Samenvatting

In this paper, we test path models that study the interrelations between primary health careprovider attitudes towards working with drinkers, their screening and brief advice activity, and theirreceipt of training and support and financial reimbursement. Study participants were 756 primaryhealth care providers from 120 primary health care units (PHCUs) in different locations throughoutCatalonia, England, The Netherlands, Poland, and Sweden. Our interventions were training andsupport and financial reimbursement to providers. Our design was a randomized factorial trial withbaseline measurement period, 12-week implementation period, and 9-month follow-up measurementperiod. Our outcome measures were: attitudes of individual providers in working with drinkers asmeasured by the Short Alcohol and Alcohol Problems Perception Questionnaire; and the proportion ofconsulting adult patients (age 18+ years) who screened positive and were given advice to reduce their alcohol consumption (intervention activity). We found that more positive attitudes were associated with higher intervention activity, and higher intervention activity was then associated with more positive attitudes. Training and support was associated with both positive changes in attitudes and higher intervention activity. Financial reimbursement was associated with more positive attitudesthrough its impact on higher intervention activity. We conclude that improving primary health careproviders’ screening and brief advice activity for heavy drinking requires a combination of trainingand support and on-the-job experience of actually delivering screening and brief advice activity.