Barriers to implementing screening and brief interventions in general practice: findings from a qualitative study in Norway (2011)

AIMS: The qualitative component of this mixed methods study aimed at obtaining more in-depth information about the barriers of implementation of screening and brief interventions (SBI) in general practice identified in the quantitative component by giving general practitioners (GPs) the opportunity to discuss and report on the particular difficulties they experience in relation to identification and treatment of alcohol problems in their daily work. METHODS: Focus-group interviews were performed with seven groups of GPs in different parts of Norway, encompassing 40 participants. The interviews were transcribed and analyzed using the QDA Miner software. RESULTS: The analysis revealed five major groups of factors influencing GPs' reluctance to use SBI for alcohol problems: (a) perception of alcohol problems, (b) integration of SBI into existing routines, (c) prevention vs. treatment, (d) structural issues and (e) the relationship between practitioner and patient. Discussion: The analysis showed that problems of implementing SBI in general practice are a complex issue. The quantitative part of the project revealed a strong association between knowledge/self-efficacy and the use of SBI. However, in the qualitative study, we were able to look in more detail at some of the findings from the first part. Even if the lack of knowledge of SBI was still significant, the five factors identified in this study appeared important for the GPs' decisions to use SBI in individual cases. [Author's abstract]