The aging population and structural changes in the family increases loneliness among elderly people. Stressful relationships with children may turn against the elders resulting in violence; this phenomenon is rising not only in Portugal but also abroad. The Portuguese situation was reviewed based on literature.

Background: Alcohol is one of the most important risk factors contributing to the global burden of disease. Screening and brief interventions in primary care settings are effective in reducing alcohol consumption. However, implementation of such interventions in routine practice has been proven difficult. Most programmes in practice and research have lacked a theoretical rationale for how they would change practitioner behaviour. Objective: To determine whether a theory-based behaviour change intervention delivered to primary care practices significantly increases delivery of alcohol screening. Methods: We will conduct a two-arm, cluster-randomized controlled, parallel, open trial. Twelve primary care practices will be randomized to one of two groups: training and support; and waiting-list control. Family physicians, nurses and receptionists will be eligible to participate. The intervention will be a training and support programme. The intervention will be tailored to the barriers and facilitators for implementing alcohol screening and brief interventions following the principles of the Behaviour Change Wheel approach. The primary outcome will be the proportion of patients screened with the Alcohol Use Disorders Identification Test. Conclusion: This study will test whether a theory-driven implementation programme increases alcohol screening rates in primary care. Results from this trial will provide a useful addition to existing evidence by informing implementation researchers what areas of behaviour change are critical to increasing alcohol screening rates. Trial registration: clinicaltrials.gov NCT02968186

Background Alcohol is one of the most important risk factors contributing to the global burden of disease. Screening and brief interventions in primary care settings are effective in reducing alcohol consumption. However, implementation of such interventions in routine practice has been proven difficult. Most programmes in practice and research have lacked a theoretical rationale for how they would change practitioner behaviour. Objective To determine whether a theory-based behaviour change intervention delivered to primary care practices significantly increases delivery of alcohol screening. Methods We will conduct a two-arm, cluster-randomized controlled, parallel, open trial. Twelve primary care practices will be randomized to one of two groups: training and support; and waiting-list control. Family physicians, nurses and receptionists will be eligible to participate. The intervention will be a training and support programme. The intervention will be tailored to the barriers and facilitators for implementing alcohol screening and brief interventions following the principles of the Behaviour Change Wheel approach. The primary outcome will be the proportion of patients screened with the Alcohol Use Disorders Identification Test. Conclusion This study will test whether a theory-driven implementation programme increases alcohol screening rates in primary care. Results from this trial will provide a useful addition to existing evidence by informing implementation researchers what areas of behaviour change are critical to increasing alcohol screening rates. Trial registration clinicaltrials.gov NCT02968186

Introduction: Alcohol is a leading risk factor contributing to the global burden of disease. National and international agencies recommend evidence-based screening and brief interventions in primary care settings in order to reduce alcohol consumption. However, the majority of primary care professionals do not routinely deliver such interventions. Objective: To identify factors influencing general practitioners/family physicians’ and primary care nurses’ routine delivery of alcohol screening and brief intervention in adults. Material and Methods: A systematic literature search will be carried out in the following electronic databases: Medline, CINAHL, CENTRAL, and PsycINFO. Two authors will independently abstract data and assess study quality using the NIH National Heart, Lung, and Blood Institute quality assessment tools for quantitative studies, and the CASP checklist for qualitative studies. A narrative synthesis of the findings will be provided, structured around the barriers and facilitators identified. Identified barriers and facilitators will be further analysed using the Behavioural Change Wheel/Theoretical Domains Framework. Discussion: This review will describe the barriers to, and facilitators for, the implementation of alcohol screening and brief interventions by general practitioners/family physicians and nurses at primary care practices. By mapping the barriers and facilitators to the domains of the Behavioural Change Wheel/Theoretical Domains Framework, this review will also provide implementation researchers with a useful tool for selecting promising practitioner-oriented behavioural interventions for improving alcohol screening and brief intervention delivery in primary care. Conclusion: This review will provide important information for implementing alcohol screening and brief intervention in primary health care.

Introduction: Alcohol is a leading risk factor contributing to the global burden of disease. National and international agencies recommend evidence-based screening and brief interventions in primary care settings in order to reduce alcohol consumption. However, the majority of primary care professionals do not routinely deliver such interventions.  Objective: To identify factors influencing general practitioners/family physicians' and primary care nurses' routine delivery of alcohol screening and brief intervention in adults.  Material and Methods: A systematic literature search will be carried out in the following electronic databases: Medline, CINAHL, CENTRAL, and PsycINFO. Two authors will independently abstract data and assess study quality using the NIH National Heart, Lung, and Blood Institute quality assessment tools for quantitative studies, and the CASP checklist for qualitative studies. A narrative synthesis of the findings will be provided, structured around the barriers and facilitators identified. Identified barriers and facilitators will be further analysed using the Behavioural Change Wheel/Theoretical Domains Framework.  Discussion: This review will describe the barriers to, and facilitators for, the implementation of alcohol screening and brief interventions by general practitioners/family physicians and nurses at primary care practices. By mapping the barriers and facilitators to the domains of the Behavioural Change Wheel/Theoretical Domains Framework, this review will also provide implementation researchers with a useful tool for selecting promising practitioner-oriented behavioural interventions for improving alcohol screening and brief intervention delivery in primary care.  Conclusion: This review will provide important information for implementing alcohol screening and brief intervention in primary health care.  Systematic Review Registration: PROSPERO CRD42016052681

Introduction: Alcohol is a leading risk factor contributing to the global burden of disease. National and international agencies recommend evidence-based screening and brief interventions in primary care settings in order to reduce alcohol consumption. However, the majority of primary care professionals do not routinely deliver such interventions.Objective: To identify factors influencing general practitioners/family physicians’ and primary care nurses’ routine delivery of alcohol screening and brief intervention in adults.Material and Methods: A systematic literature search will be carried out in the following electronic databases: Medline, CINAHL, CENTRAL, and PsycINFO. Two authors will independently abstract data and assess study quality using the NIH National Heart, Lung, and Blood Institute quality assessment tools for quantitative studies, and the CASP checklist for qualitative studies. A narrative synthesis of the findings will be provided, structured around the barriers and facilitators identified. Identified barriers and facilitators will be further analysed using the Behavioural Change Wheel/Theoretical Domains Framework.Discussion: This review will describe the barriers to, and facilitators for, the implementation of alcohol screening and brief interventions by general practitioners/family physicians and nurses at primary care practices. By mapping the barriers and facilitators to the domains of the Behavioural Change Wheel/Theoretical Domains Framework, this review will also provide implementation researchers with a useful tool for selecting promising practitioner-oriented behavioural interventions for improving alcohol screening and brief intervention delivery in primary care.Conclusion: This review will provide important information for implementing alcohol screening and brief intervention in primary health care.Systematic Review Registration: PROSPERO CRD42016052681 

Background and aims: Screening and brief interventions (SBI) in primary health-care practices (PHCP) are effective in reducing reported alcohol consumption, but have not been routinely implemented. Most programs seeking to improve implementation rates have lacked a theoretical rationale. This study aimed to test whether a theory-based intervention for PHCPs could significantly increase alcohol SBI delivery. Design: Two-arm, cluster-randomized controlled, parallel, 12-month follow-up, trial. Setting: PHCPs in Portugal. Participants: Staff from 12 PHCPs (n = 222, 81.1% women): nurses (35.6%), general practitioners (28.8%), receptionists (26.1%) and family medicine residents (9.5%); patients screened for alcohol use: intervention n = 8062; controls n = 58. Intervention and comparator: PHCPs were randomized to receive a training and support program (n = 6; 110 participants) tailored to the barriers and facilitators for implementing alcohol SBIs following the principles of the Behavior Change Wheel/Theoretical Domains Framework approach, or to a waiting-list control (n = 6; 112 participants). Training was delivered over the first 12 weeks of the trial. Measurements: The primary outcome was the proportion of eligible patients screened (unit of analysis: patient list). Secondary outcomes included the brief intervention (BI) rate per screen-positive patient and the population-based BI rate (unit of analysis: patient list), and changes in health providers' perceptions of barriers to implementation and alcohol-related knowledge (unit of analysis: health provider). Findings: The implementation program had a significant effect on the screening activity in the intervention practices compared with control practices at the 12-month follow-up (21.7% vs. 0.16%, intention-to-treat analysis, p = 0.003). Although no significant difference was found on the BI rate per screen-positive patient (intervention 85.7% vs. control 63.6%, p = 0.55, Bayes factor = 0.28), the intervention was effective in increasing the population-based BI rate (intervention 0.69% vs. control 0.02%, p = 0.006). Health providers in the intervention arm reported fewer barriers to SBI implementation and higher levels of alcohol-related knowledge at 12-month follow-up than those in control practices. Conclusion: A theory-based implementation program, which included training and support activities, significantly increased alcohol screening and population-based brief intervention rates in primary care.

Background: Alcohol is a leading risk factor contributing to the global burden of disease. Several national and international agencies recommend that screening and brief interventions (SBI) should be routinely delivered in primary care settings to reducing patients' alcohol consumption. However, evidence shows that such activities are seldom implemented in practice. A review of the barriers and facilitators mediating implementation, and how they fit with theoretical understandings of behaviour change, to inform the design of implementation interventions is lacking. This study aimed to conduct a theory-informed review of the factors influencing general practitioners' and primary care nurses' routine delivery of alcohol SBI in adults. Methods: A systematic literature search was carried out in four electronic databases (Medline, CINAHL, CENTRAL, PsycINFO) using comprehensive search strategies. Both qualitative and quantitative studies were included. Two authors independently abstracted and thematically grouped the data extracted. The barriers and facilitators identified were mapped to the domains of the Capability-Opportunity-Motivation-Behaviour system/Theoretical Domains Framework (TDF). Results: Eighty-four out of the 258 studies identified met the selection criteria. The majority of the studies reported data on the views of general practitioners (n = 60) and used a quantitative design (n = 49). A total of 660 data items pertaining to barriers and 253 data items pertaining to facilitators were extracted and thematically grouped into 46 themes. The themes mapped to at least one of the 14 domains of the TDF. The three TDF domains with the highest number of data units coded were 'Environmental Context and Resources' (n = 158, e.g. lack of time), 'Beliefs about Capabilities' (n = 134, e.g. beliefs about the ability to deliver screening and brief advice and in helping patients to cut down) and 'Skills' (n = 99, e.g. lack of training). Conclusions: This study identified a range of potential barriers and facilitators to the implementation of alcohol SBI delivery in primary care and adds to the scarce body of literature that identifies the barriers and facilitators from a theoretical perspective. Given that alcohol SBI is seldom implemented, this review provides researchers with a tool for designing novel theory-oriented interventions to support the implementation of such activity.

Background Alcohol is a leading risk factor contributing to the global burden of disease. Several national and international agencies recommend that screening and brief interventions (SBI) should be routinely delivered in primary care settings to reducing patients’ alcohol consumption. However, evidence shows that such activities are seldom implemented in practice. A review of the barriers and facilitators mediating implementation, and how they fit with theoretical understandings of behaviour change, to inform the design of implementation interventions is lacking. This study aimed to conduct a theory-informed review of the factors influencing general practitioners’ and primary care nurses’ routine delivery of alcohol SBI in adults. Methods A systematic literature search was carried out in four electronic databases (Medline, CINAHL, CENTRAL, PsycINFO) using comprehensive search strategies. Both qualitative and quantitative studies were included. Two authors independently abstracted and thematically grouped the data extracted. The barriers and facilitators identified were mapped to the domains of the Capability-Opportunity-Motivation-Behaviour system/Theoretical Domains Framework (TDF). Results Eighty-four out of the 258 studies identified met the selection criteria. The majority of the studies reported data on the views of general practitioners (n = 60) and used a quantitative design (n = 49). A total of 660 data items pertaining to barriers and 253 data items pertaining to facilitators were extracted and thematically grouped into 46 themes. The themes mapped to at least one of the 14 domains of the TDF. The three TDF domains with the highest number of data units coded were ‘Environmental Context and Resources’ (n = 158, e.g. lack of time), ‘Beliefs about Capabilities’ (n = 134, e.g. beliefs about the ability to deliver screening and brief advice and in helping patients to cut down) and ‘Skills’ (n = 99, e.g. lack of training). Conclusions This study identified a range of potential barriers and facilitators to the implementation of alcohol SBI delivery in primary care and adds to the scarce body of literature that identifies the barriers and facilitators from a theoretical perspective. Given that alcohol SBI is seldom implemented, this review provides researchers with a tool for designing novel theory-oriented interventions to support the implementation of such activity.