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      Treating Excessive Consumers With Brief Intervention to Reduce Their Alcohol Consumption : A Thankless Task?

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          Abstract

          Abstract. Background: General Practitioners’ (GP) readiness to implement screening and brief intervention to reduce alcohol consumption of excessive consumers is low. Although several barriers were identified by past research, improving these conditions has not led to improved implementation. Based on Expectancy Value Theory of Achievement Motivation we assume that low seriousness of the health problem in association with the treatment of excessive alcohol consumers may be considered as a crucial barrier too. Aims: By our study, we tested for the influence of the seriousness of the health problem on the GP’s readiness to implement brief intervention (BI) in comparison to crucial barriers such as insufficient financial reimbursement and low patient adherence. Method: In order to manipulate the seriousness of the health problem GPs were confronted with three different situations each introducing a fictitious patient with either excessive alcohol consumption, or binge drinking, or harmful alcohol consumption. Results: Questionnaires of 185 GPs were analyzed. As hypothesized GPs were less ready to treat patients with excessive consumption in comparison to patients with harmful consumption, t(184) = 5.51, p < .001, d = .40, and binge drinking, t(184) = 6.14, p < .001, d = .43. Their readiness was higher in case of high adherence, F(1, 181) = 17.35, p < .001, η 2 = .09. Limitations: Recruitment of GPs was based on voluntary participation. GPs had to assess their readiness in the artificial context of case vignettes. Conclusion: GPs’ readiness to implement a BI was influenced by the seriousness of the health problem and expected patient adherence. No such effect was found for financial reimbursement.

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          Expectancy-Value Theory of Achievement Motivation.

          We discuss the expectancy-value theory of motivation, focusing on an expectancy-value model developed and researched by Eccles, Wigfield, and their colleagues. Definitions of crucial constructs in the model, including ability beliefs, expectancies for success, and the components of subjective task values, are provided. These definitions are compared to those of related constructs, including self-efficacy, intrinsic and extrinsic motivation, and interest. Research is reviewed dealing with two issues: (1) change in children's and adolescents' ability beliefs, expectancies for success, and subjective values, and (2) relations of children's and adolescents' ability-expectancy beliefs and subjective task values to their performance and choice of activities. Copyright 2000 Academic Press.
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            AUDIT-C as a brief screen for alcohol misuse in primary care.

            The Alcohol Use Disorders Identification Test Consumption (AUDIT-C) questions have been previously validated as a 3-item screen for alcohol misuse and implemented nationwide in Veterans Affairs (VA) outpatient clinics. However, the AUDIT-C's validity and optimal screening threshold(s) in other clinical populations are unknown. This cross-sectional validation study compared screening questionnaires with standardized interviews in 392 male and 927 female adult outpatients at an academic family practice clinic from 1993 to 1994. The AUDIT-C, full AUDIT, self-reported risky drinking, AUDIT question #3, and an augmented CAGE questionnaire were compared with an interview primary reference standard of alcohol misuse, defined as a Diagnostic and Statistical Manual, 4th ed. alcohol use disorder and/or drinking above recommended limits in the past year. Based on interviews with 92% of eligible patients, 128 (33%) men and 177 (19%) women met the criteria for alcohol misuse. Areas under the receiver operating characteristic curves (AUROCs) for the AUDIT-C were 0.94 (0.91, 0.96) and 0.90 (0.87, 0.93) in men and women, respectively (p=0.04). Based on AUROC curves, the AUDIT-C performed as well as the full AUDIT and significantly better than self-reported risky drinking, AUDIT question #3, or the augmented CAGE questionnaire (p-values or =4 in men (sensitivity 0.86, specificity 0.89) and > or =3 in women (sensitivity 0.73, specificity 0.91). The AUDIT-C was an effective screening test for alcohol misuse in this primary care sample. Optimal screening thresholds for alcohol misuse among men (> or =4) and women (> or =3) were the same as in previously published VA studies.
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              The efficacy of motivational interviewing: a meta-analysis of controlled clinical trials.

              A meta-analysis was conducted on controlled clinical trials investigating adaptations of motivational interviewing (AMIs), a promising approach to treating problem behaviors. AMIs were equivalent to other active treatments and yielded moderate effects (from .25 to .57) compared with no treatment and/or placebo for problems involving alcohol, drugs, and diet and exercise. Results did not support the efficacy of AMIs for smoking or HIV-risk behaviors. AMIs showed clinical impact, with 51% improvement rates, a 56% reduction in client drinking, and moderate effect sizes on social impact measures (d=0.47). Potential moderators (comparative dose, AMI format, and problem area) were identified using both homogeneity analyses and exploratory multiple regression. Results are compared with other review results and suggestions for future research are offered.
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                Author and article information

                Contributors
                Journal
                ejh
                European Journal of Health Psychology
                Hogrefe Publishing
                2512-8442
                2512-8450
                May 3, 2021
                July 2021
                : 28
                : 3
                : 131-138
                Affiliations
                [ 1 ]Institute for General Practice and Family Medicine, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Halle, Germany
                [ 2 ]Department of Health Psychology, SRH University of Applied Health Science, Gera, Germany
                Author notes
                Thomas Fankhänel, Martin-Luther-University Halle-Wittenberg, Magdeburger Straße 8, 06112 Halle, Germany, E-mail thomas.fankhaenel@ 123456srh.de
                Author information
                https://orcid.org/0000-0002-2500-5372
                Article
                ejh_28_3_131
                10.1027/2512-8442/a000079
                61a9068b-34b2-4253-a046-13d6e37bd059
                Distributed under the Hogrefe OpenMind License https://doi.org/10.1027/a000001

                Distributed under the Hogrefe OpenMind License https://doi.org/10.1027/a000001

                History
                : September 16, 2020
                : January 19, 2021
                : February 12, 2021
                Funding
                Funding: This work has been supported by the Bundesministerium für Gesundheit (grant no. ZMVI5-2514DSM209) to Thomas Fankhänel.
                Categories
                Original Article

                Psychology,Health & Social care,Clinical Psychology & Psychiatry
                financial reimbursement,excessive alcohol consumption,brief intervention,general practice,implementation readiness

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