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Work: 2014, 47 (4), p. 543–551.
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In Sweden an education-based intervention in the workplace generated significant improvements in employees’ alcohol-related risk knowledge, but no significant effects on overall drinking or binge drinking.
Summary This study examined the impact of a short educational universal intervention on employees in a workplace in Stockholm, Sweden. The two overarching aims were to change drinking habits of employees whose drinking was risky, and to prevent future drinking problems amongst all employees in a workplace by increasing risk-related knowledge.
This study evaluated the impact of an alcohol education programme on the risk knowledge and drinking behaviours of employees in a company in Sweden.
Significant improvements were observed in employees’ alcohol-related risk knowledge, but there were no significant effects on overall alcohol consumption or binge drinking.
The major challenge of universal interventions is showing behavioural change in populations of moderate drinkers.
Two companies agreed to be involved in the study, one participated in the intervention, and the other served as the comparison group (and agreed not to work on alcohol intervention-related issues during the study period). It was unclear from the paper exactly how the companies were chosen, though it would appear that the intervention company was interested in the intervention “as a preventive measure because the employees were rather young salespersons, and many of them worked evenings”.
Employees in the intervention arm of the study were invited to attend two brief (45 minutes) lectures on risky alcohol consumption, delivered by IOGT-NTO, a non-governmental organisation in Sweden working to curb the total consumption of alcohol, raise the average age of starting to use alcohol, reduce the use of narcotic drugs, and reduce the number of young people who try narcotic drugs. Participants were encouraged to reflect on alcohol consumption in the light of evidence about the social and medical risks associated with alcohol.
In both companies, employees were asked to complete a questionnaire before the start of the study (pre-intervention), and then again at six and 12 months after the intervention (post-intervention). The questionnaires featured questions from the Alcohol Use Disorders Identification Test (AUDIT) screening questionnaire, commonly used in primary care to identify risky drinking. Effects were measured by changes (between pre-intervention and six month post-intervention, and between pre-intervention and 12 month post-intervention) in average alcohol consumption scores, frequency of binge drinking, and knowledge of alcohol-related risks.
Organisational changes produced unexpected challenges for the researchers. Pre-intervention questionnaires were distributed to (and completed by) both organisations. Unfortunately, following this, an organisational restructure in the intervention company resulted in a need to postpone the first education lecture. Facing a gap of a year and a half between the pre-intervention questionnaire and the first session, the researchers decided to distribute a second pre-intervention questionnaire. This contained fewer questions than the original questionnaire, asking only about gender, age, alcohol consumption and binge-drinking (and missing questions about knowledge of alcohol-related risks). 48 employees from the intervention group, and 159 employees from the control group, answered all relevant questions about alcohol consumption and binge drinking; and 27 employees from the intervention group, and 120 employees from the control group answered all relevant questions about alcohol risk knowledge.
Alcohol consumption. To determine whether the intervention’s impact depended on drinking levels, employees were divided into those who averaged less than 6.4gm of alcohol per day versus those who drank more. The intervention had no significant impact on the total AUDIT scores for the intervention group chart, for men and women separately, or for higher and lower consumption groups separately.
Binge drinking Participants were asked “How often do you drink six or more drinks per occasion?” (where one drink is equal to 12 grams of alcohol), and presented with the response choices: never, less than once a month, every month, every week, and daily or almost every day. These alternatives were assigned a score between 0 and four, a higher score signifying more frequent binge drinking. The analysis showed that the intervention had no impact on participants’ average binge drinking scores. However, it would likely have been difficult to reduce this number further, because the average number of binge-drinking occasions was small at the time of the pre-intervention. A score of one corresponds to “less than once a month” and the only way to lower this score would be to choose the response “never”, an unlikely choice in this context.
Risk knowledge The first pre-intervention questionnaire contained three statements about participants’ knowledge of alcohol-related risks: “anyone who drinks alcohol can develop alcohol problems”, “having a high tolerance for alcohol increases the risk of developing alcohol problems”, and “drinking a lot of alcohol on a few occasions involves a greater risk for problems than drinking a little alcohol more often”. Participants were presented with the response choices: do not agree, agree a little, agree a lot and agree completely. These alternatives were assigned a score between 1 and 4, and added up for each of the three questions, producing a total range between 3 and 12. Overall, the changes in the intervention group were significant, but were not in the control group. The intervention significantly increased risk knowledge between pre-intervention and six month questionnaires, and between pre-intervention and 12 month questionnaires (but not between six month and 12 month questionnaires). The effect was considered small to medium. There was no significant difference in the pre-intervention and post-intervention scores for the control group.
This study found that short education sessions did increase participants’ knowledge of alcohol-related risks, but six and 12 months later, did not reduce participants’ levels of alcohol consumption or binge drinking. Although this study had a small sample, the authors suggest that there is no reason to believe that another research design or a larger sample size would have produced better results, as the results were in line with previous research.
commentary Looking at the overarching aims of this study, the intervention was partially successful: increasing risk-related knowledge, but failing to change alcohol use patterns amongst employees with higher levels of alcohol consumption. Follow-ups would be needed beyond 12 months to determine whether employees retained the risk-related knowledge they gained during the intervention, and whether the acquisition of this knowledge was likely to prevent future alcohol problems. Findings beyond this study suggest that increased awareness and knowledge do not lead to behaviour change.
At the start of trial, the vast majority of participants in the intervention group fell below the threshold for risky drinking on the AUDIT screening questionnaire. In fact, only 38% of those in the higher level drinking category (drinking on average at least 6.4 grams of alcohol per day) could be classed as risky drinkers according to this questionnaire. As the authors noted, it would be difficult to show substantial changes in the behaviours of moderate drinkers without them reducing their drinking to little or nothing, a change which may not be justified on health grounds, nor desired by the employees. Additional research could focus on understanding the acceptability of this education-based intervention in the workplace.
Last revised 14 March 2016. First uploaded 17 February 2016
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