Interviewee

Dr Marko Kolsek, Professor, Department of Family Medicine, Medical Faculty, University of Ljubljana, Slovenia

Article

Kolsek, M., Struzzo, P., Svab, I. (2008) Qualitative study on community and primary health care involvement on alcohol and tobacco actions in seven European countries. Substance Use & Misuse, 43(3-4):303-16.

Summary

Primary health care is the cornerstone of many international actions that are aimed at improving health. In particular, Dr Marko Kolsek spoke with Michael Bouwman about using this approach for management of alcohol and tobacco use within seven European countries. Alcohol and tobacco use is a determinant of many illnesses and its use contextualized through the lifestyle of an individual, their culture and community. Effective translation of primary health care programs tailored towards alcohol and tobacco use across multiple countries requires awareness of cultural, socio-economic and political factors that may favor or hinder such management. Although primary health programs cannot be directly transferred between different countries, primary health program factors such as, the involvement of various actors within the community and a comprehensive program transcend boarders.

Transcript

Michael Bouwman: Introducing Dr Marko Kolšek, Professor in the Department of Family Medicine, Medical Faculty, University of Ljubljana, Slovenia. I’m speaking with Marko about his study and article: Qualitative study on community and primary health care involvement on alcohol and tobacco actions in seven European countries, co-authored with others listed on our website, and published in the journal Substance Use and Misuse. Our congratulations for your work on the important topic of alcohol and tobacco use. Would you start by explaining to our listeners the background to and aim of your study?

Marko Kolšek: Yes, thank you, let me say that it is known that alcohol and tobacco use are important determinants of illness, especially in Europe, as well as in America and Australia too. It is also known that alcohol and tobacco consumption are related to the lifestyle of an individual’s, as well as the community and its culture. So it is important to consider them also at the community level, which includes also primary health care, in addition to other sectors like schools or public administration, police, economical sectors and others. Primary health care plays an important role because of its proximity to the population and possibilities for coordinating public health policies, with the perspective of the individual. This is why primary health care has been a cornerstone of many important international actions aimed at improving health. For example, it was for blood pressure control, diabetes mellitus management, asthma management or vaccination. In order to be effective, the methodology must be country specific because of socio-economic and cultural differences. So, qualitative research methodologies have been developed to record new ideas in research. We know that some countries have clear, established methodologies in developing, country specific, community action plans on primary health care levels. And also, international experience in precipatory research, in health issues, is growing. And such corporation has the potential of increasing our understanding in effective health promotions, like taking into account cultural and socio-economic gaps and health service setting differences. And that’s the reason why we have done this study and the main aim of our study was to find an agreement on how to conduct a community action in different cultural, economical and health service settings.

Michael Bouwman: Your research identified factors associated with primary health care involvement in alcohol and tobacco use related problems. Would you elaborate on these and your other findings?

Marko Kolšek: Yes, one of the objectives of our study was to identify the factors favouring and hindering primary health care involvement in early identification, and management of alcohol and tobacco use and related problems. Maybe I can list some hindering factors that have appeared in all these seven countries.

Michael Bouwman: Certainly

Marko Kolšek: For example, the hidden character of alcohol use: it means that people are hiding, drinking, among themselves and also among other relatives or also doctors or other professionals. Another thing maybe, absence of a clear distinction, by practitioners, between hazardous and harmful use and dependency. Many professionals and many lay people are not aware of this distinction: what means hazardous drinking, what means harmful drinking, and when dependency appears. So this was found as a very important hindering factor. Another one was, familial, social and educational factors influencing alcohol and tobacco use: for example, peers are drinking or smoking, how one can resist if everybody in his group is drinking or smoking. So it’s not strange for children to smoke or to drink since they see it on TV or they see their parents drinking and smoking. Another hindering factor was that General Practitioners pointed to public responsibility in selling and advertising alcohol and tobacco, and this stressed the importance of setting up public education and mass media campaigns. They say, for example, that we cannot be successful if the government, schools and media do not do their part of the job. Another hindering factor was, many doctors think that their role is to treat ill persons not to teach them. It is too much of everything, in one week, or in one day, for a doctor to do; you have accidents, different illnesses, prevention, everything, that’s too much – overloaded. And also a lot of professionals and lay people think that there’s no use to do it, because it’s not effective, anything you try, they find it ineffective. So this is a hindering factor that we found. But there are some points that can favour involvement of General Practitioners: for example, patients find them important, because they believe that it is important, what the GP says to the patient. Another point that can favour General Practitioners involvement can be that General Practitioners can work within the family context, so you can influence different members of the family at the same time. General Practitioners have power; you can refer it to a specialist to help you help such people. And also, we have different pharmacological tools that can help people, for example, in smoking cessation, pharmacists can help us. So there’re various hindering factors and various favouring factors that can prove that General Practitioners are important, but also other actors in the community are important.

Michael Bouwman: And you mentioned that one of the limitations of your study is that documented areas cannot simply be transformed into actions in every country. Could you please elaborate on that insight?

Marko Kolšek: Our study shows that there are many common things in very different countries regarding economic, political and cultural points of view, but also there are differences. So it is reasonable to conclude that also the results cannot be transferred directly from one country to another. For example, one cannot address nurses toward comprehension of alcohol drinking if it is another professional’s role in this country. Or another example, it is not wise to propose politicians, in one country, to prepare more rigorous legislation if it is already very rigorous. So each country should take into account its own cultural, social, political, economical and other backgrounds, and our study can give them a lot of ideas. But in all countries, we found that any action, to be successful and feasible, should be comprehensive. So different actors should be included, if you want to be community action oriented and successful.

Michael Bouwman: OK, and finally what do you think are the practice implications of your research Marko?

Marko Kolšek: Movements in this direction have been already made in some of the participating countries. For example, Italy, Belgium and Slovenia are implementing a broad involvement of primary health care teams in early identification and brief interventions for hazardous and harmful drinking. Or another example, in Italy and in Slovenia, a new legislation on smoking in public places was introduced similar to this in Australia, where smoking is restricted in public places. And also in Slovenia, there were two long-term nation-wide projects, supported by the Ministry of Health, many local communities and organisations have been started to reduce alcohol drinking that involves primary health care teams, media schools and alcohol/tobacco related issues have been included in the curriculums for medical students, for physicians specialising in family medicine, and in the programs of continuous medical education. We can see this practice implication is already in real life, not only on paper, but they’re introduced in real life already.

Michael Bouwman: Ok, well thank you Marko for sharing this interesting work with us today.

Marko Kolšek: Thank you very much.