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Table 4 Study methods and outcomes

From: What can primary care services do to help First Nations people with unhealthy alcohol use? A systematic review: Australia, New Zealand, USA and Canada

Author (year)a Participant characteristics Classification of alcohol consumption Study type Length of follow-up Client outcomesb: effectiveness or perceptions Staff/service outcomesb
Treatment effectiveness
Savard [75]
(1968)
1) n = 30 alcoholic males
2a) n = 62 alcoholic males
2b) n = 39 non-abstinent, non-alcoholic males
ndpc 1) Follow up study of 30 disulfiram-treated alcoholics (sic)
2ab) Quantitative (cross-sectional)
1) 18 months
2ab) baseline interview only
1) decreased binge drinking and increased sober periods;
2ab) disulfiram is accepted excuse to decline alcohol and social pressures reduced (consumption not measured).
 
Ferguson [73]
(1970)
65 clan groups;
1) Intervention group n = 115
2) Comparison group n = 60
WHO ‘alcoholism’ Non-randomised controlled trial 6 months Reduced incarceration; n = 50/115 sober 12–24 month following disulfiram therapy; sobriety not measured in controls.  
O’Malley et al. [24] (2008) 12 tribal groups; n = 68 American Indian/Alaska Native (AI/AN) participants DSM-IV; CIWA-Ar RCT 68 weeks Significant decrease in alcohol-related consequences for naltrexone monotherapy vs placebo (p < 0.026)  
Venner et al. [69] (2016) n = 8 members of one tribe DSM-IV Uncontrolled,
pre-post study
8 months Increase in days abstinent; decrease Addiction Severity Scores  
Implementation research
Kahn and Fua [72] (1992) n = 240 participants ndp Uncontrolled pre-post study N/Ad n = 138/145 maintained sobriety post-graduation  
Clifford and Shakeshaft [59] (2011) n = 32 health staff;
n = 24 clients
ndp Mixed methods,
pre-post study
N/A   Increased staff confidence to deliver BI; increase documentation and delivery;
high-risk drinkers resistant to alcohol referral
Clifford et al. [61] (2013) n = 4 Indigenous health services
n = total of 50 clients
2001 NHMRC  guidelines Uncontrolled,
pre-post study
N/A   Increased BIs
D’Abbs et al. [62] (2013) n = 19 clients;
n = 30 quasi control;
n = 32 program staff/other stakeholders
ndp Trial with quasi-controls N/A n = 15/19 reported decrease or stop drinking post program contact.
n = 21/30 quasi-control with similar result.
Implementation challenges incl: time constraints, staff turnover, GP hesitancy to prescribe naltrexone; strengths incl multidisciplinary care, flexibility
Lovett et al. [67] (2014) n = 34 health service staff ndp Mixed methods:
quantitative (cross-sectional);
literature review
N/A   Proposed ‘yarning style’ BI; implementation challenges noted; staff least confident in BI when client not seeking help
Brett et al. [29] (2017) Qual: n = 7 staff (1 GP, 1 GP trainee, 2 nurses, 3 Aboriginal DandA workers), n = 4 clients; n = 8 community stakeholders (incl. 4 Elders)
Quant: n = 8 clients
2009 NHMRC guidelines Mixed methods (cross-sectional) N/A Qual: clients rate program as accessible, streamlined and holistic; challenges also noted.
Quant: n = 5/8 abstinent at 6-week follow up; n = 8/8 still engaged with supports. No major adverse events reported during detox
Qual: desired model principles incl. cultural safety, privacy (preventing community shame), keeping family together, peer support, accessible and streamlined. Feedback given on strengths and challenges of model as implemented
Treatment access and/or acceptability
Hall [74]
(1986)
n = 44 servicese ndp Quantitative (descriptive) N/A   n = 22 services incl. sweat lodge or encouraged use at external sites; n = 8 provided access to community-based sweat lodge; medicine man used on and off-site
Brady et al. [70]
(1998)
n = 29 services ndp Quantitative (cross-sectional) N/A   Aboriginal health services more likely to offer exclusive abstinence-based/Minnesota model of care; BI offered in half of services
Huriwai et al. [76]
(2000)
n = 6 servicesf;
total n = 105 clients
ndp Quantitative (cross-sectional) N/A Clients rated strongly the importance of cultural elements in treatment  
Robertson et al. [77] (2001) n = 90 alcohol and drug-user treatment services; n = 217 staff ndp Quantitative (cross-sectional) N/A   Strong support for cultural interventions with Māori clients
Brady et al. [71]
(2002)
n = 8 health care workers; n = 6 general practitioners; n = 25 clients AUDIT (tnsg) and 2Q’s on consumption Qualitative (not clearly specified) 18 months   5/6 doctors still using BI
DeVerteuil and Wilson [63]
(2010)
n = 7 servicese; total of n = 24 frontline staff; n = 1 staff member identified as Aboriginal ndp Qualitative (service case study) N/A   n = 6 services refer for off-site cultural activities; n = 1 service has on-site cultural programs (incl. sweat lodge accessible by non-residents)
Panaretto et al. [68] (2010) n = 4 health services; total of n = 46 staff ndp Mixed methods
(cross-sectional)
N/A   n = 3/4 services offered BI in past 12mths; challenges noted
Allan [54]
(2010)
n = 47 staff (DandA workers; primary health care workers) ndp Qualitative (action research) N/A   Conflicting approaches to care between staff
Gone [64]
(2011)
n = 4 current/former administrators;
n = 4 counsellors;
n = 11 clientsh
ndp Qualitative (ethnography) N/A   Program philosophy was based on medicine wheel and spiritual elements of AA; positive client experiences documented
Allan and Campbell [55]
(2011)
n = 149 Aboriginal people attending community events; n = 16 sewing group participants; n = 5 DandA and Aboriginal health workers ndp Uncontrolled
pre-post study
N/A Strong client engagement and client acceptability  
Clifford et al. [60] (2012) n = 5 ACCHSs; total of n = 37 health staff ndp Qualitative (descriptive) N/A   Scepticism of BI effectiveness and outcomes
Conigrave et al. [30] (2012) n = 47 participants AUDIT score of 8 +  Mixed methods
(cross-sectional)
N/A Participants unaware of outpatient treatments e.g. ambulatory withdrawal and medicines  
Legha and Novins [66] (2012) n = 18 substance abuse treatment programs serving AI/AN communities (representing 3 tribes across 7 states);
n = 77 service providers (n = 22 clinical admin staff; n = 55 frontline staff)
ndp Qualitative (grounded theory) N/A   Cultural beliefs/values core to program; adapted western models used
Calabria et al. [57] (2013) Clients of an ACCHS or DandA service n = 110 Indigenous; n = 6 non-Indigenous but have Indig. spouse or child AUDIT (tns) Quantitative (cross-sectional) N/A Strong client acceptability ratings  
Lee et al. [65]
(2013)
n = 21 staff; n = 24 female Aboriginal clients AUDIT-C score of 4 +  Mixed methods
cross-sectional survey;
qualitative (descriptive)
N/A Participant self-esteem and identity improved  
Brett et al. [56]
(2014)
n = 4 Indigenous health services;
n = 1–3 staff at each service
2009 NHMRC guidelines Qualitative (descriptive) N/A   Feedback for/on implementation of outpatient detox
Calabria et al. [58] (2014) n = 19 DandA treatment agency staff; n = 3 ACCHS health staff ndp Qualitative (not clearly specified) N/A   Tailoring process is documented and feedback gathered for adapting the counselling and counsellor certification process and improving feasibility
Hirchak et al. [31] (2018) n = 61 participants (incl. individuals with AUDs, treatment providers, and community members) ndp Qualitative (not clearly specified) N/A Rated culturally acceptable  
  1. aStudies are ordered in tables according to their focus and year of publication
  2. bThese columns contain the outcome data, qualitative or quantitative with regard to the type of participants (clients or staff and services) included in the study
  3. cNo definition provided
  4. dNot applicable
  5. eAll services were residential. Study was included as sweat lodge available for outpatients on-site or in a community-based facility
  6. fStudy included data from residential and outpatient services. Only outpatient service data was included
  7. gThreshold score not specified
  8. hService offered residential and outpatient programs with facilities also open to broader community. All data included is relevant to outpatient settings