Abreast of health: development of a context-specific digital alcohol brief intervention (ABI) in symptomatic breast clinics

Background: Potentially modifiable risk factors account for approximately 23% of breast cancer cases. In the UK, alcohol consumption alone is held responsible for 8-10% of cases diagnosed every year. Symptomatic breast clinics focus on early detection and treatment, but also offer scope for delivery of low-cost lifestyle interventions to encourage a cancer prevention culture within the cancer care system. Careful development work is required to effectively translate such interventions to novel settings. Objective: To develop a theory of change and delivery mechanism for a context-specific alcohol and lifestyle brief intervention aimed at women attending screening and symptomatic breast clinics. Methods: A formative study combined evidence reviews, analysis of mixed-method data, and user experience research to develop an intervention model, following the Six Steps in Quality Intervention Development (6SQuID) framework. Results: A web application focused on: improving awareness, encouraging self-monitoring, and reframing alcohol reduction as a positive choice to improve health was found to be acceptable to women. Accessing this in the clinic waiting area on a tablet computer was shown to be feasible. An important facilitator for change may be the heightened readiness to learn associated with a salient health visit (a ‘teachable moment’). Women may have increased motivation to change if they can develop a belief in their capability to monitor and, if necessary, reduce their alcohol consumption. Conclusions: Using the 6SQuID framework supported the prototyping and maximized acceptability and feasibility of an alcohol brief intervention for women attending symptomatic breast clinics, regardless of their level of alcohol consumption.