Implementing a Moderate Alcohol Use Program for Indigenous People: A Stakeholder Perspective

The addiction service offered in the Indigenous communities of Quebec is essentially anchored in approaches targeting abstinence and intended for people with severe problems, leaving a gap in services for people with moderate/low levels of need. Inspired by Alcochoix+, Wise Choices is an innovative targeted prevention program aimed at developing strategies to achieve and maintain moderate alcohol use. The form and content of the program have been subject to a collaborative process of cultural adaptation. This research aims to assess the initial implementation of Wise Choices by documenting implementation outcomes and identifying key barriers and facilitators.

65 stakeholders from 10 indigenous communities and 3 Health Centers were trained to facilitate Wise Choices. Following the training, between June and December 2020, 2 waves of 4 group interviews with trained stakeholders (n=14 and n=19) were conducted to support and evaluate the initial implementation. To further explore the material collected in the group interviews, individual interviews were conducted from March to June 2021 (n=13 stakeholders). The verbatims of these interviews are subject to a thematic analysis with NVivo. Implementation has been difficult and only 3 stakeholders have facilitated the program. Main barriers to implementation (pandemic context, cumbersome research protocol, novelty of the approach), as well as facilitators (couple/group formula, ongoing clinical support, partnerships) have been identified in the group interviews. In individual interviews, all stakeholders reported having beliefs consistent with the goal of moderate drinking, but their comments suggest that their sense of self-efficacy in relation to program use needs to be developed. Some reported that their participation in the training had a positive impact on their overall clinical practice.

Results of the initial implementation demonstrate that a program like Wise Choices is relevant to Indigenous communities, but that implementation processes must be adapted to be culturally appropriate.