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International Journal of Mental Health and Addiction

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Open Access 12-08-2022 | Care | Original Article

Blended-eLearning Improves Alcohol Use Care in Kenya: Pragmatic Randomized Control Trial Results and Parallel Qualitative Study Implications

Authors: Veronic Clair, Abednego Musau, Victoria Mutiso, Albert Tele, Katlin Atkinson, Verena Rossa-Roccor, Edna Bosire, David Ndetei, Erica Frank

Published in: International Journal of Mental Health and Addiction | Issue 6/2022

Abstract

Alcohol use is the 5th most important risk factor contributing to the global burden of diseases, with stigma and a lack of trained health workers as the main barriers to adequate care. This study assesses the impact of providing blended-eLearning courses teaching the alcohol, smoking, and substance involvement screening test (ASSIST) screening and its linked brief intervention (BI). In public and private facilities, two randomized control trials (RCTs) showed large and similar decreases in alcohol use in those receiving the BI compared to those receiving only the ASSIST feedback. Qualitative findings confirm a meaningful reduction in alcohol consumption; decrease in stigma and significant practice change, suggesting lay health workers and clinicians can learn effective interventions through blended-eLearning; and significantly improve alcohol use care in a low- and middle-income country (LMIC) context. In addition, our study provides insight into why lay health workers feedback led to a similar decrease in alcohol consumption compared to those who also received a BI by clinicians.

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Assanangkornchai, S., Nima, P., McNeil, E. B., & Edwards, J. G. (2015). Comparative trial of the WHO ASSIST-linked brief intervention and simple advice for substance abuse in primary care. Asian Journal of Psychiatry. https://doi.org/10.1016/j.ajp.2015.09.003CrossRefPubMed

Awenva, A.D., Read, U.M., Ofori-Attah, A.L., Doku, V.C., Akpalu, B., Osei, A.O., . . . Consortium, M.H.R.P. (2010). From mental health policy development in Ghana to implementation: What are the barriers? African Journal of Psychiatry, 13(3), 184–191. https://www.ajol.info/index.php/ajpsy/article/view/57912. Accessed 15 January 2011.

Babor, T., Kaner, E., Nilsen, P., Robaina, K., & Li, Q. (2013). Rapid review of current evidence for health promotion actions for hazardous and harmful alcohol use, with specific reference to low-and middle-income countries: WHO mainstreaming health promotion project. World Health Organization.

Bahia, K., & Suardi, S. (2019). The state of mobile internet connectivity 2019. https://www.gsma.com/mobilefordevelopment/wp-content/uploads/2019/07/GSMA-State-of-Mobile-Internet-Connectivity-Report-2019.pdf. Accessed 15 April 2020.

Betts, N. M., Baranowski, T., & Hoerr, S. L. (1996). Recommendations for planning and reporting focus group research. Journal of Nutrition Education, 28(5), 279–281. https://doi.org/10.1016/S0022-3182(96)70101-2CrossRef

Boeije, H. (2002). A purposeful approach to the constant comparative method in the analysis of qualitative interviews. Quality and Quantity, 36(4), 391–409. https://doi.org/10.1023/A:1020909529486CrossRef

Cathain, A., Thomas, K. J., Drabble, S. J., Rudolph, A., & Hewison, J. (2013). What can qualitative research do for randomised controlled trials? A systematic mapping review. BMJ Open, 3(6), e002889. https://doi.org/10.1136/bmjopen-2013-002889CrossRef

Chuma, J., & Molyneux, C. (2009). Estimating inequalities in ownership of insecticide treated nets: Does the choice of socio-economic status measure matter? Health Policy and Planning, 24(2), 83–93. https://doi.org/10.1093/heapol/czn050CrossRefPubMed

Clair, V., Mutiso, V., Musau, A., Mokaya, A., Tele, A., Frank, E., & Ndetei, D. (2016). Health workers learned brief intervention online through NextGenU.org and deliver them effectively [Abstract]. Journal of addiction medicine, 10(3), E17. https://doi.org/10.1097/adm.0000000000000224CrossRef

Clair, V., Mutiso, V., Musau, A., Mokaya, A., Frank, E., & Ndetei, D. M. (2016c). Decreasing stigma towards alcohol, tobacco and other substance use through online training [Abstract]. Journal of Addiction Medicine, 10(3), E17–E18. https://doi.org/10.1097/adm.0000000000000224CrossRef

Clair, V., Mutiso, V., Musau, A., Ndetei, D., & Frank, E. (2016e). Online learning improves substance use care in Kenya: Randomized control trial results and implications. Annals of Global Health, 82(3), 320–321. https://doi.org/10.1016/j.aogh.2016.04.585CrossRef

Clair, V., Atkinson, K., Musau, A., Mutiso, V., Bosire, E., Isaiah, G., Ndetei, D., & Frank, E. (2022). Implementing and sustaining brief addiction medicine interventions with the support of a quality improvement blended-eLearning course: Learner experiences and meaningful outcomes in Kenya. International Journal of Mental Health and Addiction.

Clair, V., Rossa-Roccor, V., Mutiso, V., Musau, A., Rieder, A., Frank, E., & Ndetei, D. (in press). Blended-eLearning impact on health worker stigma toward alcohol, tobacco and other psychoactive substance users. International Journal of Mental Health and Addiction.

Clair, V., Rossa-Roccor, V., Mokaya, A. G., Mutiso, V., Musau, A., Tele, A., Ndetei, D., Frank, E. (2019). Peer and mentor-enhanced web-based training on substance use disorders: A promising approach in low-resource settings. Psychiatric Services, 70(11), 1068–1071. https://doi.org/10.1176/appi.ps.201900201

Clark, V. L. P., Creswell, J. W., Green, D. O. N., & Shope, R. J. (2008). Mixing quantitative and qualitative approaches. In Handbook of emergent methods, 363, 363–387.

Corrigan, P. W., & Watson, A. C. (2002). Understanding the impact of stigma on people with mental illness. World Psychiatry, 1(1), 16–20. https://www.ncbi.nlm.nih.gov/pubmed/16946807. Accessed 15 January 2011

Corrigan, P. W., Watson, A. C., Warpinski, A. C., & Gracia, G. (2004). Stigmatizing attitudes about mental illness and allocation of resources to mental health services. Community Mental Health Journal, 40. https://doi.org/10.1023/b:comh.0000035226.19939.76

Dawson-Saunders, B., & Trapp, R. G. (1994). Basic & Clinical Biostatistics (2nd edn.). Prentice-Hall International.

Degenhardt, L., Glantz, M., Evans-Lacko, S., Sadikova, E., Sampson, N., Thornicroft, G., . . . Kessler, R. C. (2017). Estimating treatment coverage for people with substance use disorders: An analysis of data from the World Mental Health Surveys. World Psychiatry, 16(3), 299-307. https://doi.org/10.1002/wps.20457

Dowling, M. (2007). From Husserl to van Manen. A review of different phenomenological approaches. International Journal of Nursing Studies, 44(1), 131–142.CrossRefPubMed

Embleton, L., Atwoli, L., Ayuku, D., & Braitstein, P. (2013). The journey of addiction: Barriers to and facilitators of drug use cessation among street children and youths in Western Kenya. PLoS ONE, 8, e53435. https://doi.org/10.1371/journal.pone.0053435CrossRefPubMedPubMedCentral

Fleming, M. F., Barry, K. L., Manwell, L. B., Johnson, K., & London, R. (1997). Brief physician advice for problem alcohol drinkers. A randomized controlled trial in community-based primary care practices. JAMA: The Journal of the American Medical Association, 277, 1039–1045. http://jama.jamanetwork.com/article.aspx?articleid=414915. Accessed 15 January 2011.

Fortin, M., Stewart, M., Ngangue, P., Almirall, J., Bélanger, M., Brown, J. B., . . . Zwarenstein, M. (2021). Scaling up patient-centered interdisciplinary care for multimorbidity: A pragmatic mixed-methods randomized controlled trial. The Annals of Family Medicine, 19(2), 126-134. https://doi.org/10.1370/afm.2650

Frank, E., Tairyan, K., Everton, M., Chu, J., Goolsby, C., Hayes, A., & Hulton, A. (2016). A test of the first course (emergency medicine) that is globally available for credit and for free. Healthcare, 4(4). https://doi.org/10.1016/j.hjdsi.2016.02.003

Galway, L. P., Corbett, K. K., Takaro, T. K., Tairyan, K., & Frank, E. (2014). A novel integration of online and flipped classroom instructional models in public health higher education [journal article]. BMC Medical Education, 14(1), 181. https://doi.org/10.1186/1472-6920-14-181CrossRefPubMedPubMedCentral

George, P.P., Papachristou, N., Belisario, J.M., Wang, W., Wark, P.A., Cotic, Z., . . . Car, J. (2014). Online eLearning for undergraduates in health professions: A systematic review of the impact on knowledge, skills, attitudes and satisfaction. Journal of Global Health, 4(1), 010406. https://doi.org/10.7189/jogh.04.010406

Glenton, C., Lewin, S., & Scheel, I. B. (2011). Still too little qualitative research to shed light on results from reviews of effectiveness trials: A case study of a Cochrane review on the use of lay health workers. Implementation Science, 6(1), 53. https://doi.org/10.1186/1748-5908-6-53CrossRefPubMedPubMedCentral

Gomez, R. (2014). When you do not have a computer: Public-access computing in developing countries. Information Technology for Development, 20(3), 274–291.CrossRef

Hew, K. F., & Cheung, W. S. (2014). Students’ and instructors’ use of massive open online courses (MOOCs): Motivations and challenges. Educational Research Review, 12, 45–58.CrossRef

Hill, E., Gurbutt, D., Makuloluwa, T., Gordon, M., Georgiou, R., Roddam, H., . . . Chance-Larsen, K. (2021). Collaborative healthcare education programmes for continuing professional education in low and middle-income countries: A best evidence medical education (BEME) systematic review. BEME Guide No. 65. Medical teacher, 43(11), 1228–1241. https://doi.org/10.1080/0142159X.2021.1962832

Hjorthøj, C. R., Hjorthøj, A. R., & Nordentoft, M. (2012). Validity of timeline follow-back for self-reported use of cannabis and other illicit substances—systematic review and meta-analysis. Addictive Behaviors, 37(3), 225–233.CrossRefPubMed

Howe, L. D., Galobardes, B., Matijasevich, A., Gordon, D., Johnston, D., Onwujekwe, O., . . . Hargreaves, J. R. (2012). Measuring socio-economic position for epidemiological studies in low- and middle-income countries: A methods of measurement in epidemiology paper. International Journal of Epidemiology, 41(3), 871–886. https://doi.org/10.1093/ije/dys037

Humeniuk, R., Dennington, V., & Ali, R. (2008). The effectiveness of a brief intervention for illicit drugs linked to the alcohol, smoking and substance involvement screening test (ASSIST) in primary health care settings: A technical report of phase III findings of the WHO ASSIST randomized controlled trial. Geneva: World Health Organization

Humeniuk, R., Henry-Edwards, S., Ali, R., Poznyak, V., & Monteiro, M. G. (2010a). The ASSIST-linked brief intervention for hazardous and harmful substance use: a manual for use in primary care. World Health Organization. www.who.int/publications/i/item/the-assist-linked-brief-intervention-for-hazardous-and-harmful-substance-use

Humeniuk, R., Henry-Edwards, S., Ali, R., Poznyak, V., & Monteiro, M. (2010b). The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST): Manual for Use in Primary Care. World Health Organization. www.who.int/publications/i/item/978924159938-2

Humeniuk, R., Ali, R., Babor, T., Souza‐Formigoni, M. L. O., de Lacerda, R. B., Ling, W., . . . Poznyak, V. (2012). A randomized controlled trial of a brief intervention for illicit drugs linked to the alcohol, smoking and substance involvement screening test (ASSIST) in clients recruited from primary health‐care settings in four countries. Addiction, 107(5), 957–966. https://doi.org/10.1111/j.1360-0443.2011.03740.x

Jakobsen, J. C., Gluud, C., Wetterslev, J., & Winkel, P. (2017). When and how should multiple imputation be used for handling missing data in randomised clinical trials–a practical guide with flowcharts. BMC Medical Research Methodology, 17(1), 1–10.CrossRef

Kaner, E. F. S., Heather, N., McAvoy, B. R., Lock, C. A., & Gilvarry, E. (1999). Intervention for excessive alcohol consumption in primary health care: Attitudes and practices of english general practitioners. Alcohol and Alcoholism, 34(4), 559–566. https://doi.org/10.1093/alcalc/34.4.559CrossRefPubMed

Kaner, E. F., Dickinson, H. O., Beyer, F. R., Campbell, F., Schlesinger, C., Heather, N., . . . Pienaar, E. D. (2007). Effectiveness of brief alcohol interventions in primary care populations. Cochrane Database of Systematic Reviews(2). https://doi.org/10.1002/14651858.CD004148.pub3

Kaner, E. F. S., Beyer, F. R., Muirhead, C., Campbell, F., Pienaar, E. D., Bertholet, N., . . . Burnand, B. (2018). Effectiveness of brief alcohol interventions in primary care populations. Cochrane Database of Systematic Reviews(2). https://doi.org/10.1002/14651858.CD004148.pub4

Krueger, R. A. (1994). Focus groups: A practical guide for applied research (2nd edn.). Sage Publications.

Lewis, K. O., Cidon, M. J., Seto, T. L., Chen, H., & Mahan, J. D. (2014). Leveraging e-Learning in Medical Education. Current Problems in Pediatric and Adolescent Health Care, 44(6), 150–163. https://doi.org/10.1016/j.cppeds.2014.01.004CrossRefPubMed

Liu, Q., Peng, W., Zhang, F., Hu, R., Li, Y., & Yan, W. (2016). The effectiveness of blended learning in health professions: Systematic review and meta-analysis [original paper]. Journal of Medical Internet Research, 18(1), e2. https://doi.org/10.2196/jmir.4807CrossRefPubMedPubMedCentral

Livingston, J. D., Milne, T., Fang, M. L., & Amari, E. (2012). The effectiveness of interventions for reducing stigma related to substance use disorders: A systematic review. Addiction, 107, 39–50. https://doi.org/10.1111/j.1360-0443.2011.03601.xCrossRefPubMedPubMedCentral

Maloney, S., Haas, R., Keating, J.L., Molloy, E., Jolly, B., Sims, J., . . . Haines, T. (2012). Breakeven, cost benefit, cost effectiveness, and willingness to pay for web-based versus face-to-face education delivery for health professionals [original paper]. Journal of Medical Internet Research, 14(2), e47. https://doi.org/10.2196/jmir.2040

Maloney, S., Nicklen, P., Rivers, G., Foo, J., Ooi, Y.Y., Reeves, S., . . . Ilic, D. (2015). A cost-effectiveness analysis of blended versus face-to-face delivery of evidence-based medicine to medical students [original paper]. Journal of Medical Internet Research, 17(7), e182. https://doi.org/10.2196/jmir.4346

Marrinan, H., Firth, S., Hipgrave, D., & Jimenez-Soto, E. (2015). Let’s take it to the clouds: The potential of educational innovations, including blended learning, for capacity building in developing countries. International Journal of Health Policy and Management, 4(9), 571.CrossRefPubMedPubMedCentral

Morgan, D. L., & Krueger, R. A. (1993). When to use focus groups and why. In S. f. editions (Ed.), Successful focus groups: Advancing the state of the art (Vol. 156, pp. 3–19). Sage

Morris, C. G., & Chen, F. M. (2009). Training residents in community health centers: Facilitators and barriers. Annals of Family Medicine, 7(6), 488–494. https://www.annfammed.org/content/7/6/488.full. Accessed 15 January 2011.

Moyers, T. B., & Miller, W. R. (2013). Is low therapist empathy toxic? Psychology of Addictive Behaviors, 27(3), 878–884. https://doi.org/10.1037/a0030274CrossRefPubMed

Murray, C. J. L., Aravkin, A. Y., Zheng, P., Abbafati, C., Abbas, K. M., Abbasi-Kangevari, M., . . . Lim, S. S. (2020). Global burden of 87 risk factors in 204 countries and territories, 1990–2019: A systematic analysis for the Global Burden of Disease Study 2019. The Lancet, 396(10258), 1223–1249. https://doi.org/10.1016/S0140-6736(20)30752-2

Ndetei, D., Khasakhala, L., Ongecha-Owuor, F., Kuria, M., Mutiso, V., & Kokonya, D. (2009). Prevalence of substance abuse among patients in general medical facilities in Kenya. Substance Abuse, 30(2), 182–190. https://doi.org/10.1080/08897070902802125CrossRefPubMed

Norlyk, A., & Harder, I. (2010). What makes a phenomenological study phenomenological? An analysis of peer-reviewed empirical nursing studies. Qualitative Health Research, 20(3), 420–431.CrossRefPubMed

O’Cathain, A., Goode, J., Drabble, S. J., Thomas, K. J., Rudolph, A., & Hewison, J. (2014). Getting added value from using qualitative research with randomized controlled trials: A qualitative interview study. Trials, 15, 215–215. https://doi.org/10.1186/1745-6215-15-215CrossRefPubMedPubMedCentral

O’Donnell, A., Anderson, P., Newbury-Birch, D., Schulte, B., Schmidt, C., Reimer, J., & Kaner, E. (2013). The impact of brief alcohol interventions in primary healthcare: A systematic review of reviews. Alcohol and Alcoholism, 49(1), 66–78. https://doi.org/10.1093/alcalc/agt170CrossRefPubMedPubMedCentral

Patel, V., Araya, R., Chatterjee, S., Chisholm, D., Cohen, A., De Silva, M., Hosman, C., McGuire, H., Rojas, G., & van Ommeren, M. (2007). Treatment and prevention of mental disorders in low-income and middle-income countries. The Lancet, 370(9591), 991–1005. https://doi.org/10.1016/S0140-6736(07)61240-9

Patel, V., Weiss, H. A., Chowdhary, N., Naik, S., Pednekar, S., Chatterjee, S., . . . Kirkwood, B. R. (2010). Effectiveness of an intervention led by lay health counsellors for depressive and anxiety disorders in primary care in Goa, India (MANAS): A cluster randomised controlled trial. The Lancet, 376, 2086-2095. https://doi.org/10.1016/S0140-6736(10)61508-5

Patel, V., Chisholm, D., Parikh, R., Charlson, F. J., Degenhardt, L., Dua, T., . . . Whiteford, H. (2015). Addressing the burden of mental, neurological, and substance use disorders: Key messages from disease control priorities, 3rd edition. The Lancet, 387(10028), 1672–1685. https://doi.org/10.1016/S0140-6736(15)00390-6

Patton, M. Q. (2011). Developmental evaluation: Applying complexity concepts to enhance innovation and use. Guilford Press

Pope, C., Mays, N., & Popay, J. (2007). Synthesising qualitative and quantitative health research: A guide to methods. Open University Press. http://site.ebrary.com/lib/ubc/docDetail.action?docID=10197069. Accessed 15 April 2020.

Powell, R. A., & Single, H. M. (1996). Focus groups. International Journal for Quality in Health Care, 8(5), 499–504.CrossRefPubMed

Rabiee, F. (2004). Focus-group interview and data analysis. Proceedings of the Nutrition Society, 63(04), 655–660. https://doi.org/10.1079/PNS2004399CrossRefPubMed

Room, R. (2005). Stigma, social inequality and alcohol and drug use. Drug and Alcohol Review, 24, 143–155. https://doi.org/10.1080/09595230500102434CrossRefPubMed

Rossa-Roccor, V., Malatskey, L., & Frank, E. (2017). NextGenU.org’s free, globally available online training in lifestyle medicine. American Journal of Lifestyle Medicine, 11(2), 132–133. https://doi.org/10.1177/1559827616682444CrossRefPubMedPubMedCentral

Sandars, J. (2010). Cost-effective e-learning in medical education. In K. Walsh (Ed.), Cost effectiveness in medical education (pp. 40–48). Radcliffe Pub. https://doi.org/10.1201/9780429091285

Sandelowski, M. (2000a). Combining qualitative and quantitative sampling, data collection, and analysis techniques in mixed-method studies. Research in Nursing & Health, 23(3), 246–255. https://doi.org/10.1002/1098-240x(200006)23:3%3c246::aid-nur9%3e3.0.co;2-hCrossRef

Sandelowski, M. (2000b). Whatever happened to qualitative description? Research in Nursing & Health, 23(4), 334–340. https://doi.org/10.1002/1098-240x(200008)23:4%3c334::aid-nur9%3e3.0.co;2-gCrossRef

Sengwana, M. J., & Puoane, T. (2004). Knowledge, beliefs and attitudes of community health workers about hypertension in the Cape Peninsula, South Africa. Curationis, 27(1), 65–71. https://doi.org/10.4102/curationis.v27i1.958CrossRefPubMed

Shorbaji, N. A., Atun, R., Car, J., Majeed, A., & Wheeler, E. (2015). eLearning for undergraduate health professional education; A systematic review informing a radical transformation of health workforce development. https://apps.who.int/iris/bitstream/handle/10665/330089/9789241508261-eng.pdf. Accessed April 15 2020.

Sinclair, P., Kable, A., & Levett-Jones, T. (2015). The effectiveness of internet-based e-learning on clinician behavior and patient outcomes: A systematic review protocol. JBI Database of Systematic Reviews and Implementation Reports, 13(1), 52–64. https://doi.org/10.1016/j.ijnurstu.2016.01.011CrossRefPubMed

Sissine, M., Segan, R., Taylor, M., Jefferson, B., Borrelli, A., Koehler, M., & Chelvayohan, M. (2014). Cost comparison model: Blended eLearning versus traditional training of community health workers. Online Journal of Public Health Informatics, 6(3), e196–e196. https://doi.org/10.5210/ojphi.v6i3.5533CrossRefPubMedPubMedCentral

Sobell, L., & Sobell, M. (1992). Timeline follow-back, a technique for assessing self-reported alcohol consumption. In R. Litten & J. Allen (Eds.), Measuring Alcohol Consumption (pp. 41–72). Humana Press. https://doi.org/10.1007/978-1-4612-0357-5_3

Spillman, L. (2014). Mixed methods and the logic of qualitative inference. Qualitative Sociology, 37(2), 189–205. https://doi.org/10.1007/s11133-014-9273-0CrossRef

Tarrow, S. (2004). Bridging the quantitative-qualitative divide. In Rethinking social inquiry: Diverse tools, shared standards (Vol. 17180, pp. 171–180)

The World Bank. (2020). Individuals using the Internet (% of population) | Data. https://data.worldbank.org/indicator/IT.NET.USER.ZS?view=map. Accessed 27 January 2020.

Todd, Z., Nerlich, B., McKeown, S., & Clarke, D. D. (Eds.). (2004). Mixing methods in psychology: The integration of qualitative and quantitative methods in theory and practice (1st edn.). Psychology Press. https://doi.org/10.4324/9780203645727

Topolski, T. D., LoGerfo, J., Patrick, D. L., Williams, B., Walwick, J., & Patrick, M. B. (2006). The rapid assessment of physical activity (RAPA) among older adults. Preventing chronic disease, 3(4), A118–A118. https://www.cdc.gov/pcd/issues/2006/oct/06_0001.htm. Accessed 15 January 2011.

Tsuei, S. H., Clair, V., Mutiso, V., Musau, A., Tele, A., Frank, E., & Ndetei, D. (2017). Factors Influencing Lay and Professional Health Workers’ Self-efficacy in Identification and Intervention for Alcohol, Tobacco, and Other Substance Use Disorders in Kenya. International Journal of Mental Health and Addiction, 15(4), 766–781. https://doi.org/10.1007/s11469-017-9775-6

van Boekel, L. C., Brouwers, E. P. M., van Weeghel, J., & Garretsen, H. F. L. (2013). Stigma among health professionals towards patients with substance use disorders and its consequences for healthcare delivery: Systematic review. Drug and Alcohol Dependence, 131(1–2), 23–35. https://doi.org/10.1016/j.drugalcdep.2013.02.018CrossRefPubMed

van Ginneken, N., Chin, W. Y., Lim, Y. C., Ussif, A., Singh, R., Shahmalak, U., . . . et al. (2021). Primary‐level worker interventions for the care of people living with mental disorders and distress in low‐ and middle‐income countries. Cochrane Database of Systematic Reviews(8). https://doi.org/10.1002/14651858.CD009149.pub3

Vigo, D., Thornicroft, G., & Atun, R. (2016). Estimating the true global burden of mental illness; Supplementary appendix. The Lancet Psychiatry, 3(2), 171–178(S171–176). https://www-sciencedirect-com.ezproxy.library.ubc.ca/science/article/abs/pii/S2215036615005052. Accessed 15 April 2020.

Vyas, S., & Kumaranayake, L. (2006). Constructing socio-economic status indices: How to use principal components analysis. Health Policy and Planning, 21(6), 459–468.CrossRefPubMed

Walsh, K., Rutherford, A., Richardson, J., & Moore, P. (2010). NICE medical education modules: An analysis of cost-effectiveness. Education for Primary Care, 21(6), 396–398.PubMed

Wilkinson, S. (1998). Focus group methodology: A review. International Journal of Social Research Methodology, 1(3), 181–203. https://doi.org/10.1080/13645579.1998.10846874CrossRef

World Health Organization. (2010). mhGAP intervention guide for mental, neurological and substance use disorders in non-specialized health settings. World Health Organization

World Health Organization. (2018). Global status report on alcohol and health 2018 https://apps.who.int/iris/bitstream/handle/10665/274603/9789241565639-eng.pdf?ua=1

World Health Organization. (2019). The technical package SAFER: A world free from alcohol related harms [Internet]. Geneva: World Health Organization; 2019 [cited 2020 Jan 29]. 24 p. In.

Zeger, S. L., Liang, K.-Y., & Albert, P. S. (1988). Models for longitudinal data: A generalized estimating equation approach. Biometrics, 44(4), 1049–1060. https://doi.org/10.2307/2531734

Title: Blended-eLearning Improves Alcohol Use Care in Kenya: Pragmatic Randomized Control Trial Results and Parallel Qualitative Study Implications
Authors: Veronic Clair
Abednego Musau
Victoria Mutiso
Albert Tele
Katlin Atkinson
Verena Rossa-Roccor
Edna Bosire
David Ndetei
Erica Frank
Publication date: 12-08-2022
Publisher: Springer US
Keyword: Care
Published in: International Journal of Mental Health and Addiction / Issue 6/2022
Print ISSN: 1557-1874
Electronic ISSN: 1557-1882
DOI: https://doi.org/10.1007/s11469-022-00841-x

At a glance: The STEP trials

Springer Medicine

Blended-eLearning Improves Alcohol Use Care in Kenya: Pragmatic Randomized Control Trial Results and Parallel Qualitative Study Implications

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

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