In Phase III of the WHO Project, the brief intervention programme under study was the Drink-less Programme used in conjunction with the AUDIT screening questionnaire. This programme was originally designed and tested on GPs in Australia. However, to meet the aim of Phase IV of achieving a widespread implementation of early identification and brief intervention (EIBI) in the particular primary health care setting of each participating country, it is clearly necessary to adjust the EIBI package to each country’s particular needs and circumstances. In addition, in the course of conducting Phase III of the WHO Project, investigators in many of the participating countries noted various recommendations from GPs and other health professionals regarding the specific form and contents of the EIBI package, comments that stemmed mainly from the varying circumstances in which primary health care was organized and delivered in each country. Finally, research findings on EIBI have accumulated since the WHO Phases I and II, on which the AUDIT Questionnaire and the Drink-less Programme were based, and these new findings provide the opportunity to improve important features of the EIBI package.
Aspects of the EIBI package that could be revised in Phase IV include early identification methods, length of intervention, intervention procedures, intervention materials, responsible personnel, training methods and the strategy used to reframe understandings of alcohol-related issues.
The main research method to be used in the customisation process is the focus group. Groups will consist primarily of health care professionals who would be asked to discuss barriers to the implementation of EIBI in primary health care, how these barriers might best be overcome and how an EIBI package should be developed to facilitate dissemination and implementation in the conditions of primary health care of the country in question. Groups can either be composed of single professional or mixed professional affiliations and both single and mixed groups could be used in a participating country.
Another type of focus group that might be run is with potential recipients of the EIBI package, i.e., patients attending primary health care facilities or simply members of the general public who sometime make use of primary health care.
The information from focus groups could be supplemented by a set of one-to-one interviews with a convenience sample of primary health care professionals. These interviews should include the full range of professional affiliations that might be involved in EIBI work, a full representation of types of primary health care delivery applying in the country in question (e.g. solo and group practices, urban and rural settings), and a mixture of gender, age and experience of primary health care workers.
In some participating countries, structured questionnaires will be used to supplement information obtained from focus groups and semi-structured interviews. This applies particularly to countries that did not take part in the questionnaire study forming part of Phase III (i.e., Strand 1).
A Delphi study may also be used as this method has potential usefulness in the Phase IV study as a method of soliciting the views of, and forming a consensus among, all those with expert knowledge of EIBI in each participating country.
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