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Published on: January 5, 2018
Implementation process evaluation and preliminary effect analysis of an outpatient multidisciplinary follow-up
Hanna van Roozendaal1, Inge Glazemakers2,3, Lieve Verboven4
1Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Antwerp, 2610, Belgium. hanna.vanroozendaal@uantwerpen.be.
Background:
The number of adolescents with acute alcohol intoxication in Belgium is concerning and standardised follow-up care for these adolescents is lacking. Therefore, a six-month follow-up treatment program called SPIRIT, which stands for Screening and Personalised Feedback Intervention for Alcohol-Intoxicated Teenagers), was developed and pilot-tested in Antwerp (Belgium) in this study. The program consisted of personalised feedback, motivational interviewing, psychological screening, and parental involvement, METHODS: The primary objective of this pilot study was to evaluate the implementation process of SPIRIT, guided by the Consolidated Framework for Implementation Research (CFIR). Interviews with paediatricians, brainstorming meetings with stakeholders, and participant surveys were conducted and analysed qualitatively. Thematic content deriving from the qualitative data coding was linked to CFIR domains and relevant constructs, which were assessed as factors influencing implementation, relating to (1) barriers and (2) facilitators to implementation. The study's secondary objective consisted of the preliminary analysis of SPIRITs effectiveness in decreasing problematic alcohol use, parent-child interaction, parenting skills, and the detection of underlying psychological disorders. Surveys for participants and their parents were conducted at the moment of discharge from the emergency department (T0) and at follow-up six months later (T2).
Results:
The qualitative analysis revealed that 2 of the CFIR constructs were considered barriers for implementation, namely the constructs financing (outer setting) and sustainability (outcome addendum). Fifteen constructs were considered as a combination of a facilitator and barrier (mainly the domains 'outer setting', 'inner setting' and 'individuals'). The results also showed a strong innovation design and implementation process, with 21 CFIR constructs serving as facilitators in mainly these two above-mentioned domains. Additionally, the quasi-experimental effect analysis showed a decrease in problematic alcohol use among the 12 participants (from a median AUDIT-C score of 4.0 to 1.0, p = 0.013). Also, an improvement in the conflict behaviour between participants (the median Conflict Behaviour Questionnaire, CBQ, score decreased from 6.0 to 1.5, p = 0.044) and their mothers (median CBQ decreased from 8.5 to 3.5, p = 0.037) was seen. Moreover, a significant increase in the parenting skills of fathers was observed (a decrease in mean Parenting Style score from 3.3 to 2.7, p = 0.046).
Conclusions:
Despite the low sample size, the preliminary effect analysis of this study demonstrated promising results in decreasing problematic alcohol use and improving parent-child interaction. The barriers (mainly in the inner and outer setting domains, for instance patient flow and financing) and facilitators (mainly in the innovation and implementation process domain) assessed in this study using the CFIR framework, could be considered by researchers, physicians and policy makers when implementing similar follow-up programs in healthcare contexts.
Trial Registration:
ISRCTN, ISRCTN15542211, 22/04/2025, retrospectively registered.
