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1. Introduction
Primary health care providers find screening and giving brief advice for heavy drinking a difficult business [1,2,3]. This can be changed with professional and organizational-based interventions [4,5]. During the 1970s, the Maudsley Alcohol Pilot Project was set up in the United Kingdom to make practical recommendations for an improved local response to dealing with drinking problems [6]. The project, which subsequently informed the United Kingdom’s Royal College of General Practitioners’ report on alcohol [7], was premised on the view that to respond to drinking problems adequately, primary health care providers need to be involved.
The Maudsley Alcohol Pilot Project used the Alcohol and Alcohol Problems Perception Questionnaire (AAPPQ) as a theoretical basis to understand why community agents have difficulty with alcohol problems, and as a basis to monitor improvement [8,9]. In the AAPPQ, for which a shortened version is available [10,11], role security measures role adequacy, for example, “I feel I can appropriately advise my patients about drinking and its effects”; and role legitimacy, for example, “I feel I have the right to ask patients questions about their drinking when necessary”. Role insecurity is expressed at the emotional level as therapeutic commitment, which measures motivation, for example, “pessimism is the most realistic attitude to take toward drinkers”; task specific self-esteem, for example, “all in all I am inclined to feel I am a failure with drinkers”; and work satisfaction, for example, “in general, it is rewarding to work with drinkers”.
The Maudsley Alcohol Pilot Project found that primary health care providers often failed to recognize and respond to drinking problems because they felt anxieties about their role adequacy through not having the information and skills necessary to recognize and respond to drinkers; and because they felt anxieties about their role legitimacy through being uncertain as to whether or indeed how far drinking problems came within their responsibilities. The project proposed that the key to increasing on-the-job experience and effectiveness was to provide education and training to primary health care providers along with supporting brief advice activity, such as referral opportunities, to improve their role security and therapeutic commitment, which, in turn, would lead to more brief advice activity.
Although there have been a number of international studies examining providers’ attitudes in this field...