Scaling up alcohol prevention in primary health care: exploring factors influencing alcohol screening in Colombia, Mexico and Peru

Alcohol use is a significant risk factor for bad health. Primary health care providers can play an important role in detecting patients with harmful or hazardous drinking patterns through asking a few simple questions about alcohol use during routine consultation with help of a standardized instrument. In practice however, providers often encounter barriers to performing such alcohol screening. This thesis focuses on evaluation of the factors influencing the screening practice of primary health care providers in three Latin American countries; Colombia, Mexico and Peru. This research is based on the data collected through process evaluation of an implementation study conducted as part of the SCALA project (Scaling up risky alcohol use prevention and management, including dealing with co-morbid depression in primary health care, scalaproject.eu). Through the lens of implementation science, the thesis presents assessment of the key stakeholders' perception of intervention appropriateness, including possible barriers to its implementation. Furthermore, it describes the development of mixed-methods process evaluation protocols and finally identifies which factors (related to training, professional role, individual motivation, organisation and wider environment) were associated with providers' screening practice by integrating the findings from process and outcome evaluation.