Reducing alcohol use among adolescents through a community-based, multicomponent intervention: an implementation research approach

Background

Harmful use of alcohol is considered one of the major risk factors responsible for the worldwide rise of non-communicable diseases. One effective strategy to reduce harmful alcohol consumption later in life is to delay alcohol use onset among adolescents through evidence-based programs. Despite the established knowledge related to the efficacy of a preventive intervention to reduce adolescent alcohol consumption, there is a large gap related to the process of translating this evidence into practice in real life. Especially in low and middle-income countries (LMICs), there is a necessity to turn the investments to understanding the challenges related to how to implement these interventions in different settings. In Brazil, a partnership between the United Nations Office for Drugs and Crimes and the Ministry of Health allowed the country to culturally adapt and implement programs with proven international evidence of effectiveness. After adaptation, these programs were supposed to be disseminated by municipalities. However, despite being highly promising on the national scene, the programs have been mostly discontinued due to a lack of “know-how to do”, lack of stakeholder involvement and lack of multisectoral intervention. On the other hand, in Mozambique, a country with the same language and similar culture, no interventions are implemented or evaluated to reduce adolescent alcohol use. In this context, Brazil’s experience in this field would be ideal to kick-start the process. Brazilian experience is not complete and needs improvement in its implementation; thus, the implementation could occur simultaneously in the two countries.

Aims

This proposal aims, in Brazil, to develop a multicomponent and multisectoral community-based intervention including the programs brought by UNODC and that have been disseminated through erratic strategies and, in Mozambique, the development of a similar intervention, but with all adaptations needed to the country, seizing the opportunity to work together with a multinational team that has large experience on program evaluation and dissemination.

Project plan

In both countries, we will conduct implementation research with a hybrid design, that is, considering the diad implementation-effectiveness, through the implementation research cycle proposed by the WHO framework: (1) Identification of the appropriate intervention; (2) Adaptation and piloting of the intervention; (3) Implementation and evaluation of the intervention; and (4) Scale-up. The study will use a mixed-methods approach to evaluate the following outcomes: readiness, appropriateness, acceptability, feasibility, fidelity, adoption, reach, sustainability, and effectiveness (real-world efficacy). The Brazil-Mozambique partnership intends to address health inequities among LMICs, to offer capacity-building and technology transfer to overcome the challenges related to the implementation of a community-based intervention to prevent adolescent alcohol use.

Principal investigators

Funding organisations

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