Barriers and enablers to delivery of Making Every Contact Count: A cross-sectional study

BACKGROUND: The public health impact of the Irish Making Every Contact Count (MECC) brief intervention programme is dependent on delivery by healthcare professionals. We aimed to identify enablers and modifiable barriers to MECC intervention delivery to optimize MECC implementation. METHODS: Online cross-sectional survey design. Healthcare professionals (n = 4050) who completed MECC eLearning were invited to complete an online survey based on the Theoretical Domains Framework (TDF). Multiple regression analysis identified predictors of MECC delivery (logistic regression to predict delivery or not; linear regression to predict the frequency of delivery). Data were visualized using Confidence Interval-Based Estimates of Relevance (CIBER). RESULTS: Seventy-nine percent of participants (n = 283/357) had delivered a MECC intervention. In the multiple logistic regression (Nagelkerke's R2 = .34), the significant enablers of intervention delivery were ‘professional role’ (OR = 1.86 [1.10, 3.15]) and ‘intentions/goals’ (OR = 4.75 [1.97, 11.45]); significant barriers included ‘optimistic beliefs about consequences’ (OR = .41 [.18, .94]) and ‘negative emotions’ (OR = .50 [.32, .77]). In the multiple linear regression (R2 = .29), the significant enablers of frequency of MECC delivery were ‘intentions/goals’ (b = 10.16, p = .02) and professional role (b = 6.72, p = .03); the significant barriers were ‘negative emotions’ (b = −4.74, p = .04) and ‘barriers to prioritisation’ (b = −5.00, p = .01). CIBER analyses suggested six predictive domains with substantial room for improvement: ‘intentions and goals', ‘barriers to prioritisation', ‘environmental resources', ‘beliefs about capabilities', ‘negative emotions’ and ‘skills'. CONCLUSIONS: High levels of brief intervention delivery were identified, however, there were also many missed opportunities and significant barriers to delivery. KEY MESSAGES: • Implementation interventions to enhance MECC delivery should target intentions, goals, beliefs about capabilities, negative emotions, environmental resources, skills, and barriers to prioritization. • Future interventions should address these barriers by: (a) supporting setting intentions and goals; (b) improving training and (c) ensuring the environment is conducive to MECC delivery.