Exploring the Teachable Moment for Alcohol Reduction in Breast Clinics: Formative Work to Inform Intervention Design, Development, Process Evaluation

Lead Research Organisation: University of Southampton
Department Name: Clinical and Experimental Sciences

Abstract

The Chief Medical Officers have recently announced updates to the national alcohol guidelines reflecting new scientific evidence that risks of alcohol on health are dose-dependent, and there is no 'safe' level of alcohol consumption. There is now a need to increase public awareness of this recent evidence to all types of alcohol consumers, whether light or heavy drinkers, in order to reduce alcohol intake across the whole population. There is relatively little research as to whether providing alcohol brief interventions for moderate drinkers (who are still at increased risk of cancer including breast cancer) is either acceptable or feasible.
Evidence tends to show that patients and the wider public are both more receptive to health improvement advice and more open to make positive changes in their lifestyle when facing significant health events, for instance pregnancy or a visit to an Emergency Department, this has been described as 'readiness to change'. Many opportunistic brief interventions use these health service encounters to increase the effectiveness of public health advice.
We propose an early phase study to determine the information about alcohol needed by women attending these clinics, how tailored and supportive feedback can be provided, and what tools may help develop this into a long-term intrinsic motivation to reduce alcohol consumption. We propose to explore the acceptability and feasibility of an opportunistic alcohol brief intervention (ABI) delivered electronically to women during health care attendances related to breast cancer, when women maybe particularly alert to breast health initiatives. Every year, approximately 275,000 women in England are referred urgently to clinics for suspected breast cancer, and a further 4.4 million women take up a mammography as part of the NHS Breast Screening Programme. Our recent Cancer Research UK-funded pilot study found that less than 20% of women attending these appointments identified alcohol as a risk factor for breast cancer, despite now well-established evidence that this is the case.
The proposed formative work is driven by what women in clinics would find most useful and acceptable. It aims to identify the most appropriate means to empower women to better understand their own alcohol consumption, and the benefits of reduction, capitalising on the heightened receptivity provided by the context of breast clinic waiting areas. We will do this using a range of research methods (survey, semi structured interviews, and focus groups), the results of which will feed into each other to give us the most appropriate format to share alcohol risk information and health improvement advice that addresses women referred to these clinics information needs in a positive and empowering way. We will also explore the acceptability of spreading the ABI to the family and friends of participants, where appropriate.
Finally, we will test the prototype intervention with clinic attendees. Results will show whether enough patients engage with the intervention, accept and understand the advice, and ultimately feel a determination to act upon it. All these would confirm sufficient potential to justify a future main study assessing the efficacy of the intervention on alcohol reduction.

Technical Summary

Existing research on alcohol brief interventions (ABI) has yet to examine the potential for suspected breast cancer clinics and breast screening mammography as a 'teachable moment'. We propose an early phase study to assess:
(i) women's information needs regarding effects of alcohol on cancer risk,
(ii) the nature of tailored feedback required, and
(iii) the potential of a digital ABI to develop alcohol awareness into a long-term intrinsic motivation to reduce alcohol consumption.
We will also investigate the potential to involve their social network, with the hypothesis that friends and family may also experience a 'teachable moment' due to the anxiety surrounding a suspected breast cancer referral or screening appointment.
Early phase work will finalise a comprehensive review of the literature on alcohol intervention and behaviour change techniques in health care settings and efficacy of digital lifestyle interventions, and complete our draft logic model, started in preparation for this application.
This knowledge will feed into a person-based approach to intervention development to involve patients in the design of an ABI. A continuous electronic clinic survey will measure determinants of readiness to change, intrinsic motivation, participants' demographic and clinical characteristics and level of alcohol consumption. Semi-structured interviews and focus groups will comment on currently available applications, and help design personalised feedback and optional web-based modules helping participants maintain awareness and motivation over time. Acceptability and feasibility will finally be measured in real-world conditions by testing the intervention prototype in clinics (using the LifeGuide digital behaviour change design software platform).
Patients, clinicians, public health specialists, and commissioners, will be involved throughout to co-create the planned intervention.

Publications

10 25 50
 
Description A Context-Specific Digital Alcohol Brief Intervention in Symptomatic Breast Clinics (Abreast of Health): Development and Usability Study paper is on the reading list for the MSc in Developing and Evaluating complex interventions at University of Glasgow.
Geographic Reach Local/Municipal/Regional 
Policy Influence Type Influenced training of practitioners or researchers
Impact Sinclair JMA, Dutey-Magni PF, Kaner E, McCann M, Anderson AS, Baird J, Baker M, Cutress R, Copson ER. A Context-Specific Digital Alcohol Brief Intervention in Symptomatic Breast Clinics (Abreast of Health): Development and Usability Study JMIR Res Protoc 2020;9(1):e14580. URL: https://www.researchprotocols.org/2020/1/e14580 DOI: 10.2196/14580 PMID: 32012091 the paper is on the reading list for the MSc in Developing and Evaluating complex interventions at the University of Glasgow
URL https://www.researchprotocols.org/2020/1/e14580
 
Description Coppafeel! and Abreast of Health PPI seminar 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Undergraduate students
Results and Impact (Coppafeel! and Abreast of Health seminar - March) The research team held a joint meeting with the members of a local breast health university based charity, Coppafeel!. This collaborative event involved a short presentation followed by a feedback session regarding the content being used within the research. Persons who attended responded positively to the research and gave significant feedback regarding thoughts and feelings of the material being presented. Heightened awareness of alcohol consumption levels and breast cancer risk factor awareness were reported following the session, with those attending reporting feeling more aware and engaged with their health as well as interested in participating in future research as PPI members.
Year(s) Of Engagement Activity 2018
URL https://www.facebook.com/events/1760108174297889/
 
Description International Women's Day workshop held by Julia Sinclair 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Other audiences
Results and Impact (International Women's Day seminar- March) The research team held a presentation and workshop event as part of the university wide International Women's Day celebrations, focussing on health. The presenter (Julia Sinclair, co-PI) delivered a presentation followed by a feedback session regarding the content being used within the research. Persons who attended responded positively to the research and gave significant feedback regarding thoughts and feelings of the material being presented. Heightened awareness of alcohol consumption levels and breast cancer risk factor awareness were reported following the session, with those attending reporting feeling more aware and engaged with their health as well as interested in participating in future research as PPI members.
Year(s) Of Engagement Activity 2018
URL https://www.eventbrite.co.uk/e/womens-health-matters-if-you-know-your-numbers-you-get-to-choose-tick...
 
Description Interview for local news (Daily Echo - January) 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Public/other audiences
Results and Impact (Daily Echo - January) Co-PI of this research, Julia Sinclair, took part in an interview regarding alcohol and breast cancer and the Abreast of Health Study (this award). Aim of this discussion was to raise awareness of this link and our research and encourage research participation. A good response was documented, and members of the public reported an interest in this research and approached members of the research team for more information on how to get involved. This also lead to further contact with media in the local area who were also interested in this topic due to the Dry January campaign.
Year(s) Of Engagement Activity 2018
URL http://www.dailyecho.co.uk/News/15801518.Southampton_researchers_lead_study_into_effects_of_alcohol_...
 
Description Interview for local news (Solent TV - January) 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Public/other audiences
Results and Impact (That's Solent TV - January) Co-PI of this research, Julia Sinclair, took part in a video interview regarding alcohol and breast cancer and the Abreast of Health Study (this award). Aim of this discussion was to raise awareness of this link and our research and encourage research participation. The final video was broadcast on That's Solent TV (a local news channel) and then uploaded to youtube. This has since been embedded on the research website for this study, and serves a brief introductory interview for people to watch when they visit this site.
Year(s) Of Engagement Activity 2018
URL https://www.youtube.com/watch?v=IULyPsI0M8w
 
Description Interview for local news (UoS News - December) 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Postgraduate students
Results and Impact (UoS News - December) Co-PI of this research, Julia Sinclair, took part in an interview regarding alcohol and breast cancer and the Abreast of Health Study (this award). Aim of this discussion was to raise awareness of this link and our research and encourage research participation. A good response was documented, and members of the public and other members of the University reported an interest in this research and approached members of the research team for more information on how to get involved.
Year(s) Of Engagement Activity 2017
URL https://www.southampton.ac.uk/news/2017/12/abreast-of-health.page
 
Description Interview for national news (BBC Radio 5 Live - February) 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Public/other audiences
Results and Impact (BBC 5 Live- February) Co-PI of this research, Julia Sinclair, took part in a live radio discussion regarding alcohol and the Abreast of Health Study (this award). Aim of this discussion was to raise awareness of alcohol dangers and our research and encourage research participation. A good response was documented, and many members of the public reported an interest in this research and approached members of the research team for more information on how to get involved.
Year(s) Of Engagement Activity 2018
URL http://www.bbc.co.uk/programmes/b09r7bdl
 
Description Interview for regional news (BBC Solent - November) 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Media (as a channel to the public)
Results and Impact (BBC Solent - November) Co-PI of this research, Julia Sinclair, took part in a live radio discussion regarding alcohol and breast cancer and the Abreast of Health Study (this award). Aim of this discussion was to raise awareness of this link and our research and encourage research participation. A good response was documented, and many members of the public, as well as other media sources, reported an interest in this research and approached members of the research team for more information on how to get involved.
Year(s) Of Engagement Activity 2017
URL http://www.bbc.co.uk/programmes/p05kbx2l
 
Description Presence at hospital health event (UHS occupational health event) 
Form Of Engagement Activity Participation in an open day or visit at my research institution
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Professional Practitioners
Results and Impact (UHS occupational health open day - September) The research team had a stall at the local hospital for an occupational health outreach event. The aim of this event was to raise health awareness, with the Abreast of Health team raising awareness of the risks of alcohol consumption, and encouraging research participation. A good response was documented, and hospital employees as well as members of the public and patients reported an interest in this research and approached members of the research team for more information on how to get involved.
Year(s) Of Engagement Activity 2017
 
Description Presence at hospital open day (UHS open day) 
Form Of Engagement Activity Participation in an open day or visit at my research institution
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Public/other audiences
Results and Impact (UHS open day - September) The research team had a stall at the local hospital for the hospital wide open day. The aim of this event was to raise health awareness, with the Abreast of Health team raising awareness of the risks of alcohol consumption, and encouraging research participation. A good response was documented, and members of the public and patient groups reported an interest in this research and approached members of the research team for more information on how to get involved.
Year(s) Of Engagement Activity 2017
 
Description Study Engagement Facebook Page 
Form Of Engagement Activity Engagement focused website, blog or social media channel
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Public/other audiences
Results and Impact Study specific facebook page created to aid dissemination of ideas and encourage research and PPI participation. Page acts as a source of contact for people interested in the study to find out about study updates, participation possibilities, interesting related news, and to show their support of the Abreast of Health study. The page has been well received, and several PPI surveys and events have been advertised in this way.
Year(s) Of Engagement Activity 2017
URL http://facebook.com/abreastofhealth
 
Description Study Newsletter 
Form Of Engagement Activity A magazine, newsletter or online publication
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Public/other audiences
Results and Impact Study newsletter created to be disseminated among PPI channels and in clinics. This newsletter is a bi-monthly update to give information regarding the study progression and any interesting information that our PPI members may want to know about. Response has been good, with many participants and PPI members reporting positive views and willingness to use as a sharing point to those outside of the study reach. This has then been used to encourage others to participate in research and PPI activities.
Year(s) Of Engagement Activity 2017