Country and policy factors influencing the implementation of primary care-based alcohol screening: A comparison of Colombia, Mexico and Peru

TY - JOUR

T1 - Country and policy factors influencing the implementation of primary care-based alcohol screening: A comparison of Colombia, Mexico and Peru

AU - Kokole, Daša

AU - Mercken, Liesbeth

AU - Anderson, Peter

AU - Mejía-Trujillo, Juliana

AU - Perez-Gomez, Augusto

AU - Bustamante, Ines

AU - Schulte, Bernd

AU - Piazza, Marina

AU - Natera Rey, Guillermina

AU - Arroyo, Miriam

AU - Pérez De León, Alejandra

AU - Bautista Aguilar, Natalia

AU - Medina Aguilar, Perla Sonia

AU - O'Donnell, Amy

AU - de Vries, Hein

AU - Jané-Llopis, Eva

PY - 2023/1

Y1 - 2023/1

N2 - Researchers and practitioners recognise the importance of context when implementing healthcare interventions, but the influence of wider environment is rarely mapped. This paper identifies the country and policy-related factors potentially explaining the country differences in outcomes of an intervention focused on improving detection and management of heavy alcohol use in primary care in Colombia, Mexico and Peru. Qualitative data obtained through interviews, logbooks and document analysis are used to explain quantitative data on number of alcohol screenings and screening providers in each of the countries. Existing alcohol screening standards in Mexico, and policy prioritisation of primary care and consideration of alcohol as a public health issue in Colombia and Mexico positively contributed to the outcome, while the COVID-19 pandemic had a negative impact. In Peru, the context was unsupportive due to a combination of: political instability amongst regional health authorities; lack of focus on strengthening primary care due to the expansion of community mental health centres; alcohol considered as an addiction rather than a public health issue; and the impact of COVID-19 on healthcare. We found that wider environment-related factors interacted with the intervention implemented and can help explain country differences in outcomes.

AB - Researchers and practitioners recognise the importance of context when implementing healthcare interventions, but the influence of wider environment is rarely mapped. This paper identifies the country and policy-related factors potentially explaining the country differences in outcomes of an intervention focused on improving detection and management of heavy alcohol use in primary care in Colombia, Mexico and Peru. Qualitative data obtained through interviews, logbooks and document analysis are used to explain quantitative data on number of alcohol screenings and screening providers in each of the countries. Existing alcohol screening standards in Mexico, and policy prioritisation of primary care and consideration of alcohol as a public health issue in Colombia and Mexico positively contributed to the outcome, while the COVID-19 pandemic had a negative impact. In Peru, the context was unsupportive due to a combination of: political instability amongst regional health authorities; lack of focus on strengthening primary care due to the expansion of community mental health centres; alcohol considered as an addiction rather than a public health issue; and the impact of COVID-19 on healthcare. We found that wider environment-related factors interacted with the intervention implemented and can help explain country differences in outcomes.

KW - Humans

KW - Mexico/epidemiology

KW - Colombia/epidemiology

KW - Peru/epidemiology

KW - Pandemics

KW - COVID-19/diagnosis

KW - Policy

KW - Primary Health Care

U2 - 10.1080/17441692.2023.2207410

DO - 10.1080/17441692.2023.2207410

M3 - SCORING: Journal article

C2 - 37156224

VL - 18

SP - 2207410

JO - GLOB PUBLIC HEALTH

JF - GLOB PUBLIC HEALTH

SN - 1744-1692

IS - 1

ER -