King's College London

Research portal

Impact of primary healthcare providers’ initial role security and therapeutic commitment on implementing brief interventions in managing risky alcohol consumption: a cluster randomised factorial trial

Research output: Contribution to journalArticle

M. Keurhorst, P. Anderson, M. Heinen, Preben Bendtsen, Begoña Baena, Krzysztof Brzózka, Joan Colom, Paolo Deluca, Colin Drummond, Eileen Kaner, Karolina Kłoda, Artur Mierzecki, Dorothy Newbury-birch, Katarzyna Okulicz-kozaryn, Jorge Palacio-vieira, Kathryn Parkinson, Jillian Reynolds, Gaby Ronda, Lidia Segura, Luiza Słodownik & 8 more Fredrik Spak, Ben Van Steenkiste, Paul Wallace, Amy Wolstenholme, Marcin Wojnar, Antoni Gual, M. Laurant, M. Wensing

Original languageEnglish
JournalImplementation Science
Issue number1
Accepted/In press7 Jul 2016
Published16 Jul 2016


  • Impact of primary healthcare_KEURHORST_Accepted 7Jul2016_GOLD VoR

    Impact_of_primary_healthcare_KEURHORST_Accepted_7Jul2016_GOLD_VoR.pdf, 482 KB, application/pdf

    Uploaded date:28 Jul 2016

    Version:Final published version

    Licence:CC BY

    © 2016 Keurhorst et al. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.

King's Authors



Brief interventions in primary healthcare are cost-effective in reducing drinking problems but poorly implemented in routine practice. Although evidence about implementing brief interventions is growing, knowledge is limited with regard to impact of initial role security and therapeutic commitment on brief intervention implementation.


In a cluster randomised factorial trial, 120 primary healthcare units (PHCUs) were randomised to eight groups: care as usual, training and support, financial reimbursement, and the opportunity to refer patients to an internet-based brief intervention (e-BI); paired combinations of these three strategies, and all three strategies combined. To explore the impact of initial role security and therapeutic commitment on implementing brief interventions, we performed multilevel linear regression analyses adapted to the factorial design.


Data from 746 providers from 120 PHCUs were included in the analyses. Baseline role security and therapeutic commitment were found not to influence implementation of brief interventions. Furthermore, there were no significant interactions between these characteristics and allocated implementation groups.


The extent to which providers changed their brief intervention delivery following experience of different implementation strategies was not determined by their initial attitudes towards alcohol problems. In future research, more attention is needed to unravel the causal relation between practitioners’ attitudes, their actual behaviour and care improvement strategies to enhance implementation science.

Download statistics

No data available

View graph of relations

© 2018 King's College London | Strand | London WC2R 2LS | England | United Kingdom | Tel +44 (0)20 7836 5454