Factors associated with alcohol screening and brief interventions: a cross-sectional study of cardiology clinicians in Sweden

Alcohol screening and brief interventions (SBI) are effective strategies to reduce hazardous alcohol use in healthcare settings but are implemented inconsistently in cardiology practice. There is a need to understand factors associated with alcohol prevention practices in clinical cardiology to bridge this evidence-practice gap. The aim of this study was to investigate factors associated with SBI practices in cardiology. Multi-centre cross-sectional study. We surveyed clinicians at cardiology services in 12 regions across Sweden. The outcome was participants’ tendency to initiate SBI. Predictor variables included perceived importance of alcohol screening, level of comfort discussing alcohol habits with patients, perceived reliability of self-reported alcohol habits, and perceived competence for screening and brief interventions. Analyses included Wilcoxon signed-rank tests and ordinal logistic regression models. In total, 692 clinicians participated in the survey (nurses = 55%; doctors = 19%; assistant nurses = 22%). Perceived importance of screening was not significantly associated with initiating SBI (OR = 1.55, 95%CI = 0.75–3.20). However, greater comfort when discussing alcohol habits was strongly associated with participants’ tendency to initiate SBI (OR = 4.06, 95%CI = 2.62–6.30) in maximally-adjusted models. Competence with screening (OR = 1.65, 95%CI = 1.06–2.56) and brief interventions (OR = 1.93, 95%CI = 1.30–2.85), and perceived reliability of self-reported alcohol habits (OR = 1.54, 95%CI = 1.12–2.13) were also positively associated with initiating SBI. While most (> 95%) participants considered it important that cardiology patients are asked about their alcohol habits, just 27% indicated that they often or always initiate SBI (z = 21.88, p < .001). Many cardiology clinicians in Sweden view alcohol screening as important, but these views are frequently not aligned with self-reported clinical practice. Findings highlight a need to empower clinicians to initiate conversations about alcohol use with their patients and for improved training to support SBI implementation. Promising strategies may include creating workflows that normalize discussions around alcohol use and clinician training that focuses on challenging stereotypes associated with alcohol use disorder.