Using the ADAPT Guidance to Culturally Adapt a Brief Intervention to Reduce Alcohol Use Among Injury Patients in Tanzania

Overview

Journal PLOS Glob Public Health

Date 2025 Feb 6

PMID 39913646

Authors

Catherine A Staton

Armand Zimmerman

Msafiri Pesambili

Ashley J Phillips

Anna Tupetz

Joao Vitor Perez de Souza

Judith Boshe

Michael H Pantalon

Monica Swahn

Blandina T Mmbaga

Joao Ricardo Nickenig Vissoci

Affiliations

Soon will be listed here.

Abstract

Harmful alcohol use is a leading risk factor for injury-related death and disability in low- and middle-income countries (LMICs). Brief negotiational interventions (BNIs) in emergency departments (EDs) effectively reduce alcohol intake and re-injury rates. However, most BNIs are developed in high-income countries, with limited evidence of their effectiveness in LMICs. To address this gap, we culturally adapted a BNI for alcohol-related injury patients at Kilimanjaro Christian Medical Centre (KCMC), a tertiary hospital in Tanzania. Our study followed the ADAPT guidance to culturally adapt an existing high-income country BNI for use in the KCMC, a tertiary hospital in Tanzania. The adaptation included: 1) a systematic review of effective alcohol harm reduction interventions in similar settings; 2) consultations with local and international healthcare professionals experienced in counseling and substance abuse treatment; 3) group discussions to refine goals and finalize adaptations. The adapted BNI protocol and assessment scales ensured intervention fidelity. At KCMC, 30% of injury patients screened positive for alcohol use disorder (AUD), with a five-fold increased risk of injury, primarily from road traffic accidents and violence. A systematic review highlighted limited data on patient-level interventions in low-resource settings. Our adapted BNI, 'Punguza Pombe Kwa Afya Yako (PPKAY)', based on the FRAMES model, showed high feasibility and acceptability, with 84% of interventions achieving ≥80% adherence and 98% patient satisfaction. PPKAY is the first culturally adapted alcohol BNI for injury patients in an African ED. Our study demonstrates our approach to adapting substance use interventions for use in low resource settings and shows that cultural adaptation of alcohol use interventions is feasible, beneficial and empowering for our team. Our study lays a framework and method for other low resourced settings to integrate cultural adaptation into the implementation of a BNI in low resource EDs.

References

Haagsma J, Graetz N, Bolliger I, Naghavi M, Higashi H, Mullany E . The global burden of injury: incidence, mortality, disability-adjusted life years and time trends from the Global Burden of Disease study 2013. Inj Prev. 2015; 22(1):3-18. PMC: 4752630. DOI: 10.1136/injuryprev-2015-041616. View

Field C, Caetano R . The role of ethnic matching between patient and provider on the effectiveness of brief alcohol interventions with Hispanics. Alcohol Clin Exp Res. 2009; 34(2):262-71. PMC: 2827200. DOI: 10.1111/j.1530-0277.2009.01089.x. View

Griffin S, Karia F, Zimmerman A, Minnig M, Swahn M, Makelarski J . A Mixed-Methods Study: Sex Differences in Experiences of Stigma Associated With Alcoholism and Alcohol Use Disorders Among Injury Patients in Tanzania. Alcohol Clin Exp Res. 2020; 44(8):1700-1707. PMC: 7480464. DOI: 10.1111/acer.14402. View

Mbatia J, Jenkins R, Singleton N, White B . Prevalence of alcohol consumption and hazardous drinking, tobacco and drug use in urban Tanzania, and their associated risk factors. Int J Environ Res Public Health. 2009; 6(7):1991-2006. PMC: 2738894. DOI: 10.3390/ijerph6071991. View

Peltzer K, Naidoo P, Louw J, Matseke G, Zuma K, Mchunu G . Screening and brief interventions for hazardous and harmful alcohol use among patients with active tuberculosis attending primary public care clinics in South Africa: results from a cluster randomized controlled trial. BMC Public Health. 2013; 13:699. PMC: 3733870. DOI: 10.1186/1471-2458-13-699. View

Kaner E, Bland M, Cassidy P, Coulton S, Dale V, Deluca P . Effectiveness of screening and brief alcohol intervention in primary care (SIPS trial): pragmatic cluster randomised controlled trial. BMJ. 2013; 346:e8501. PMC: 3541471. DOI: 10.1136/bmj.e8501. View

Staton C, Vissoci J, El-Gabri D, Adewumi K, Concepcion T, Elliott S . Patient-level interventions to reduce alcohol-related harms in low- and middle-income countries: A systematic review and meta-summary. PLoS Med. 2022; 19(4):e1003961. PMC: 9004752. DOI: 10.1371/journal.pmed.1003961. View

Torres V, Williams E, Ceballos R, Donovan D, Ornelas I . Participant Satisfaction and Acceptability of a Culturally Adapted Brief Intervention to Reduce Unhealthy Alcohol Use Among Latino Immigrant Men. Am J Mens Health. 2020; 14(3):1557988320925652. PMC: 7328216. DOI: 10.1177/1557988320925652. View

Staton C, Vissoci J, Wojcik R, Hirshon J, Mvungi M, Mmbaga B . Perceived barriers by health care providers for screening and management of excessive alcohol use in an emergency department of a low-income country. Alcohol. 2018; 71:65-73. PMC: 6467255. DOI: 10.1016/j.alcohol.2018.01.003. View

10.

Staton C, Friedman K, Phillips A, Minnig M, Sakita F, Ngowi K . Feasibility of a pragmatic randomized adaptive clinical trial to evaluate a brief negotiational interview for harmful and hazardous alcohol use in Moshi, Tanzania. PLoS One. 2023; 18(8):e0288458. PMC: 10399826. DOI: 10.1371/journal.pone.0288458. View

11.

Whitty M, Nagel T, Jayaraj R, Kavanagh D . Development and evaluation of training in culturally specific screening and brief intervention for hospital patients with alcohol-related injuries. Aust J Rural Health. 2015; 24(1):9-15. DOI: 10.1111/ajr.12195. View

12.

Johnson M, Jackson R, Guillaume L, Meier P, Goyder E . Barriers and facilitators to implementing screening and brief intervention for alcohol misuse: a systematic review of qualitative evidence. J Public Health (Oxf). 2010; 33(3):412-21. DOI: 10.1093/pubmed/fdq095. View

13.

Papas R, Gakinya B, Mwaniki M, Lee H, Keter A, Martino S . A randomized clinical trial of a group cognitive-behavioral therapy to reduce alcohol use among human immunodeficiency virus-infected outpatients in western Kenya. Addiction. 2020; 116(2):305-318. PMC: 7671944. DOI: 10.1111/add.15112. View

14.

Tsarouk T, Thompson E, Herting J, Walsh E, Randell B . Culturally specific adaptation of a prevention intervention: an international collaborative research project. Addict Behav. 2007; 32(8):1565-81. DOI: 10.1016/j.addbeh.2006.11.013. View

15.

Pengpid S, Peltzer K, van der Heever H, Skaal L . Screening and brief interventions for hazardous and harmful alcohol use among university students in South Africa: results from a randomized controlled trial. Int J Environ Res Public Health. 2013; 10(5):2043-57. PMC: 3709363. DOI: 10.3390/ijerph10052043. View

16.

Lakes K, Lopez S, Garro L . Cultural competence and psychotherapy: Applying anthropologically informed conceptions of culture. Psychotherapy (Chic). 2011; 43(4):380-96. PMC: 3654669. DOI: 10.1037/0033-3204.43.4.380. View

17.

Joseph J, Basu D . Efficacy of Brief Interventions in Reducing Hazardous or Harmful Alcohol Use in Middle-Income Countries: Systematic Review of Randomized Controlled Trials. Alcohol Alcohol. 2016; 52(1):56-64. DOI: 10.1093/alcalc/agw054. View

18.

Ornelas I, Allen C, Vaughan C, Williams E, Negi N . Vida PURA: A Cultural Adaptation of Screening and Brief Intervention to Reduce Unhealthy Drinking Among Latino Day Laborers. Subst Abus. 2014; 36(3):264-71. PMC: 4390400. DOI: 10.1080/08897077.2014.955900. View

19.

Whitesell N, Mousseau A, Keane E, Asdigian N, Tuitt N, Morse B . Integrating Community-Engagement and a Multiphase Optimization Strategy Framework: Adapting Substance Use Prevention for American Indian Families. Prev Sci. 2019; 20(7):1136-1146. PMC: 6774198. DOI: 10.1007/s11121-019-01036-y. View

20.

Mitsunaga T, Larsen U . Prevalence of and risk factors associated with alcohol abuse in Moshi, northern Tanzania. J Biosoc Sci. 2007; 40(3):379-99. DOI: 10.1017/S0021932007002441. View