To our knowledge, CICA is the first alcohol-focused champion role of its kind to be investigated across multiple intervention sites. It is also the first evaluation of a health champion programme that uses methodological triangulation to strengthen inferences about effectiveness.
There was evidence that lay people trained as AHCs were able to have conversations with members of their communities who were consuming alcohol at higher risk levels, demonstrating a level of skill and confidence that can sometimes be absent in health professionals. AHCs, their co-ordinators and the public valued the role. However, significant infrastructure is needed to support an intervention such as CICA, and time is needed to develop and embed a group of volunteers.
Despite evidence (from the process evaluation) of some planned activity taking place at local level, we were not able to show that CICA was effective, nor was it cost-effective. There are likely to be two main reasons for this. Firstly, the number of champions trained was too small to generate an effect that is measurable at the area-level of analysis. Secondly, the AHCs were less willing (and had less opportunity) to get involved with alcohol licensing decisions. Since licensing policies have an impact at an area level, this theoretically would have been more likely to generate a significant area-level effect. The evidence from this study is that communities continue to struggle to influence statutory processes that affect alcohol availability where they live, and further consideration of how to resource increasing community engagement is necessary. Moreover, despite evidence demonstrating that ASBIs can have a moderate effect on consumption at an individual level, brief interventions may not have a direct effect on the selected primary outcomes at a population level.
Recommendations
The findings of this research have led to several recommendations to support effective implementation of a place-based health promotion utilising community assets:
- Ensure all stakeholders have a clear understanding of the place-based ‘role’ being implemented, including its scope and purpose.
- Ensure providers or commissioned services have clear understanding of their own role, anticipated outcomes and the skills and capacity to support inexperienced alcohol/health issue-focused volunteer groups.
- Prepare the ground at community level, well in advance of a formal implementation period, to build community understanding, support and involvement to aid recruitment at the appropriate time.
- Develop and resource a multipronged recruitment strategy utilising digital technologies, social media, community influencers, leaflets/posters and word-of-mouth.
- Be prepared for a longer/sustained period of supporting new champions – especially since the aim is to target areas of high need where existing levels of confidence and literacy might be low.
In terms of AHC activities:
- Focus the brief advice component of the intervention on the majority of people who use alcohol who are not alcohol dependent/in highest need. There needs to be a conscious effort to reiterate this during set-up, training and ongoing support.
- Use a systems approach to consider the whole alcohol treatment system as part of the wider infrastructure of support, inclusive of population-based health promotion and prevention.
- In order to intervene in licensing policy, consider an intervention at a wider scale, providing dedicated community licensing officers with adequate resources and capacity to deliver a training and support programme at a local authority level (average 180,000 population) to mobilise communities in areas where there are higher numbers of licensed premises.
- Our research suggests that local licensing policy might benefit from a rebalance to become more community-centred, with the support of national policy to address fears of reprisal and setting out standards to increase the inclusivity and accessibility of statutory processes.
In terms of evaluation design:
- Other natural experiment evaluations should include the kind of triangulation used in this evaluation to guard against overinterpretation of spurious results.
- Given that the preferred activity of the AHCs was giving brief advice, it is likely that an area-level analysis would not be sensitive enough to measure any effect. Alternative study designs could be sought.