Developing a Brief Negotiational Intervention for Alcohol in Moshi, Tanzania
Globally, alcohol causes over 1.8 million deaths annually. In fact, for individuals 15-49 years of age, high-risk alcohol use is the leading disease-attributed risk factor for death. In high-income countries, a brief negotiational interview administered in an Emergency Department cost-effectively reduces alcohol related harm. Unfortunately, in low and middle-income countries, alcohol use is rapidly increasing, but factors influencing alcohol use and approaches to reduce alcohol related harm are largely unknown. This career development award would provide me the dedicated research time, research skills and funding to fill this gap.
With partners in Tanzania, I have shown that 30% of patients presenting with injuries to Kilimanjaro Christian Medical Center (KCMC) Emergency Department (ED) had consumed alcohol prior to their injury. By definition, these patients are deemed "harmful alcohol users" with very high risk of repeated alcohol-related harm. Based on high-income setting data, hazardous or 'at-risk' and harmful alcohol users would benefit from an intervention -- a brief negotiational interview -- to reduce alcohol use and harm. Therefore, I propose to develop and test a culturally-appropriate brief negotiational interview in Tanzania. The intervention, utilizing motivational interviewing principles, will be a one-time, 15-minute, practitioner-led discussion of safe drinking behaviors, and negotiation of changes in alcohol use. I will test the intervention in the KCMC ED for patients presenting with an alcohol related consequence or injury during what is known as a "teachable moment."
My central hypothesis is that a brief negotiational interview administered in the KCMC ED will decrease high-risk alcohol use as measured by the Alcohol Use Disorder Identification Tool (AUDIT). Utilizing my existing experience and what I will gain through the proposed mentorship and education in mixed methods research, motivational interviewing, implementation research, and global clinical trials, I will prepare the tools required to conduct a pragmatic clinical trial to test this hypothesis.
**Aim1:** Define patients, families and healthcare providers' current perspectives on alcohol use. Using surveys and focus groups with patients, family members, and healthcare providers, I will define current alcohol use practices and obstacles to alcohol reduction. To successfully complete this aim, I will seek education on focus group and survey methods to augment my quantitative data skills. I will analyze the data explaining how and why alcohol impacts KCMC patients' lives.
**Aim 2:** Develop a culturally-appropriate nurse-delivered brief negotiational interview (BNI) utilizing motivational interviewing, to be delivered in the KCMC Emergency Department. We will iteratively develop and improve a BNI in order to ensure adherence to the widely accepted %u2018FRAMES' model of motivational interviewing. Then, we will validate our outcome tools. To reach this aim, I will gain knowledge in motivational interviewing principles, Swahili language training, and mentorship in protocol development for BNIs testing in Swahili.
**Aim 3:** Conduct a pilot trial of the intervention. Feasibility of study procedures, patient acceptability of the intervention and trial, and patient enrollment and retention will be tested in a pilot randomized pragmatic clinical trial. During this aim, I will have mentorship and didactics on global clinical trials, implementation research, and grant writing.