COVID-19 disruption - impact on SCALA

The COVID-19 pandemic in 2020 has had various impacts on SCALA, and the SCALA study has made several changes to continue and advance during the different pandemic situations, including a telemedecine adaptation of the SCALA package.

How the COVID-19 pandemic impacts on SCALA and other primary health initiatives to tackle drinking:

• It is normal and understandable that people are experiencing increased feelings of fear, worry, and stress in the uncertain context of the COVID-19 pandemic. Although the evidence is still not robust, this could cause some people to adopt unhelpful coping strategies, such as drinking more alcohol or harmful drinking behaviours (e.g., binge drinking, excessive drink around minors, violence associated with drinking)
• The health service is under strain from coping with the health consequences of the virus; leaving professionals less time to devote to other issues, such as training and screening for harmful alcohol use. Professionals are also under stress, and may find it harder to apply new methods
• The SCALA study timing and format have had to be adapted to work around these issues and the necessary switch to telemedicine that COVID-19 has brought about

In order to continue the SCALA project and study, several changes were required to enable professionals to take on training and talking with patients about alcohol, and to continue collecting the data needed to study the SCALA package effectiveness:

• Country partners in Colombia, Peru and Mexico have started keeping log diaries to document the changes and challenges in their countries due to the virus
• The researchers are in contact with providers to explore ways to support mental health and well-being (of professionals and the general population) in this difficult situation
• The ‘tally sheets’ to input and record data have been developed as an online version to avoid transmission through physical paper copies
• Given the unusual mental strain that the pandemic places on populations, several of the clinical tools and materials have been adjusted for this phase 2 to place greater emphasis on detecting and treating depression in the intervention package. This involves screening for depression in all primary health patients (as opposed to screening for depression only in patients identified as risk drinkers), and required changes in clinical materials and data collection instruments.
• In response to the physical lockdown of PHC units, the SCALA partners in Peru (UPCH) developed online versions of the training and intervention package for future implementation. The telemedicine package uses responsive online versions of the key clinical materials that are accessible and viewable via smartphone as well as web browser (in Spanish): 
  • Short alcohol leaflet for patients (Mat11)
  • Patient alcohol leaflet (Mat10)
  • Depression leaflet (Mat9)
• A second implementation phase (phase 2) of 6 months has been undertaken from December 2020 to May 2021, to recuperate data lost through disruption due to COVID