2010, Number 2
La búsqueda de moderación en el consumo de alcohol. Adaptación de los conocimientos a la práctica
Martínez VNA, Medina-Mora IME, Berenzon GS
Full text
Language: Spanish
References: 34
Page: 161-167
PDF size: 214.41 Kb.
ABSTRACT
Alcohol abuse in Mexico has an enormous impact on people’s health. This problem has led authorities to undertake actions to combat and reduce both consumption levels and their consequences. The interventions, focusing on handling problem drinkers —people who already show symptoms of dependence and consume more than one drug, including alcohol—, have proved their effectiveness in various scenarios. In the work setting, this problem is no exception and has also been a focus of concern and the implementation of actions to prevent excess alcohol consumption and provide care for persons beginning to display problems.However, implementing programs in the workplace has proved complicated. Other countries have found that many programs are not correctly evaluated or simply not evaluated, making it impossible to determine their effectiveness in solving the problems for which they were designed. Moreover, the personnel that implement them are not properly trained, programs are expensive to implement, and conflicts of interest tend to arise.
In Mexico, low-cost, effective actions have been implemented for this population. However, the time available for undertaking preventive activities is limited, while the length of workers’ shifts means that they do not have enough time for these activities.
One current challenge is the Translation of Research as a tool for the development of efficient, simpler, more practical, and safer interventions, without ignoring the discovery of new information regarding health and disease prevention, as well as creating more efficient treatments and improving existing ones. Within this perspective, researchers worked to produce a brief intervention to reduce harmful alcohol consumption among the working population. It is based on the principles of cognitive social theory put forward by Bandura, in which alcohol consumption is regarded as learned behavior, that causes problems and may be replaced by healthy behaviors, provided dependence has not developed. Another of the components included is motivational theory, according to which the effectiveness of a particular form of treatment is related to individuals’ motivation to continue it. The aim of this article is to describe the process of translation of research, derived from the implementation of cognitive social and motivational theories to adapt an intervention program designed in a comic book format that is easy to read and understand to teach workers with excess alcohol consumption to moderate their consumption.
Method: The work was carried out in two stages:
Phase 1. Adaptation of a brief intervention to a comic book format. A comic was produced using the elements of a brief intervention. In order to ensure that the concepts put forward in the base theory were accessible to the target population, they were subjected to a process of cognitive laboratories following the methodology proposed by Beatty.
The comic was produced to make the material easier to read and understand. The process began with a scriptwriter who translated the theoretical contents, together with the terms obtained in the cognitive laboratories into a story that would reflect the target population. This version was subjected to an evaluation described in stage 2.
Phase 2. Evaluation of language, characters, contents, and format of comic.
Participants: Researchers worked with 49 subjects from various firms and states in Mexico, 59.2% of whom were men, mostly between the ages of 24 and 42, and over half of whom were married (61.2%). Half had only completed high school or less.
Instrument: The questionnaire contained demographic questions and indicators to evaluate the comic for: format, understanding of contents, characters, language, and perceived usefulness for reducing problem drinking, among other things.
Procedure: Participants attended a training course during which they were asked to evaluate the comic. Each one was given a printed copy and a questionnaire. The subjects volunteered to participate and were guaranteed the confidentiality of the information they provided.
Results: Over 85% said that they were used to reading on a daily to weekly basis. Most of them thought that the illustrations were attractive and felt that the characters reflected the role they played in the story. They did not like the length of the comic or the fact that the drawings were extremely detailed, with too much text. They also disliked the font and the type of language used.
Nearly 80% thought that the reading material was neither tedious nor dull. Most rated the story good or very good and thought that the title encouraged people to read it and that they would use it if they had drinking problems. They also identified themselves with the characters and the situations described in the comic. What they liked best was the way the topic was dealt with in a comic, the way the problem was highlighted, the type of language used (colloquial), the message given, the goal setting, the way they became involved in the reading, and the link between users and the family environment.
Finally, the evaluations of the comic showed that some drawings were regarded as aggressive, the children’s language did not match their parents’, and the order of the dialogues was confusing.
This moment in the translation of the intervention made it possible to make changes in several aspects included in the final version. The comic was given to a proofreader to correct spelling mistakes while maintaining the colloquial tone.
Discussion: This activity resulted in a comic in which the characters guide the workers through a series of strategies to reduce consumption. This complies with the principles of translating research by adapting the concepts derived from social and motivational cognitive theory, which have proved their effectiveness in dealing with addictive behaviors.
The inclusion of experts from various areas made it possible to adapt knowledge, by incorporating strategies from the latter into a script that included the dialogues and sketched the characters that would form part of the story. The experts continued to participate during the evaluation process until the final version, with the definitive images, and final dialogues and exercises.
Having the workers targeted by the intervention try out various aspects of the material made it possible to adjust the language, contents and the story told, the characters’ performance and appearance and the way the exercises and dialogues were carried out. This also made it possible to see how useful the workers found it in reducing their own consumption or helping the people around them —family, co-workers and friends— to do so. In order to produce this sort of material, it is essential to use colloquial language that will be understood by the target population, which is the most delicate stage of the process since it involves the correct use of technical assumptions, since otherwise, one would work from a totally different perspective.
This material can reach men of productive age, who are those that make less use of health services, meaning that it is a tool that covers this inaccessible sector of the population. However, the workers were also given the possibility of seeking help from specialists if they failed to achieve their objectives, in which case the comic achieves the objective of raising awareness.
Lastly, one of the limitations of the material concerns the fact that the subject himself has to follow up his own progress, meaning that the adaptation must be carried out as rigorously as possible. It also implies that the material must be evaluated through an analysis of the changes that take place in workers as a result of using it.
The next stage will therefore be to test the intervention through the comic in a controlled test and to evaluate its efficiency in reducing alcohol abuse problems, as well as the subject’s possible progression to severe dependence.
REFERENCES
Campillo C, Díaz R, Romero M, Cerrud J, Villatoro J. La intervención eficaz del médico general en el tratamiento de bebedores cuyo hábito alcohólico representa un riesgo para su salud o ya les ha ocasionado algún daño. (Resultados preliminares de un ensayo clínico doble ciego y prospectivo). Salud Mental 1992;15(2):14-19.