Title: Communities in Charge of Alcohol (CICA) Programme: Evaluation of an alcohol health champions programme in Greater Manchester
Funder: Department of Health and Social Care

Abstract: BACKGROUND: The availability of, and access to, alcohol is a key determinant of alcohol harm. The newly devolved Greater Manchester (GM) Combined Authority is commissioning a new programme ‘Communities in Charge of Alcohol’ (CICA), which aims to facilitate local communities to reduce alcohol availability through local licensing processes. This approach fits with Government policy to empower local communities to influence the alcohol environment[1]. AIMS: to evaluate the effectiveness and cost savings of CICA and understand the context and factors that enable or hinder the intervention. DESIGN OF INTERVENTION: CICA is a complex intervention that aims to tackle alcohol harm at different levels. Lay volunteers who already have a ‘health champion’ role will be trained to become alcohol health champions (AHCs), who will be able to (1) give alcohol-related brief advice to individuals, and (2) help communities influence alcohol availability in the local environment. The intervention will be applied to 10 small areas (~4000-7000 residents each) in GM. The implementation of the intervention is already planned and is outside direct researcher control. Researchers will be able to randomise the order of roll-out of CICA to bring a quasi-experimental approach to the evaluation. EVALUATION: This project is organised into three workpackages (WP), which will compare areas in which CICA has been implemented to control areas (matched using propensity score matching prior to the start of the intervention). WP1 is the process evaluation, and will examine the local policy context (i.e. factors in different neighbourhoods that might affect intervention delivery and the response to it); implementation of the intervention especially dose (the ‘amount’ of the intervention that is implemented, and whether it is delivered as planned) and reach (e.g. the numbers that receive the intervention and whether it reaches the target group); response to the intervention (e.g. levels of engagement, attitudes towards it, does the response of participants change the way the intervention is implemented); and outcomes in terms of community engagement with the licensing process. Methods used will include: interviews with stakeholders, practitioners and health champions; focus groups with community members; and document review. WP2 will be the quantitative outcomes analysis. Routinely collected data on key performance indicators (alcohol-related hospital admissions data, emergency department attendance data, ambulance call outs, and reported crime rates) will be aggregated at the area of the intervention (areas comprising 4,000-7,000 residents) and analysed using log-rate growth models and timeseries analyses to quantify the effect of the CICA programme. WP3 is an economic evaluation that will consider the cost of the alcohol health champions training and support infrastructure. WP3 will rely on input from WP1 and WP2 to determine the costs of setting up and cost savings that may be realised elsewhere (e.g. due to reduced alcohol hospital admissions). IMPACT: If successful CICA would be rolled out in GM immediately, while national decision makers will be briefed on opportunities for UK roll-out. We will share what is known about how it works (processes, barriers and opportunities). If effective and cost-saving, this grass-roots intervention could have a considerable impact on alcohol-related population burden if rolled out in the UK.

Lay abstract: Excessive alcohol consumption harms an individual’s health and social relationships. It places a burden on hospitals. It also harms society more generally, as urban areas become less pleasant to visit and crime increases. The impact of alcohol abuse is worse for people living in poorer areas. The amount of alcohol consumed in different communities depends on a range of factors, with a variety of studies showing that the widespread availability of cheap alcohol increases both levels of drinking and harm to individuals and society. The goal of this project is to provide vital evidence for local authorities planning community action on alcohol, by rigorously evaluating a programme called ‘Communities In Control of Alcohol’ (CICA) that is planned to take place in Greater Manchester. Through CICA, local people who have previously received existing ‘health champions’ training will be trained as ‘alcohol health champions’ (AHCs). These AHCs will in turn be able to train others, and all trained individuals will achieve a formal Level 2 qualification as an AHC. Training will enable AHCs to have informal healthy conversations with family, friends and colleagues, organise healthy events and model healthy behaviour with respect to alcohol. CICA will provide training and local support for communities to get involved in alcohol licensing decisions, and aims to put local communities in a position to help reduce the availability of alcohol and the impact of alcohol abuse. Each of the ten boroughs in Greater Manchester will choose a small geographic area (consisting of around 4,000-7,000 residents) to apply the CICA programme. This will be an area that has high current levels of alcohol harm and significant economic and social deprivation. During the first year of the project, five individuals in each area will be trained and these will be supported in rolling out training to a further 30 individuals in each area (350 in total across Greater Manchester). In order to take advantage of this ‘natural experiment’ we will compare before and after CICA, and we will select areas in each borough that are similar in terms of geography and social variables to the sites being investigated to act as comparison sites. We will use a range of methods to assess whether CICA does indeed reduce alcohol harm. These include observations, where researchers shadow AHCs to understand how they work in the community, and surveys of AHCs to understand how they are applying their new knowledge and skills. By comparing the CICA areas with the matched comparison areas that have not experienced CICA, we will also be able to measure whether the intervention reduces the undesirable consequences of alcohol such as hospital admissions, A&E attendances, ambulance call outs and levels of crime over a one to four year period. If the intervention does appear to reduce these harms in the community, in year five we will also be able to calculate whether CICA could save society money. This would involve calculating the costs of running CICA versus the potential money saved. If successful, CICA will be immediately applied throughout GM to benefit the population of 3million people. National policy and decision makers will be briefed on how CICA might work if applied to the whole of the UK, and how much money could be saved by doing so. As well as this, we will promote the findings widely in the press, through social media as well as scientific journals and conferences.

Research activity codes: 3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING;3.2 INTERVENTIONS TO ALTER PHYSICAL AND BIOLOGICAL ENVIRONMENTAL RISKS
Health categories: CANCER AND NEOPLASMS;CARDIOVASCULAR;ORAL AND GASTROINTESTINAL;STROKE