28th September 2012

Location: Barcelona, Spain

View conference flyer

The conference aims to:

  • Enhance research on EIBI/SBI implementation as a public health tool
  • Expand EIBI/SBI in emerging economies.
  • Promote expansion of EIBI/SBI to other drugs
  • Continue promoting the use of new technologies on the implementation of EIBI/SBI
  • Review the major achievements on EIBI/SBI research in the last 9 years since INEBRIA was launched and the INEBRIA contribution to them.

IBA in Wider Settings: Conference Report

9 May

Social work, criminal justice, pharmacy, housing, homelessness, police: all these settings are becoming increasingly the focus of research and implementation initiatives relating to IBA.  A recent conference (27th March 2012) organised by Edinburgh Cyrenians, in association with Comic Relief, Create Consultancy, Alcohol Research UK and INEBRIA was attended by professionals and researchers from all these fields.  With a key note address on the state of the evidence base for IBA by Dr. Richard Saitz, and a following presentation ‘How to decide what to do, whatever the evidence‘ from Dr. Andrew Tannahill, the day got off to an intriguing start.

Further presentations focused on how to implement IBA into routine practice, an example of how Edinburgh Cyrenians rolled out alcohol interventions across their frontline homelessness services, and a discussion of the place of alcohol in the lives of hard to reach groups.  Workshops discussed selection of screening tools, training, gender issues and web technology relating to IBA.

The full list of speakers and presentations from the conference are available.

Last year the Alcohol Academy held an event and published a briefing paper exploring ways to achieve widespread IBA delivery.

Who needs IBA?

16 Apr

Recognising the ‘right’ group of patients or service users for delivering identification and brief advice is one of the first hurdles to be overcome by non-specialists getting to grips with delivery.  Most IBA guidance, based on reasonable evidence, suggests that those who might benefit from brief advice are drinking at increasing or higher risk levels.  We spend quite a bit of time on training talking about how you can identify these people using screening questions, and crucially, how you can’t identify them by looking, guessing or assuming!

So why is it then that when we follow-up participants some months after training courses, some still report that they have not delivered IBA because ‘my clients don’t need it’?  Some say that all their clients are drinking too much to benefit from IBA; others that their service users do not drink enough to need help, but these conclusions are not necessarily based on screening.  Why?

Well, I have a few theories…firstly I think it is worth acknowledging that this could just be an excuse, perhaps training participants just feel bad if they haven’t delivered and so they want to give us a good reason why.

Or perhaps it is true – though it seems unlikely that practitioners working with the general public, have not come across anyone at all who is drinking more than the recommended limits, but not in a dependent way!

I think the former is more likely, but it is not as simple as them making it up to satisfy us.  I think they are rationalising to themselves as well as us, why they haven’t delivered.  And I think (among other reasons) it comes down to the fact that in order to truly recognise the target groups for IBA, we need to recognise that included in the target group are folk, well, just like us.  Or if not us, like folk we know and like.  Not a stereotype ‘heavy drinker’, never mind ‘alcoholic’.  And that might mean recognising that we, or our family or friends, have a choice to make too…enjoy our drink and accept the risks, or cut the drink and cut the risk…

Delivering IBA is just about giving everybody that information, and that choice.