Journal Article

Developing a brief motivational intervention for young adults admitted with alcohol intoxication in the emergency department – Results from an iterative qualitative design

Gaume, Jacques, Fortini, Cristiana, Daeppen, Jean-Bernard, Grazioli, Véronique S., Paroz, Sophie, Bertholet, Nicolas

2021

Overview

Unhealthy alcohol use among young adults is a major public health concern. Brief motivational interventions for young adults in the Emergency Department (ED) have shown promising but inconsistent results. Based on the literature on brief intervention and motivational interviewing efficacy and active ingredients, we developed a new motivational intervention model for young adults admitted in the ED with alcohol intoxication. Using an iterative qualitative design, we first pre-tested this model by conducting 4 experimental sessions and 8 related semi-structured interviews to evaluate clinicians' and patients' perceptions of the intervention's acceptability and feasibility. We then conducted a consultation meeting with 9 international experts using a nominal group technique. The intervention model was adjusted and finally re-tested by conducting 6 new experimental sessions and 12 related semi-structured interviews. At each round, data collected were analyzed and discussed, and the intervention model updated accordingly. Based on the literature, we found 6 axes for developing a new model: High level of relational factors (e.g. empathy, alliance, avoidance of confrontation); Personalized feedback; Enhance discrepancy; Evoke change talk while softening sustain talk, strengthen ability and commitment to change; Completion of a change plan; Devote more time: longer sessions and follow-up options (face-to-face, telephone, or electronic boosters; referral to treatment). A qualitative analysis of the semi-structured interviews gave important insights regarding acceptability and feasibility of the model. Adjustments were made around which information to provide and how, as well as on how to deepen discussion about change with patients having low levels of self-exploration. The experts' consultation addressed numerous points, such as information and advice giving, and booster interventions. This iterative, multi-component design resulted in the development of an intervention model embedded in recent research findings and theory advances, as well as feasible in a complex environment. The next step is a randomized controlled trial testing the efficacy of this model.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Addictions / Adolescent / Adolescents / Adults / Alcohol Drinking / Alcohol use / Alcoholic Intoxication - psychology / Alcoholism / Alcohols / Anxiety disorders / Biology and Life Sciences / Blood / Blood levels / Cannabis / Cocaine / Crisis Intervention - methods / Data analysis / Demographic aspects / Disorders / Drinking of alcoholic beverages / Drug abuse / Drug dependence / Drunkenness / Editing / Emergency medical care / Emergency medical services / Emergency Service, Hospital - trends / Evaluation Studies as Topic / Female / Funding / Health aspects / Hospitalization / Humans / Injuries / Intervention / Intoxication / Male / Medicine / Medicine and Health Sciences / Methodology / Motivation / Motivational Interviewing - methods / Narcotics / People and Places / Physical Sciences / Psychiatry / Psychological aspects / Psychosocial Intervention - methods / Public health / Qualitative analysis / Reviews / Social aspects / Social Sciences / Stakeholder Participation / Switzerland / Teenagers / Tobacco / Working groups / Young Adult / Young adults / Youth