Abstract
Background: This study aims to understand patients perspectives on the implementation of screening brief intervention and referral (SBIR) for modifiable risk factors (alcohol, tobacco, and physical inactivity) and their behavior change.
Approach: Alberta Health Services is implementing SBIR for modifiable risk factors into the Electronic Health Records (EHR) across acute and ambulatory care settings (Integrated Prevention in EHR (IPiC) Health). Co-design and qualitative descriptive approaches were employed to understand patients SBIR experiences and their stages of change behavior (Transtheoretical Model - TTM). Prior to SBIR implementation: We conducted semi-structured interviews with seven patient advisors (PAs) in three rounds of interviews to understand their perspectives: ) personal and clinical history with factors; 2) approaches to implement each factor and expectations for follow-up; 3) feedback on SBIR handouts and training resources. Interviews lasted 30-60 minutes, audio recorded, transcribed verbatim, and conducted abductive thematic analysis in NVivo 2/4. Findings informed the creation of SBIR materials and care resources (provider training resources for modifiable risk factors, prompts in EHR, referral pathways to resources, and patient survey tools). Additionally, PAs were consulted on strategies to follow-up with primary care providers after receiving SBIR. SBIR Implementation stage: We recruited diverse patients one month after they received SBIR and scored medium/ high risk on factors from intervention sites. We purposively sampled patients for in-depth interviews to ensure equity and diversity (gender, ethnicity, socio-economic status, age, immigration status, risk factor, and clinical site). Data collection and analysis was the same as PAs. The semi-structured interview guide was based on the Consolidated Framework for Implementation Research (CFIR), Health Stigma and Discrimination Framework, and TTM. This iterative form of assessment ensures that SBIR is patient centered and equitable. Conference date October 2024: An additional 2 patient interviews will be completed and analyzed.
Results: We have completed 37 interviews with PAs and patients. Preliminary findings indicate barriers are: Patient level: (Need) habitual alcohol use at mealtimes/social gatherings; internalized stigma - failure to stop smoking/ poor health was their fault; perceived stigma - feeling judged for having an alcohol/ health problem. (Capacity): lacked knowledge of negative health consequences from smoking, drinking, and inactivity and strategies to change. (Opportunity) existing co-morbidities limited physical activities outside the home. (Motivation): lacked motivation to change behavior. Local attitudes/values: social acceptance / encouragement of heavy drinking in teen/early adult years; family/ friends with history of smoking / drinking; lack of social support to reduce alcohol and increase physical activity. Connections (referral): providers did not make referrals. (Patient-Centeredness): health condition related stigma - PAs experienced judgement / dismissal/ disregard due to smoking.Reported facilitators to behavior change include: (Patient-Centeredness) trusting relationship with their providers; encouragement to take small steps towards positive health behavior; (Capacity) patient knowledge and awareness of health behavior change benefit their energy levels; and (sociocultural values) socially supported physical activities/alcohol free gatherings.
Implications: Patients perspectives contribute to the adaptation of SBIR for modifiable risk factors to ensure health equity, including provider training / communication to destigmatize brief interventions, developing accessible patient referral pathways, and educational resources. The successful implementation of SBIR will addresses patients health challenges related to modifiable risk factors and improves patient health outcomes. Our next steps involve adaption of SBIR across diverse clinical settings for spread, scale, and sustainability.