Screening, brief intervention, and referral to treatment training for Nigerian primary care physicians: A pilot evaluation of knowledge, attitudes, self-efficacy, and barriers to implementation

Substance use disorder (SUD) poses a significant public health challenge in sub-Saharan Africa, where evidence-based approaches such as Screening, Brief Intervention, and Referral to Treatment (SBIRT) are rarely integrated into primary healthcare. In Nigeria, primary care providers often lack substance use prevention training, limiting their ability to identify and manage individuals with risky substance use patterns. This pilot study is the first documented evaluation of structured SBIRT training delivered to physicians within Nigeria's primary healthcare system, assessing changes in self-reported knowledge, attitudes, delivery self-efficacy, and perceived implementation barriers. A single-group, pre-post pilot study was conducted with primary care physicians selected by the Lagos State Primary Healthcare Board. Of 33 enrolled, 25 (76%) completed both baseline and post-training assessments after a two-day train-the-trainer SBIRT course. Baseline data were summarized descriptively, and pre-post changes were analyzed using Wilcoxon signed-rank tests with rank-biserial effect sizes and 95% confidence intervals.At baseline, 9% (3/33) had prior SBIRT training, 79% (26/33) were unaware of validated screening tools, 36% (12/33) believed all SUD cases required referral regardless of severity, and 33% (11/33) viewed SUD as a moral failing. Post-training, significant changes were observed across all self-reported domains (r = 0.45-0.85, p < 0.05). Training satisfaction was high (94%), although time constraints and clinical workload were cited as key SBIRT implementation barriers. In this pilot study, structured SBIRT training was associated with improvements in primary care physicians' self-reported knowledge, attitudes, and delivery self-efficacy. Addressing time and workload barriers may support sustainable implementation in the Nigerian primary healthcare system.