Implementation of a Multicomponent Responsible Beverage Service Programme in Sweden – A Qualitative Study of Promoting and Hindering Factors

Open access

Abstract

AIMS – The objective of this study was to identify factors that either promote or hinder implementation of a multicomponent Responsible Beverage Service programme in Swedish municipalities. DESIGN – Forty semi-structured interviews were conducted in six municipalities and directed content analysis, guided by the Consolidated Framework for Implementation Research (CFIR), was performed. RESULTS – The CFIR framework was useful as an underlying theoretical model in this study. Importance of the following factors, described in the five domains of CFIR, was empirically supported in this study: local needs, evidence strength and advantages of the intervention, costs and available resources, clear goals, evaluation and feedback, access to knowledge and information, clear role definitions and cooperation, and enthusiastic key persons with high confidence in the effectiveness of the intervention. Hindering factors listed by the informants were lack of enthusiasm and opportunities to specialise, low degree of self-efficacy, unengaged decision-makers, complexities of the programme, and a top-down approach. CONCLUSIONS – This study indicates that previously identified factors shown to promote and hinder implementation processes are also valid in the context of multicomponent community action programmes like RBS. Suggestions on how to elude some of the hindering factors are proposed, e.g. to develop long-time financial plans, to provide better information about the RBS program in full, and to stress the importance of collaboration between representatives from the municipalities, police authorities and owners of on-licenced premises.

Abstract

AIMS – The objective of this study was to identify factors that either promote or hinder implementation of a multicomponent Responsible Beverage Service programme in Swedish municipalities. DESIGN – Forty semi-structured interviews were conducted in six municipalities and directed content analysis, guided by the Consolidated Framework for Implementation Research (CFIR), was performed. RESULTS – The CFIR framework was useful as an underlying theoretical model in this study. Importance of the following factors, described in the five domains of CFIR, was empirically supported in this study: local needs, evidence strength and advantages of the intervention, costs and available resources, clear goals, evaluation and feedback, access to knowledge and information, clear role definitions and cooperation, and enthusiastic key persons with high confidence in the effectiveness of the intervention. Hindering factors listed by the informants were lack of enthusiasm and opportunities to specialise, low degree of self-efficacy, unengaged decision-makers, complexities of the programme, and a top-down approach. CONCLUSIONS – This study indicates that previously identified factors shown to promote and hinder implementation processes are also valid in the context of multicomponent community action programmes like RBS. Suggestions on how to elude some of the hindering factors are proposed, e.g. to develop long-time financial plans, to provide better information about the RBS program in full, and to stress the importance of collaboration between representatives from the municipalities, police authorities and owners of on-licenced premises.

References

  • Anderson, P., & Baumberg, B. (2006). Alcohol in Europe. London: Institute of Alcohol Studies.

  • Anderson, P., Chisholm, D., & Fuhr, D. C. (2009). Effectiveness and cost-effectiveness of policies and programmes to reduce the harm caused by alcohol. Lancet, 373, 2234–2246.

  • Andréasson, S., Sjöström, E., & Bränström, R. (2007). A Six-Community Prevention Trial to Reduce Alcohol and Drug Use–Related Problems in Sweden: Planning and Early Findings. Substance Use & Misuse, 42, 2017–2027.

  • Babor, T. F., Caetano, R., Casswell, S., Edwards, G., Giesbrecht, N., Graham, K., et al. (2010). Alcohol No Ordinary Commodity, Research and Public Policy (2nd ed.). Oxford, UK: Oxford University Press.

  • Buvik, K. & Baklien, B. (2006). Skal det være noe mer før vi stenger – en evaluering av Ansvarlig vertskap i Trondheim. SIRUS rapport nr 4/2006: Statens institutt for rusmiddelforskning.

  • Casswell, S. (2000). A decade of community action research. Substance Use & Misuse, 35, 55–74.

  • Carroll, C., Patterson, M., Wood, S., Booth, A., Rick, J., & Balain, S. (2007). A conceptual framework for implementation fidelity. Implementation Science, 2, 40.

  • Damschroder, L. J., Aron, D., Keith, R., Kirsh, S., Alexander, J., & Lowery, J. C. (2009). Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implementation Science, 4, 50. doi:10.1186/1748-5908-4-50

  • Damschroder, L. J., & Hagedorn, H. J. (2011). A Guiding Framework and Approach for Implementation Research in Substance Use Disorders Treatment. Psychology of Addictive Behaviors, 25(2), 194–205.

  • Damschroder, L. J. & Lowery, J. C. (2013). Evaluation of a large-scale weight management programme using the consolidated framework for implementation research (CFIR). Implementation Science, 8, 51. doi:10.1186/1748-5908-8-51

  • Demers, A., Kairouz, S., Adlaf, E. M., Gliksman, L., Newton-Taylor, B., & Marchand, A. (2002). Multilevel analysis of situational drinking among Canadian undergraduates. Social Science & Medicine, 55, 415–424.

  • Durlak, J. A., & DuPre, E. (2008). Implementation Matters: A Review of Research on the Influence of Implementation on Program Outcomes and the Factors Affecting Implementation. American Journal of Community Psychology, 41, 327–350.

  • Durlak, J. A. (1997). Successful prevention programs for children and adolescents. New York: Plenum Press.

  • Dusenbury, L., Brannigan, R., Falco, M., & Hansen, W. B. (2003). A review of research on fidelity of implementation: Implications for drug abuse prevention in school settings. Health Education Research, 18, 237–256.

  • Eccles, MP., Armstrong, D., Baker, R., Cleary, K., Davies, H., Davies, S., et al. (2009). An implementation research agenda. Implementation Science, 4, 18. doi:10.1186/1748-5908-4-18

  • Fixsen, D. L., Naoom, S. F., Blase, K. A., Friedman, R. M., & Wallace, F. (2005). Implementation Research: A Synthesis of the Literature. Tampa, Florida, US: Louis de la Parte Florida Mental Health Institute Publication.

  • Flay, B., Biglan, A., Boruch, R., Castro, F., Gottfredson, D., Kellam, S. et al. (2005). Standards of Evidence: Criteria for Efficacy, Effectiveness and Dissemination. Prevention Science, 6(3), 151–175.

  • Gliksman, L., McKenzie, D., Single, E., Douglas, R., Brunet, S., & Moffatt, K. (1993). The role of alcohol providers in prevention: an evaluation of a server intervention programme. Addiction, 88, 1195–1203.

  • Graham, K., & Homel, R. (2008). Raising the bar: Preventing aggression in and around bars, pubs and clubs. Cullompton, UK: Willan Publishing.

  • Graham, K., Osgood, D. W., Wells, S., & Stockwell, T. (2006). To what extent is intoxication associated with aggression in bars? A multilevel analysis. Journal of Studies on Alcohol, 67, 382–390.

  • Graham, K., Osgood, D. W., Zibrowski, E., Purcell, J., Gliksman, L., Leonard, K., et al. (2004). The effect of the Safer Bars programme on physical aggression in bars: results of a randomized controlled trial. Drugs and Alcohol Review, 23, 31–41.

  • Graneheim, U. H., & Lundman, B. (2004). Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Education, 24, 105–112.

  • Greenhalgh, T., Robert, G., Bate, P., Macfarlane, F., & Kyriakidou, O. (2004). Diffusion of innovations in health service organisations. A systematic literature review. Oxford, UK: BMJ Books, Blackwell Publishing.

  • Holder, H. D. (1998). Alcohol and the community: a systems approach to prevention. Cambridge, UK: Cambridge University Press.

  • Holder, H. D. (2000). Community prevention of alcohol problems. Addictive Behaviors, 25(6), 843–859.

  • Holder, H. D., & Moore, R. (2000). Institutionalization of community action projects to reduce alcohol use–related problems: Systematic facilitators. Substance Use & Misuse, 35, 75–86.

  • Holder, H. D., Gruenewald, P. J., Ponicki, W. R., Treno, A. J., Grube, J. W., Saltz, R. et al. (2000). Effects of community-based interventions on high-risk drinking and alcohol-related injuries. JAMA, 284, 2341–2347.

  • Hsieh, H. F., & Shannon, S. E. (2005). Three approaches to qualitative content analysis. Qualitative Health Research, 15, 1277–1288.

  • Ilott, I., Gerrish, K., Booth, A., & Field, B. (2013). Testing the Consolidated Framework for Implementation Research on health care innovations from South Yorkshire. Journal of Evaluation in Clinical Practice, 19(5), 915–924. doi: 10.1111/j.1365-2753.2012.01876.x

  • John, P. (1998). Analysing public policy. London: Continuum.

  • Johnsson, K. O. & Berglund, M. (2009). Do Responsible Beverage Programs reduce breath alchol concentration among patrons: a five-month follow-up of a randomized controlled trial. Substance Use & Misuse, 44, 1592–1601.

  • Jones, L., Hughes, K., Atkinson, A. M., & Bellis, M. A. (2011). Reducing harm in drinking environments: a systematic review of effective apporaches. Health Place, 17, 508–518.

  • Knafl, K. A., & Breitmayer, B. J. (1991). Triangulation in qualitative research: issues of conceptual clarity and purpose. In J. M. Morse (Ed.), Qualitative nursing research. Newbury Park: SAGE Publications.

  • Kvale, S. (1996). InterWiews. London: Sage Publications.

  • Lauritzen, H. C. & Baklien, B. (2007). Overskjenking i Bergen – en oppfølgingsevaluering av Ansvarlig vertskap i Bergen. SIRUS rapport nr 5/2007: Statens institutt for rusmiddelforskning.

  • Leonard, K. E., Quigley, B. M., & Collins, R. L. (2002). Physical aggression in the lives of young adults: Prevalence, location and severity among college and community samples. Journal of Interpersonal Violence, 17, 533–550.

  • Lepp, M., & Ringsberg, K. C. (2002). Phenomenography – a qualitative research approach. In L. R. M. Hallberg (Ed.), Qualitative methods in public health research – Theoretical foundations and practical examples. Lund, Sweden: Studentlitteratur.

  • Miles, M. B., & Huberman, A. M. (1994). Qualitative data analysis. An expanded sourcebook. (2nd ed.). Thousands Oaks, California, USA: Sage Publications.

  • Norström, T. (1998). Effects on criminal violence of different beverage types and private and public drinking. Addiction, 93, 689–699.

  • OECD (2011). Health at a glance 2011: OECD indicators. OECD, 2011

  • Rehm, J., Colin, M., Popoya, S., Thavorncharoensap, M., Teerawattananon, Y., & Jayadeep, P. (2009). Global burden of disease and injury and economic cost attributable to alcohol use and alcohol-use disorders. Lancet, 373, 2223–2233.

  • Rogers, E. (2003). Diffusion of Innovations (5 uppl. ed.). London: Free Press.

  • Room, R., & Rossow, I. (2001). The share of violence attributable to drinking. Journal of Substance Use, 6, 218–228.

  • Rossow, I. & Baklien, B. (2011). Applying mixed methods in evaluation of a community prevention project: reflections on strengths and challenges. Nordic Studies on Alcohol and Drugs, 28, 487–500.

  • Swedish National Institute of Public Health. (2006). Responsible Beverage Service – a method for preventing alcohol-related injuries in bars, pubs and restaurants. Östersund, Sweden: Swedish National Institute of Public Health.

  • Stockwell, T. (2001). Responsible alcohol service: lessons from evaluations of server training and policing initiatives. Drug and Alchol Review, 20, 257–265.

  • Trolldal, B., Brännström, L., Mallie, I., Paschall, M. J., & Leifman, H. (2013a). Effects of a multi-component responsible beverage service programme on violent assaults in Sweden. Addiction, 108, 89–96.

  • Trolldal, B., Haggård, U., & Guldbrandsson, K. (2013b). Factors associated with implementation of a multicomponent responsible beverage service program-results from two surveys in 290 Swedish municipalities. Substance Abuse Treatment, Prevention, and Policy, 8, 11. doi:10.1186/1747-597X-8-1..

  • Trolldal, B., Holder, H., Agnéus, H., & Edin, A. (2000). Description of the Swedish Alcohol System 1995–2000: Production, import, export, wholesale and retail. In H. Holder (Ed.), Sweden and the European Union – Changes in national alcohol policy and their consequences. Stockholm, Sweden: Almqvist & Wiksell International.

  • Wagenaar, A., Murray, D., & Toomey, T. (2000). Communities mobilizing for change on alcohol (CMCA): Effects of a randomized trial on arrests and traffic crashes. Addiction, 95, 209–217.

  • Wallin, E. (2004). Responsible beverage service. Effects of a community action project. Stockholm, Sweden: Karolinska Institutet.

  • Wallin, E., Norström, T., & Andréasson, S. (2003). Alcohol prevention targeting licensed premises: a study of effects on violence. Journal of Studies on Alcohol, 64, 270–277.

  • Warpenius, K., Holmila, M., & Mustonen, H. (2010). Effects of a community intervention to reduce the serving of alcohol to intoxicated patrons. Addiction, 105, 1032–1040.

Anderson, P., & Baumberg, B. (2006). Alcohol in Europe. London: Institute of Alcohol Studies.

Anderson, P., Chisholm, D., & Fuhr, D. C. (2009). Effectiveness and cost-effectiveness of policies and programmes to reduce the harm caused by alcohol. Lancet, 373, 2234–2246.

Andréasson, S., Sjöström, E., & Bränström, R. (2007). A Six-Community Prevention Trial to Reduce Alcohol and Drug Use–Related Problems in Sweden: Planning and Early Findings. Substance Use & Misuse, 42, 2017–2027.

Babor, T. F., Caetano, R., Casswell, S., Edwards, G., Giesbrecht, N., Graham, K., et al. (2010). Alcohol No Ordinary Commodity, Research and Public Policy (2nd ed.). Oxford, UK: Oxford University Press.

Buvik, K. & Baklien, B. (2006). Skal det være noe mer før vi stenger – en evaluering av Ansvarlig vertskap i Trondheim. SIRUS rapport nr 4/2006: Statens institutt for rusmiddelforskning.

Casswell, S. (2000). A decade of community action research. Substance Use & Misuse, 35, 55–74.

Carroll, C., Patterson, M., Wood, S., Booth, A., Rick, J., & Balain, S. (2007). A conceptual framework for implementation fidelity. Implementation Science, 2, 40.

Damschroder, L. J., Aron, D., Keith, R., Kirsh, S., Alexander, J., & Lowery, J. C. (2009). Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implementation Science, 4, 50. doi:10.1186/1748-5908-4-50

Damschroder, L. J., & Hagedorn, H. J. (2011). A Guiding Framework and Approach for Implementation Research in Substance Use Disorders Treatment. Psychology of Addictive Behaviors, 25(2), 194–205.

Damschroder, L. J. & Lowery, J. C. (2013). Evaluation of a large-scale weight management programme using the consolidated framework for implementation research (CFIR). Implementation Science, 8, 51. doi:10.1186/1748-5908-8-51

Demers, A., Kairouz, S., Adlaf, E. M., Gliksman, L., Newton-Taylor, B., & Marchand, A. (2002). Multilevel analysis of situational drinking among Canadian undergraduates. Social Science & Medicine, 55, 415–424.

Durlak, J. A., & DuPre, E. (2008). Implementation Matters: A Review of Research on the Influence of Implementation on Program Outcomes and the Factors Affecting Implementation. American Journal of Community Psychology, 41, 327–350.

Durlak, J. A. (1997). Successful prevention programs for children and adolescents. New York: Plenum Press.

Dusenbury, L., Brannigan, R., Falco, M., & Hansen, W. B. (2003). A review of research on fidelity of implementation: Implications for drug abuse prevention in school settings. Health Education Research, 18, 237–256.

Eccles, MP., Armstrong, D., Baker, R., Cleary, K., Davies, H., Davies, S., et al. (2009). An implementation research agenda. Implementation Science, 4, 18. doi:10.1186/1748-5908-4-18

Fixsen, D. L., Naoom, S. F., Blase, K. A., Friedman, R. M., & Wallace, F. (2005). Implementation Research: A Synthesis of the Literature. Tampa, Florida, US: Louis de la Parte Florida Mental Health Institute Publication.

Flay, B., Biglan, A., Boruch, R., Castro, F., Gottfredson, D., Kellam, S. et al. (2005). Standards of Evidence: Criteria for Efficacy, Effectiveness and Dissemination. Prevention Science, 6(3), 151–175.

Gliksman, L., McKenzie, D., Single, E., Douglas, R., Brunet, S., & Moffatt, K. (1993). The role of alcohol providers in prevention: an evaluation of a server intervention programme. Addiction, 88, 1195–1203.

Graham, K., & Homel, R. (2008). Raising the bar: Preventing aggression in and around bars, pubs and clubs. Cullompton, UK: Willan Publishing.

Graham, K., Osgood, D. W., Wells, S., & Stockwell, T. (2006). To what extent is intoxication associated with aggression in bars? A multilevel analysis. Journal of Studies on Alcohol, 67, 382–390.

Graham, K., Osgood, D. W., Zibrowski, E., Purcell, J., Gliksman, L., Leonard, K., et al. (2004). The effect of the Safer Bars programme on physical aggression in bars: results of a randomized controlled trial. Drugs and Alcohol Review, 23, 31–41.

Graneheim, U. H., & Lundman, B. (2004). Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Education, 24, 105–112.

Greenhalgh, T., Robert, G., Bate, P., Macfarlane, F., & Kyriakidou, O. (2004). Diffusion of innovations in health service organisations. A systematic literature review. Oxford, UK: BMJ Books, Blackwell Publishing.

Holder, H. D. (1998). Alcohol and the community: a systems approach to prevention. Cambridge, UK: Cambridge University Press.

Holder, H. D. (2000). Community prevention of alcohol problems. Addictive Behaviors, 25(6), 843–859.

Holder, H. D., & Moore, R. (2000). Institutionalization of community action projects to reduce alcohol use–related problems: Systematic facilitators. Substance Use & Misuse, 35, 75–86.

Holder, H. D., Gruenewald, P. J., Ponicki, W. R., Treno, A. J., Grube, J. W., Saltz, R. et al. (2000). Effects of community-based interventions on high-risk drinking and alcohol-related injuries. JAMA, 284, 2341–2347.

Hsieh, H. F., & Shannon, S. E. (2005). Three approaches to qualitative content analysis. Qualitative Health Research, 15, 1277–1288.

Ilott, I., Gerrish, K., Booth, A., & Field, B. (2013). Testing the Consolidated Framework for Implementation Research on health care innovations from South Yorkshire. Journal of Evaluation in Clinical Practice, 19(5), 915–924. doi: 10.1111/j.1365-2753.2012.01876.x

John, P. (1998). Analysing public policy. London: Continuum.

Johnsson, K. O. & Berglund, M. (2009). Do Responsible Beverage Programs reduce breath alchol concentration among patrons: a five-month follow-up of a randomized controlled trial. Substance Use & Misuse, 44, 1592–1601.

Jones, L., Hughes, K., Atkinson, A. M., & Bellis, M. A. (2011). Reducing harm in drinking environments: a systematic review of effective apporaches. Health Place, 17, 508–518.

Knafl, K. A., & Breitmayer, B. J. (1991). Triangulation in qualitative research: issues of conceptual clarity and purpose. In J. M. Morse (Ed.), Qualitative nursing research. Newbury Park: SAGE Publications.

Kvale, S. (1996). InterWiews. London: Sage Publications.

Lauritzen, H. C. & Baklien, B. (2007). Overskjenking i Bergen – en oppfølgingsevaluering av Ansvarlig vertskap i Bergen. SIRUS rapport nr 5/2007: Statens institutt for rusmiddelforskning.

Leonard, K. E., Quigley, B. M., & Collins, R. L. (2002). Physical aggression in the lives of young adults: Prevalence, location and severity among college and community samples. Journal of Interpersonal Violence, 17, 533–550.

Lepp, M., & Ringsberg, K. C. (2002). Phenomenography – a qualitative research approach. In L. R. M. Hallberg (Ed.), Qualitative methods in public health research – Theoretical foundations and practical examples. Lund, Sweden: Studentlitteratur.

Miles, M. B., & Huberman, A. M. (1994). Qualitative data analysis. An expanded sourcebook. (2nd ed.). Thousands Oaks, California, USA: Sage Publications.

Norström, T. (1998). Effects on criminal violence of different beverage types and private and public drinking. Addiction, 93, 689–699.

OECD (2011). Health at a glance 2011: OECD indicators. OECD, 2011

Rehm, J., Colin, M., Popoya, S., Thavorncharoensap, M., Teerawattananon, Y., & Jayadeep, P. (2009). Global burden of disease and injury and economic cost attributable to alcohol use and alcohol-use disorders. Lancet, 373, 2223–2233.

Rogers, E. (2003). Diffusion of Innovations (5 uppl. ed.). London: Free Press.

Room, R., & Rossow, I. (2001). The share of violence attributable to drinking. Journal of Substance Use, 6, 218–228.

Rossow, I. & Baklien, B. (2011). Applying mixed methods in evaluation of a community prevention project: reflections on strengths and challenges. Nordic Studies on Alcohol and Drugs, 28, 487–500.

Swedish National Institute of Public Health. (2006). Responsible Beverage Service – a method for preventing alcohol-related injuries in bars, pubs and restaurants. Östersund, Sweden: Swedish National Institute of Public Health.

Stockwell, T. (2001). Responsible alcohol service: lessons from evaluations of server training and policing initiatives. Drug and Alchol Review, 20, 257–265.

Trolldal, B., Brännström, L., Mallie, I., Paschall, M. J., & Leifman, H. (2013a). Effects of a multi-component responsible beverage service programme on violent assaults in Sweden. Addiction, 108, 89–96.

Trolldal, B., Haggård, U., & Guldbrandsson, K. (2013b). Factors associated with implementation of a multicomponent responsible beverage service program-results from two surveys in 290 Swedish municipalities. Substance Abuse Treatment, Prevention, and Policy, 8, 11. doi:10.1186/1747-597X-8-1..

Trolldal, B., Holder, H., Agnéus, H., & Edin, A. (2000). Description of the Swedish Alcohol System 1995–2000: Production, import, export, wholesale and retail. In H. Holder (Ed.), Sweden and the European Union – Changes in national alcohol policy and their consequences. Stockholm, Sweden: Almqvist & Wiksell International.

Wagenaar, A., Murray, D., & Toomey, T. (2000). Communities mobilizing for change on alcohol (CMCA): Effects of a randomized trial on arrests and traffic crashes. Addiction, 95, 209–217.

Wallin, E. (2004). Responsible beverage service. Effects of a community action project. Stockholm, Sweden: Karolinska Institutet.

Wallin, E., Norström, T., & Andréasson, S. (2003). Alcohol prevention targeting licensed premises: a study of effects on violence. Journal of Studies on Alcohol, 64, 270–277.

Warpenius, K., Holmila, M., & Mustonen, H. (2010). Effects of a community intervention to reduce the serving of alcohol to intoxicated patrons. Addiction, 105, 1032–1040.

Nordic Studies on Alcohol and Drugs

The Journal of Nordic Centre for Welfare and Social Issues

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