Feasibility and acceptability of an adapted WHO alcohol brief intervention: Pilot of a three-armed randomized trial in Sri Lanka

Background Risky drinking (RD) is a major health hazard in Sri Lanka. Alcohol brief intervention (BI) has been proven effective in minimizing RD but has not been utilised in Sri Lanka. We therefore aimed to adapt the WHO alcohol BI and targeted educational material to Sri Lanka, assess their feasibility and acceptability and evaluate appropriateness of methodology and measures for a future RCT. Study design A three-arm parallel-group pilot RCT. Methods The BI was adapted based on expert feedback. The study included male inpatients (with AUDIT-C screening score ≥5) of a tertiary hospital. The three study arms were: adapted brief intervention (ABI), education about unit of alcohol (UOA), and feedback on screening results (FOA). Trained research assistants (RAs) screened and implemented the interventions. We report on follow-up rates (feasibility), participant and RA feedback (acceptability), recruitment efficiency and data quality (methodological appropriateness), and appropriateness of outcome measures. Results The ABI included a structured training manual for implementers, an alcohol information leaflet, and a personal information sheet. Patient follow-up rates were 69 %, 40 % and 71 % for FOA, UOA and ABI arms respectively. Family member recruitment was 31 %. Patient and RA feedback for ABI was overwhelmingly positive. Many patients were abstinent at baseline (37.5 %) and follow-up (75.9 %), mainly due to health concerns. FMQ revealed high ‘total family burden’. Patients struggled with TLFB recall. High childhood adversity prevalence (95.7 %) and low alcohol knowledge were observed. Conclusions The ABI demonstrated high acceptability among patients and RAs. All three interventions could be trialled in a future RCT. All measures except TLFB proved appropriate. Our innovative approach of evaluating outcomes from family members' perspectives proved feasible and valuable. The inpatient setting was not appropriate, rather a setting where patients continue their day-to-day activities, including usual drinking, should be considered in a future RCT.