Integrating brief alcohol interventions with tobacco addictions treatment in primary care: qualitative study of health care practitioner perceptions

Background Randomized trials of complex interventions are increasingly including qualitative components to further understand factors that contribute to the success of complex interventions. In this paper, we explore the experiences of health care professionals who participated in the COMBAT trial; a web-based intervention implemented in the Ontario-wide Smoking Treatment for Ontario Patients (STOP) Program to prompt primary care practitioner delivery of a brief alcohol intervention as part of a smoking cessation program. This study conducted qualitative interviews with primary care practitioners to understand the factors influencing implementation and acceptability of the intervention. Methods Twenty three primary care practitioners were selected for a qualitative interview using intensity sampling, ensuring representation across study arms, organization types, and rates of intervention delivery. Interviews were 45 to 90 minutes in length and conducted by phone using an interview guide that was informed the National Implementation Research Network’s Hexagon tool. Interview recordings were transcribed and coded iteratively between three researchers to achieve consensus on emerging themes. Results Most interviewed practitioners recognized the need to simultaneously address risky alcohol use and tobacco use, and shared that this type of work fits within the priorities of their respective clinics. Although most practitioners were knowledgeable about the evidence of health risks associated with dual alcohol and tobacco use, most still felt they could have benefited from additional training – beyond the two webinars delivered by the STOP program – prior to the launch of the COMBAT initiative. Practitioners acknowledged the value of adding a validated screening tool to the STOP program’s baseline questionnaire; however, following through with a brief intervention and referral to treatment proved challenging due to limited time. Conclusions While practitioners recognized the value of the COMBAT initiative, insufficient training and time were frequently reported as barriers to adoption and delivery. The results of the study also show that practitioners’ beliefs were reflective of the current social norms around alcohol use and this influenced their decision to offer a brief alcohol intervention to patients. Future designs of primary care-based interventions need emphasize organizational and sociocultural factors as part of the design.