Current practices and intention to provide alcohol-related health advice in primary dental care

KEY POINTS * The delivery of alcohol-related health advice to patients is advocated as one measure to moderate alcohol consumption. * Highlights that GDPs are in an ideal position to

identify excessive alcohol consumption and offer advice. * Posits that beliefs derived from psychological models may be helpful in understanding this behaviour and may provide targets for an

intervention to encourage behaviour change. ABSTRACT OBJECTIVES To determine whether general dental practitioners (GDPs) currently provide alcohol-related advice (ARA) and to inform the

development of an intervention, should one be required. METHOD Cross-sectional postal survey of a random sample of 300 GDPs in Scotland. The questionnaire assessed beliefs derived from

psychological models that explain behaviour in terms of beliefs that are amenable to change, and so may inform development of an intervention to encourage the provision of ARA. RESULTS Sixty

percent of GDPs responded. Eighty-three percent of participating GDPs (145/175) had not provided ARA to patients in the previous ten working days. Attitude (perceived consequences), control

beliefs (perceived difficulty), subjective norm (perceived social pressure), and self-efficacy (confidence) significantly predicted intention to provide ARA. Alcohol-related knowledge or

personal alcohol behaviour did not predict intention to provide ARA. CONCLUSIONS There is scope to increase the provision of ARA in primary care dentistry and this study identified

predictive beliefs, which could be targeted to encourage this behaviour. The next phase is to develop and test an intervention to encourage GDPs to provide ARA. SIMILAR CONTENT BEING VIEWED

BY OTHERS SYSTEMATIC OVERVIEW OF SYSTEMATIC REVIEWS AND CLINICAL GUIDELINES: ASSESSMENT AND PREVENTION OF BEHAVIOURAL RISK FACTORS ASSOCIATED WITH ORAL CANCER TO INFORM DENTAL PROFESSIONALS

IN PRIMARY CARE DENTAL PRACTICES Article 07 March 2022 USE OF AUDIT-C ALCOHOL SCREENING TOOL IN NHS GENERAL DENTAL PRACTICES IN NORTH LONDON Article 13 May 2021 BEHAVIOUR CHANGE INTERVENTION

FOR SMOKELESS TOBACCO (ST) CESSATION DELIVERED THROUGH DENTISTS WITHIN A DENTAL SETTING: A FEASIBILITY STUDY PROTOCOL Article Open access 21 April 2022 BACKGROUND Alcohol is responsible for

4.0% of the global burden of disease and is directly related to a multitude of adverse health conditions.1,2,3,4 In Scotland alone, alcohol-related health issues account for National Health

Service financial expenditure in the order of hundreds of millions of pounds each year.5,6,7 Evidence suggests that the provision of alcohol-related advice (ARA) by healthcare professionals

in primary care could help moderate alcohol consumption.8,9,10,11,12,13 Recently, the Scottish Intercollegiate Guidelines Network and the National Institute for Health and Clinical

Excellence have developed guidelines to help clinicians recognise and tackle excessive alcohol consumption in attending patients.14,15 The focus of these guidelines is on the provision of

advice by general medical practitioners; however general dental practitioners (GDPs) are potentially in an ideal position to identify excessive alcohol consumption and to provide ARA,

particularly since alcohol is a well-established primary aetiological risk factor in the development of oral cancer.16,17,18,19 Nevertheless, there is a relative dearth of information about

whether GDPs currently provide ARA.20,21 Therefore the first aim of this study is to determine whether GDPs in Scotland currently provide ARA. The second aim is to inform the development of

an intervention to encourage GDPs to provide alcohol-related advice, should one be required. The focus is on understanding GDPs' intention to provide alcohol-related advice since

intention to perform a behaviour has been shown to be a reliable indicator of actual performance.22,23,24 In order to achieve this aim we assessed beliefs derived from two psychological

models, the Theory of Planned Behaviour (TPB) and Social Cognitive Theory (SCT).22,25 These specific theories were chosen because they explain behaviour in terms of beliefs that are amenable

to change, they have been rigorously evaluated in other healthcare settings and have good evidence of predictive value for health relevant behaviours for healthcare professionals as well as

patients.26,27,28,29 The TPB predicts that an individual is more likely to provide ARA if they have high intention to do so, if they think it will be easy for them to do (high perceived

behavioural control), if they believe that doing so will result in consequences that are valued (positive attitude) and if the individual believes that people they respect would want them to

perform that behaviour (positive subjective norm). SCT predicts that an individual is more likely to undertake a behaviour if they are confident in their performance ability (high

self-efficacy). Given that knowledge regarding the definition of excessive alcohol consumption and associated risk may influence whether GDPs provide advice, knowledge was also assessed as a

possible predictive variable. Additionally, it is plausible to posit that GDPs' own alcohol-related behaviour may influence whether they provide ARA to patients; so a measure of

personal alcohol consumption was also included in this study. The research questions are: * 1 Do GDPs in Scotland currently provide alcohol-related health advice? * 2 What beliefs might

predict GDPs' intention to provide alcohol-related health advice in primary care? METHODS The current study was a cross-sectional postal survey. Participants were GDPs randomly selected

from across Scotland. All general dental practitioners from a database containing details of NHS dentists practising in Scotland were assigned a number through computer random number

generation. These random numbers were placed in numerical order from the smallest to the largest, and the first 300 practitioners selected to receive an invitation to participate in this

study. ETHICAL CONSIDERATIONS The Fife, Forth Valley & Tayside Research Ethics Service on behalf of the Research Ethics Service Office considered the study to be an anonymous

invitational dental service audit and formal ethical review was not required. MEASURES The measures assessing theoretical variables were created by following established principles and

procedures.23,30,31 Preliminary work involving exploratory semi-structured interviews with a convenience sample of GDPs determined the salient views on the identification of alcohol misuse

and provision of ARA in primary care and these results informed the development of the questionnaire items for this study.32 Unless otherwise stated, all measures were scored on seven-point

scales. OUTCOME MEASURES CURRENT BEHAVIOUR GDPs were asked whether ARA was delivered in the preceding ten working days ('In the last ten working days have you provided alcohol-related

advice? – yes/no'). Ten working days was an arbitrary cut-off point determined by the authors as an appropriate time for this behaviour to have occurred at least once, given the

evidence base.14,15 INTENTION Two items assessed intention to provide alcohol advice: 'I intend to provide alcohol-related advice as part of patient management' and 'In

general I have a plan about when I would provide alcohol advice as part of patient management'; the total intention score was a sum of these two items with higher scores reflecting

greater overall intention. Possible scores ranged from 2-14. PREDICTIVE MEASURES ATTITUDE * 1 'Attitude indirect' included all 11 possible consequences to providing ARA identified

in the preliminary study of GDPs: it would benefit the patient; improve the patients' oral cancer awareness; embarrass patients; upset patients; result in a more thorough examination;

ensure patients' healthcare needs are appropriately managed; properly fulfil their role as a dentist; or improve professional relationships with patients.32 Participants were asked how

strongly they agreed with each of these consequences and how important they were. Each consequence score was multiplied by the corresponding evaluation score. The total score was the mean of

the multiplicative scores. Possible scores ranged from 1 to 49 * 2 'Attitude direct' was the mean score of eight general attitude items: 'I think providing alcohol-related

advice is: not useful-useful; not embarrassing-embarrassing; something I am not confident to do–something I am confident I can do; not practical–practical; not interesting–interesting; not

relevant–relevant; not beneficial–beneficial; something I do not want to do–something I really want to do'. PERCEIVED BEHAVIOURAL CONTROL (PBC) * 1 'PBC indirect' was the mean

score of 13 items relating to possible barriers to determining alcohol problems, to providing ARA, and to managing patients identified in the preliminary study: 'In relation to

providing alcohol-related health advice how difficult do you find it to: talk to an embarrassed patient; find the time to include the advice during a consultation; know what to say; provide

related literature; effectively influence what patients do?' 'How difficult do you find it to: determine the alcohol intake of your patients; record the alcohol intake of your

patients; identify at-risk drinking behaviour; refer a patient to a general medical practitioner; refer a patient to a consultant for alcohol addiction; refer a patient to a telephone

helpline; follow available guidelines; undertake training on alcohol-related matters?'. Participants were asked to rate how difficult it would be for them to overcome these barriers

('not at all difficult' to 'extremely difficult'). All items were scored with higher scores reflecting greater perceived behavioural control (less difficulty in

overcoming each barrier) * 2 'PBC direct' was the mean score of four general items related to barriers to providing ARA: 'I would like to provide alcohol-related advice but

don't really know if I can; whether I provide alcohol-related advice is entirely up to me; I can provide alcohol-related advice if I really wanted to' and 'I think providing

alcohol advice is difficult' * 3 'PBC general advice' was the score from a single item related to self-report difficulty in providing any type of advice: 'In general I

find it difficult to give any type of advice to patients'. SUBJECTIVE NORM * 1 The indirect measure of subjective norm included seven items assessing whether they felt motivated to

comply the people identified in the preliminary study as putting pressure on them to provide ARA. These were 'the General Dental Council; the British Dental Association; Scottish

Intercollegiate Guidelines Network; Scottish Dental Clinical Effectiveness Programme; National Institute for Health and Clinical Excellence; colleagues; and patients.' 'SN

indirect' was the mean of seven multiplicative scores of these items * 2 Direct subjective norm 'SN direct' was the score of a single self-report item regarding pressure to

provide alcohol-related advice: 'I feel under pressure to provide alcohol advice'. SELF-EFFICACY * 1 'Self-efficacy alcohol advice' was assessed with eight items:

'How confident are you that you can: determine the alcohol intake of your patients; record the alcohol intake of your patients; identify at-risk drinking behaviour; refer a patient to a

general medical practitioner; refer a patient to a consultant for alcohol addiction; refer a patient to a telephone helpline; follow available guidelines; undertake training on

alcohol-related matters?'. The total score was the mean of the sum of these items, with higher scores reflecting greater self-efficacy (greater confidence) for providing alcohol related

advice * 2 'Self-efficacy general advice' was assessed with six items related to confidence in providing advice in general: 'How confident are you that you: can talk to a

patient about a sensitive topic; can find the time to include the advice during a consultation; will know what to say; provide related literature; can effectively influence what patients do;

discuss issues that you find embarrassing with patients?' The total self-efficacy score for general advice was the mean of the sum of these items, with higher scores reflecting greater

self-efficacy for providing any advice to patients. KNOWLEDGE Knowledge was assessed with ten items, four relating to the maximum safe amount of alcohol consumed in a single session for

standard drinks of beer, wine, spirits or alco-pops and six items on the relationship between alcohol and health outcomes such as general health, oral health, oral cancer, smoking and oral

cancer, caries and periodontal disease. Each correct answer was given a score of one. Possible scores ranged from zero to ten. PERSONAL BEHAVIOUR This was assessed using the Alcohol Use

Disorders Identification Tool (AUDIT).33 This is a ten-item questionnaire with a possible score of 40. Higher total scores reflect higher tendency towards alcohol-related harm or dependence:

scores below 8 indicate low harm, in the range 8-15 represent a medium or hazardous alcohol problem, 16 or greater represents an increased level of harm, and scores above 20 warrant further

investigation and evaluation for dependence.33,34 DEMOGRAPHICS Demographic variables included time qualified as a dentist; gender; number of clinical sessions (0.5 days) worked on average

per week; total practice list size; if the practice was rural and/or remote; the number of other clinicians in the practice and whether the respondent was a vocational trainer. POWER

CALCULATION AND SAMPLE SIZE _A priori_ power analysis showed that a sample size of 178 would be required to achieve a medium effect size = 0.15 with 95% power based on a critical F = 1.85

using a multiple regression statistical test with 11 predictors (attitude direct/indirect, perceived behavioural control direct/indirect/general advice, subjective norm direct/indirect,

self-efficacy alcohol advice/general advice, knowledge, and personal behaviour). PROCEDURE Previous surveys in this population have achieved response rates of approximately 60%. Therefore,

questionnaires were sent to a random sample of 300 GDPs working in the general dental services. A follow-up reminder letter with a duplicate questionnaire was sent three weeks after the

first and followed subsequently with postcard reminder at six weeks. STATISTICAL ANALYSIS Ten percent of data was randomly selected for double entry with descriptive statistics completed to

ensure consistency and accuracy of data entry. Statistical significance was based on two-sided tests with p <0.05 as the criterion. Missing data for each questionnaire item was replaced

with the individual's mean over all the items of that measure, providing only two or fewer items from that measure were missing. The data was examined for univariate outliers using z

scores >3.29 (p = 0.001) and multivariate outliers using residuals scores, with a criterion of Mahalanobis distance at p <0.001. Variables were examined for their approximation to a

normal distribution using skewness and kurtosis statistics with cut-off greater than ±1. Measures were tested for internal consistency using Cronbach's alpha. The relationship between

the predictive variables and the outcome variable of intention to provide ARA was examined using Pearson's correlation analysis and multiple regression analysis. Multicollinearity was

tested by screening for correlations between predictive variables greater than 0.90, low tolerance (1-SMC) and high standard errors (relative to the scale of each variable) for regression

coefficients.35 RESULTS RESPONSE RATE AND PARTICIPANTS Out of the 300 questionnaires posted, six were returned undeliverable with 175 completed and returned giving a response rate of 60%

(175/294). The final sample profile was: 60% (104/172) were male, qualified, on average, for 19 years (SD = 9.1), worked full-time (mean (SD) sessions per week = 9 (2.26)), with a practice

list size of 2,081 (SD = 1,351). Eleven percent (18/172) were vocational trainers and 24% (42/172) considered their practice to be remote and/or rural. The average number of other dentists

in the practice was three, ranging from zero to 13. Eighty-three percent (142/171) worked in general dental practice, 13% (22/171) in salaried services, 5% (8/171) in community dental

services and 1% (2/171) in hospital-based services. Ninety-two percent (158/171) worked in only one service while 8% (13/171) reported working in two or more services. DATA No outliers were

identified. All variables showed psychometrically acceptable levels of skewness or kurtosis. There was no evidence of multicollinearity: the highest Pearson correlation was r = 0.65 between

self-efficacy alcohol advice and PBC indirect; the collinearity diagnostics showed the tolerance values for all variables included in the models were over 0.6 and the standard errors of the

regression coefficients were all less than 0.1. DO GDPS CURRENTLY PROVIDE ALCOHOL-RELATED ADVICE? Eighty-three percent (142/172) had not provided advice in the previous ten working days.

WHAT BELIEFS MIGHT PREDICT GDPS' INTENTION TO PROVIDE ALCOHOL-RELATED HEALTH ADVICE IN PRIMARY CARE? On average, GDPs have low intention to provide ARA (mean 3.57; SD = 1.40).

Descriptive statistics for the predictive variables assessed in this study are shown in Table 1. The results suggest that participating GDPs do not have a positive attitude to providing ARA,

believe that providing ARA is difficult and also have low self-efficacy in providing ARA in primary care. Additionally, in general they do not feel under pressure to provide ARA. With an

average score of 3 out of 10, GDPs showed relatively poor knowledge on recommended alcohol consumption guidelines and associated risk. Personal alcohol consumption, as assessed by the AUDIT,

was generally below the accepted threshold score of 8 for harmful alcohol consumption, with 85% scoring less than 8, approximately 14% exhibiting moderate levels of harm and one respondent

scoring in the high alcohol harm range bordering on dependence. Intention to provide alcohol advice was significantly related to attitude indirect/direct, PBC indirect, PBC general advice,

subjective norm indirect/direct and self-efficacy alcohol advice/general advice. Each of these variables were entered into a stepwise multiple regression with intention as the dependent

variable (Table 2). Attitude direct/indirect, self-efficacy general advice, and subjective norm indirect explained 35% of the variance in intention to provide ARA. Individual items from

these variables were then entered into a further exploratory stepwise multiple regression equation (Table 3). Five items explained 41% of the variance in intention: 'I think providing

alcohol-related advice is practical'; 'I am confident I can provide related literature'; 'My providing alcohol advice is likely to cause embarrassment'; 'I feel

under pressure from colleagues to provide advice and am motivated to do what my colleagues think I should'; and 'I think providing alcohol related advice is beneficial'.

Neither knowledge nor personal alcohol-related behaviour (the dentist's own drinking habits) were significantly related to intention to provide ARA. DISCUSSION The first aim of this

study was to determine if GDPs currently provide ARA. Few participating GDPs currently provide ARA, suggesting that there is scope to improve this behaviour. This result is consistent with

previous studies with GDPs in the United Kingdom which incorporated alcohol-related issues.20,36,37 The second aim of this study was to identify beliefs that predict intention to provide ARA

to inform the development of an intervention to encourage the delivery of advice. All of the beliefs derived from the psychological theories significantly predicted intention to provide ARA

and acted in accordance with theoretical expectations in that more positive attitude, higher subject norm, greater perceived behavioural control and self-efficacy all were associated with

greater intention to provide alcohol-related advice. A stepwise regression analysis explored the relative importance of each of the predictive variables in accounting for the variance in

intention to provide ARA (Table 2). Attitude (direct/indirect), self-efficacy general advice and subjective norm (indirect) accounted for 35% of the variance in intention. An item analysis

was then performed to identify the pivotal items within these predictive variables (Table 3). Only five items accounted for 41% of the variance in intention (F (5,98) = 15.34, p <0.001):

'I think providing alcohol related advice is practical' (β = 0.17), 'I am confident about providing related literature' (β = 0.26), 'Providing alcohol advice is not

likely to cause me embarrassment' (β = 0.22), 'I feel under pressure to provide alcohol advice from colleagues' (β = 0.22) and 'I think providing alcohol related advice

is beneficial' (β = 0.20). The results of the item analysis suggest that GDPs may be encouraged to provide ARA by an intervention which addresses these specific issues. Knowledge of

recommended sensible alcohol consumption guidelines was relatively poor, although this did not seem to be an issue as knowledge was not related to intention to provide ARA. This is

consistent with previous work suggesting that knowledge alone is usually not sufficient to influence behaviour and that implementation effectiveness is often reliant on factors other than

knowledge.38,39,40 Personal alcohol behaviour also was not associated with intention to provide ARA. These results suggest that an intervention which targets either of these variables is

unlikely to encourage GDPs to provide ARA. CONCLUSION The results of this study suggest that there is scope to increase the provision of alcohol-related health advice in primary care

dentistry. This study also identified some possible targets of an intervention to encourage GDPs to provide alcohol-related advice in primary dental care. The next phase is to develop and

evaluate an intervention to encourage GDPs to provide ARA, based on the results of this study. REFERENCES * Anderson P, Baumberg B . _Alcohol and public health in Europe. Short report_.

London: Institute of Alcohol Studies UK, 2007. Google Scholar  * Room R, Babor T, Rehm J. Alcohol and public health. _Lancet_ 2005; 365: 519–530. Article  Google Scholar  * World Health

Organisation. _WHO Expert Committee on Problems Related to Alcohol Consumption. Second report_. Geneva: World Health Organisation, 2007. * Rehm J, Taylor B, Patra J. Volume of alcohol

consumption, patterns of drinking and burden of disease in the European region 2002. _Addiction_ 2006; 101: 1086–1095. Article  Google Scholar  * Audit Scotland. _Drug and alcohol services

in Scotland. Report_. Edinburgh: Audit Scotland, 2009. * Health Economics Unit, ASDHD, Scottish Government. _Costs of alcohol use and misuse in Scotland_. Edinburgh: The Scottish Government,

2008. * NHS National Services Scotland. _Alcohol statistics Scotland 2009_. Edinburgh: ISD Publications, 2009. * Ballesteros J, Duffy J C, Querejeta I, Arino J, Gonzalez-Pinto A. Efficacy

of brief interventions for hazardous drinkers in primary care: systematic review and meta-analyses. _Alcohol Clin Exp Res_ 2004; 28: 608–618. Article  Google Scholar  * Beich A, Gannik D,

Malterud K. Screening and brief intervention for excessive alcohol use: qualitative interview study of the experiences of general practitioners. _BMJ_ 2002; 325(7369): 870B–872B. Article 

Google Scholar  * Beich A, Thorsen T, Rollnick S. Screening in brief intervention trials targeting excessive drinkers in general practice: systematic review and meta-analysis. _BMJ_ 2003;

327(7414): 536–542. Article  Google Scholar  * Cuijpers P, Riper H, Lemmers L. The effects on mortality of brief interventions for problem drinking: a meta-analysis. _Addiction_ 2004; 99:

839–845. Article  Google Scholar  * Kaner E F, Beyer F, Dickinson H O et al. Effectiveness of brief alcohol interventions in primary care populations. _Cochrane Database Syst Rev_ 2007; (2):

CD004148. Google Scholar  * Richmond R, Heather N, Wodak A, Kehoe L, Webster I. Controlled evaluation of a general practice-based brief intervention for excessive drinking. _Addiction_

1995; 90: 119–132. Article  Google Scholar  * National Institute for Health and Clinical Excellence. _Alcohol use disorders: preventing the development of hazardous and harmful drinking_.

NICE public health guidance 24. London: NICE, 2010. * Scottish Intercollegiate Guidelines Network. _The management of harmful drinking and alcohol dependence in primary care: a national

clinical guideline_. Edinburgh: Scottish Intercollegiate Guidelines Network, 2003. * Carter L M, Ogden G R. Oral cancer awareness of general medical and general dental practitioners. _Br

Dent J_ 2007; 203: E10. Article  Google Scholar  * Hashibe M, Brennan P, Benhamou S et al. Alcohol drinking in never users of tobacco, cigarette smoking in never drinkers, and the risk of

head and neck cancer: pooled analysis in the International Head and Neck Cancer Epidemiology Consortium. _J Natl Cancer Inst_ 2007; 99: 777–789. Article  Google Scholar  * Petti S. Lifestyle

risk factors for oral cancer. _Oral Oncol_ 2009; 45: 340–350. Article  Google Scholar  * Warnakulasuriya S. Global epidemiology of oral and oropharyngeal cancer. _Oral Oncol_ 2009; 45:

309–316. Article  Google Scholar  * Dyer T A, Robinson P G. General health promotion in general dental practice – the involvement of the dental team. Part 2: a qualitative and quantitative

investigation of the views of practice principals in South Yorkshire. _Br Dent J_ 2006; 201: 45–51. Article  Google Scholar  * Dyer T A, Robinson P G. General health promotion in general

dental practice – the involvement of the dental team. Part 1: a review of the evidence of effectiveness of brief public health interventions. _Br Dent J_ 2006; 200: 679–685. Article  Google

Scholar  * Ajzen I. The theory of planned behaviour. _Organ Behav Hum Decis Process_ 1991; 50: 179–211. Article  Google Scholar  * Conner M, Norman P . _Predicting health behaviour: research

and practice with social cognition models_. 2nd ed. Maidenhead: Open University Press, 2005. Google Scholar  * Eccles M P, Hrisos S, Francis J et al. Do self-reported intentions predict

clinicians' behaviour: a systematic review. _Implement Sci_ 2006; 1: 28. Article  Google Scholar  * Bandura A. Health promotion from the perspective of social cognitive theory. _Psychol

Health_ 1998; 13: 623–649. Article  Google Scholar  * Bonetti D, Eccles M, Johnston M et al. Guiding the design and selection of interventions to influence the implementation of

evidence-based practice: an experimental simulation of a complex intervention trial. _Soc Sci Med_ 2005; 60: 2135–2147. Article  Google Scholar  * Bonetti D, Johnston M, Pitts N B et al. Can

psychological models bridge the gap between clinical guidelines and clinicians' behaviour? A randomised controlled trial of an intervention to influence dentists' intention to

implement evidence-based practice. _Br Dent J_ 2003; 195: 403–407. Article  Google Scholar  * Bonetti D, Pitts N B, Eccles M et al. Applying psychological theory to evidence-based clinical

practice: identifying factors predictive of taking intra-oral radiographs. _Soc Sci Med_ 2006; 63: 1889–1899. Article  Google Scholar  * Walker A E, Grimshaw J M, Armstrong E M. Salient

beliefs and intentions to prescribe antibiotics for patients with a sore throat. _Br J Health Psychol_ 2001; 6: 347–360. Article  Google Scholar  * Azjen I. _Constructing a TPB

questionnaire: conceptual and methodological considerations_. Available at http://people.umass.edu/∼aizen/pdf/tpb.measurement.pdf (accessed 19 September 2011). Google Scholar  * Francis J J,

Eccles M P, Johnston M et al. _Constructing questionnaires based on the theory of planned behaviour. A manual for researchers_. Newcastle: Centre for Health Services Research, 2004. Google

Scholar  * Shepherd S, Young L, Clarkson J, Bonetti D, Ogden G R. General dental practitioner views on providing alcohol related health advice; an exploratory study. _Br Dent J_ 2010; 208:

E13. Article  Google Scholar  * Babor T F, Higgins-Biddle J C, Saunders J B, Monteiro M G . _AUDIT – the Alcohol Use Disorders Identification Test. Guidelines for use in primary care_. 2nd

ed. Geneva: World Health Organisation, 2001. Google Scholar  * Fiellin D A, Reid M C, O'Connor P G. Screening for alcohol problems in primary care: a systematic review. _Arch Intern

Med_ 2000; 160: 1977–1989. Article  Google Scholar  * Tabachnick B G, Fidell L S . _Using multivariate statistics_. 4th ed. Needham Heights, MA: Allyn & Bacon, 2001. Google Scholar  *

Brocklehurst P R, Baker S R, Speight P M. A qualitative study examining the experience of primary care dentists in the detection and management of potentially malignant lesions. Mechanics of

the referral and patient communication. _Br Dent J_ 2010; 208: E4. Article  Google Scholar  * Warnakulasuriya K A, Johnson N W. Dentists and oral cancer prevention in the UK: opinions,

attitudes and practices to screening for mucosal lesions and to counselling patients on tobacco and alcohol use: baseline data from 1991. _Oral Dis_ 1999; 5: 10–14. Article  Google Scholar 

* Eccles M, Grimshaw J, Walker A, Johnston M, Pitts N. Changing the behaviour of healthcare professionals: the use of theory in promoting the uptake of research findings. _J Clin Epidemiol_

2005; 58: 107–112. Article  Google Scholar  * McGlone P Watt R, Sheiham A. Evidence-based dentistry: an overview of the challenges in changing professional practice. _Br Dent J_ 2001; 190:

636–639. Article  Google Scholar  * Nilsen P, Aalto M, Bendtsen P, Seppa K. Effectiveness of strategies to implement brief alcohol intervention in primary healthcare – a systematic review.

_Scand J Prim Health Care_ 2006; 24: 5–15. Article  Google Scholar  Download references ACKNOWLEDGEMENTS We would like to thank the Scottish Dental Practice Based Research Network (SDPBRN)

team who supported and funded this study; and the University of Dundee. AUTHOR INFORMATION AUTHORS AND AFFILIATIONS * Lecturer in Oral Surgery,, S. Shepherd * Senior Research Fellow,, D.

Bonnetti * Director of the Effective Dental Practice Programme, Dental Health Services Research Unit, University of Dundee, The Mackenzie Building, Kirsty Semple Way, Dundee, DD2 4BF, J. E.

Clarkson * Professor of Oral Surgery, Unit of Oral Surgery and Medicine, University of Dundee Dental Hospital and School, Park Place, Dundee, DD1 4HN, G. R. Ogden * Research and Development

Manager, Scottish Dental Clinical Effectiveness Programme, Dundee Dental Education Centre, Frankland Building, Smalls Wynd, Dundee, DD1 4HN, L. Young Authors * S. Shepherd View author

publications You can also search for this author inPubMed Google Scholar * D. Bonnetti View author publications You can also search for this author inPubMed Google Scholar * J. E. Clarkson

View author publications You can also search for this author inPubMed Google Scholar * G. R. Ogden View author publications You can also search for this author inPubMed Google Scholar * L.

Young View author publications You can also search for this author inPubMed Google Scholar CORRESPONDING AUTHOR Correspondence to S. Shepherd. RIGHTS AND PERMISSIONS Reprints and permissions

ABOUT THIS ARTICLE CITE THIS ARTICLE Shepherd, S., Bonnetti, D., Clarkson, J. _et al._ Current practices and intention to provide alcohol-related health advice in primary dental care. _Br

Dent J_ 211, E14 (2011). https://doi.org/10.1038/sj.bdj.2011.822 Download citation * Accepted: 07 April 2011 * Published: 07 October 2011 * Issue Date: 08 October 2011 * DOI:

https://doi.org/10.1038/sj.bdj.2011.822 SHARE THIS ARTICLE Anyone you share the following link with will be able to read this content: Get shareable link Sorry, a shareable link is not

currently available for this article. Copy to clipboard Provided by the Springer Nature SharedIt content-sharing initiative