- Project MH18 (2018 — 2022)
- Mental Health Research Programme
Sri Lanka
Background
Alcohol is in the top five causes of disability and death world-wide, contributing to 5.9% (over one in 20) of all deaths globally, 17% of deaths from unintentional injuries and 16% of gastrointestinal deaths are attributable to alcohol. South East Asia has the second highest rate of harm per litre of alcohol in the world (after Eastern Europe). This relates to riskier consumption patterns, including use of illicit alcohol. In rural Sri Lanka, alcohol consumption is a significant social and medical problem and is strongly linked with high annual incidence of suicide and deliberate self-harm (363/100,000). Sri Lanka currently has the world’s third highest male suicide rate and alcohol is a major cause of domestic violence and depression in families.
Aims
Our original study was a mixed methods design that included a step-wedge cluster RCT to test the effectiveness of the intervention and a qualitative study on process and implementation. The objective for the study was to examine whether the intervention used in the pilot study can be successfully delivered on a larger scale to 20 villages to produce similar benefits. While this objective remains, the operating context has substantially changed and so we have adapted our study to focus more specifically on the process and implementation outcomes. In addition the extensive baseline information will allow us to investigate the impact of COVID and restrictions on these communities using a cohort design.
Project plan
The study employed a mixed methods design, the quantitative cohort study focused on the impact COVID and the financial crisis on alcohol use, mental health and social impacts, and the qualitative assessment evaluated the implementation of a complex intervention. While many of our measures remain the same some of our tools for assessing the implementation of the modified intervention have been revised. The study sample always focused on delivery of the intervention to the whole of the selected communities and this will remain. For the cohort study we utilised the data collected in the baseline assessment and repeat these assessments of drinking patterns, mental health, social capital, and financial stress to ascertain if major shifts in the villages were observed since the COVID outbreak. This included the additional questions about the impact of the pandemic on households and drinking in the study population that were approved in May 2020. We also took the opportunity to assess the digital readiness of these communities to engage in assessment and intervention elements.
Our primary outcomes for the study were:
To measure the effect of COVID-19 and associated restrictions on alcohol use and depression within each village.
To measure the community readiness for alcohol prevention in each village
To assess the effect of COVID-19 restrictions on village social capital and financial stress.
To evaluate the acceptability and feasibility of the different components of the intervention.
To evaluate context specific barriers to, and facilitators of, implementation of a hybrid educational intervention to prevent alcohol misuse.
Undertake an ex-ante cost analysis for the intervention.
Impact
The project team has developed a range of public facing resources, providing information about the risks of alcohol consumption.
Funding organisations
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