Alcohol misuse in sexual health clinics: examining the opportunity and challenges to intervene

Abstract

Introduction: Alcohol brief interventions appear to be effective when delivered in emergency medical settings. Clear links between alcohol use and poor sexual health have led to suggestions that this approach should be extended to sexual health clinics. The SHEAR study (Sexual Health and Excessive Alcohol, Randomised trial) examined the effectiveness of brief intervention compared to control treatment over a six month period. In this thesis I explore the process and outcomes of alcohol brief interventions in sexual health clinics in the context of this trial. Methods: I analysed quantitative and qualitative data in a convergent parallel design and used a grounded theory approach to generate a mid-range theory. Results: Over two thirds (68.49%) of those screened were excessive drinkers and those drinking excessively were more likely to have had unprotected sex whilst feeling drunk (difference in proportion = 17.69, [95% CI 13.06 to 21.56], p < 0.001). While 98.8% received Brief Advice, only 20.4% accepted further intervention from an Alcohol Health Worker. The only factor to predict acceptance of the full intervention was reason for attendance, with those presenting for a sexual health check-up being more likely to receive the full intervention (difference in proportion=15.94, [95% CI 3.76 to 26.97], p-value=0.010). Making a ‘link’ between attendance and drinking did not affect people’s willingness for further intervention. I propose the mid-range theory of ‘perpetual appraisal’ which is salient in many professional and personal interactions and helps explain the lack of uptake and effectiveness of alcohol brief intervention when delivered in sexual health clinics. Conclusion: Focus on ‘teachable moment’ to implement alcohol interventions does not suit the sexual health setting. Whilst people attending these clinics generally accept being asked questions about drinking, most do not appreciate the label of ‘excessive drinker’. Targeted interventions in sexual health clinics and more upstream research are warranted.