Evaluating the programme and behavior change theories of a community alcohol education intervention in rural Sri Lanka: a study protocol

ABSTRACT

Risky alcohol use is a major public health problem globally and in Sri Lanka. While a reduction in alcohol consumption can result in physical, mental, and social benefits, behaviour change is difficult to achieve. Effective, context-adapted interventions are required to minimise alcohol-related harm at a community level. THEATRE is a complex, community-based intervention evaluating whether a promising Sri Lankan pilot study that utilised arts-based research to moderate alcohol use can be scaled up. While the scaled-up pilot study protocol is presented elsewhere, the aim of this protocol paper is to describe the intervention programme theory and evaluation design, and modifications made to the study resulting from COVID-19 and the financial crisis. Drawing on the Behaviour Change Wheel (BCW) and Theoretical Domains Framework, behaviour change theories are presented with potential pathways to guide implementation and evaluation. Alcohol consumption patterns and context of drinking is detailed. The multifaceted intervention targets individuals and communities using arts-based interventions. Four of nine BCW functions are employed in the design of the intervention: education, persuasion, modelling and enablement, and training. Modifications made to the study due to COVID-19 and the financial crisis are described. Ethical approval was obtained from the Ethics Review Committee, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka (ERC/2018/21—July 2018 and Feb 2022) and the University of Sydney (2019/006). Findings will be disseminated locally to community members and key stakeholders and via international peer-reviewed publications.

KEYWORDS:

• Alcohol
• community-based
• health promotion
• behaviour change wheel
• education entertainment

Responsible Editor Maria Nilsson

Responsible Editor Maria Nilsson

Disclosure statement

No potential conflict of interest was reported by the author(s).

Author contributions

JBS Writing -original draft (lead); Conceptualisation (supporting), Methodology (supporting);

KL Writing – review and editing (equal); Methodology (supporting); funding acquisition; intervention development (lead)

AHD Conceptualisation (lead); Writing – review and editing (equal); funding acquisition (lead); Methodology (lead);

AD Writing – review and editing (equal); Methodology (supporting);

LS Writing – review and editing (equal); Methodology (supporting); Supervision (supporting);

JP Writing – review and editing (equal); Methodology (supporting); Supervision (supporting);

TR Writing – review and editing (equal); Methodology (supporting); Supervision (equal);

FK Writing – review and editing (equal); Methodology (supporting);

NG Conceptualisation (supporting); Writing – review and editing (supporting); Methodology (supporting); funding acquisition (lead)

KC Writing – review and editing (equal); Methodology (supporting); funding acquisition

PS Writing – review and editing (supporting)

DH Writing – review and editing (supporting); Methodology (supporting); intervention development (lead)

AB Writing – review and editing (supporting)

CP Writing – review and editing (supporting)

KS Writing – review and editing (supporting)

MH Writing – review and editing (supporting)

SM Writing – review and editing (supporting)

PF Writing – review and editing (supporting)

MP Supervision (lead); Conceptualisation (lead) Writing -original draft (lead); funding acquisition (supporting); Methodology (lead)

Data availability statement

Deidentified data and code are available upon request (email: [email protected]).

Ethics and consent

The Ethics Review Committee, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka (ERC/2018/21) and the University of Sydney Human Research Ethics Committee (2019/006) reviewed and approved the study and amendments. Clinical Trial Registration is SLCTR/2018/037. The study was adapted to account for contextual changes in Sri Lanka and to ensure the safety of both community members and staff. Dissemination activities are planned with the communities to share their stories of change and artworks. Findings will be shared with local stakeholders and within academic journals and conferences.

Paper context

Multipronged interventions are needed to address the complex nature in which alcohol is consumed, including the use of illicit alcohol. Building on a promising pilot intervention that utilised arts-based efforts, this study will provide a deeper understanding of intervention components that makes it successful and relevant (or not). This paper presents the programme theory, intervention design, and modifications made due to multiple crises during the development and implementation phases.

Supplementary data

Supplemental data for this article can be accessed online at https://doi.org/10.1080/16549716.2023.2273625.

Additional information

Funding

This work was supported by the National Health and Medical Research Council (NHMRC): Global Alliance for Chronic Diseases [GNT1146354]. KC was funded by an NHMRC Practitioner Fellowship [GNT1117582].