Rural-SBI

In Georgia, as in many countries around the world, the use of alcohol and other substances has a significant impact on population health. These problems are often not identified in a timely manner, especially at the level of primary care – that is, the first point of contact when a person seeks medical attention.
Primary care physicians (family doctors, rural clinic staff) have a unique opportunity to detect risks early, discuss alcohol, tobacco, and other substance use with patients, and offer simple but effective interventions. However, in practice this does not always happen, which may be due to limited time, lack of appropriate training, systemic barriers, stigma, and cultural factors.
The aim of this project is to analyze these challenges and develop solutions that can realistically work within the context of rural primary care in Georgia.
The study uses an approach known as Screening and Brief Intervention (SBI). During screening, the physician asks a patient several standardized questions to assess alcohol or other substance use, frequency of use, and level of risk. If the patient is identified as being at risk, the physician provides a brief (5–10 minute) counseling session, explains the risks, gives recommendations, and helps motivate behavioral change. This method is low-cost, easy to implement, and has been shown in international research to be effective.
The project is based on clearly defined Specific Aims, which include: examining existing practices and challenges at the primary care level, particularly in the management of non-communicable diseases and risk behaviors (e.g., alcohol and drug use); identifying the experiences and needs of patients and healthcare professionals; and developing and pilot a context-adapted, implementable digital educational intervention based on the evidence generated. These aims ensure that the research is practically applicable and directly contributes to improving the health system.
The study will examine how physicians perceive this approach, what barriers prevent its use, what facilitates its implementation, how patients respond, what educational resources and approaches are needed, and what systemic changes are required. Within the study, educational materials will be developed for rural physicians, and relevant training will be provided.
The project will use both qualitative and quantitative research methods. The focus is on people’s experiences, opinions, and attitudes, as well as the needs of the Georgian population.
The study will assess existing practice and the working environment through interviews with physicians and field visits, as well as consultations with employers, professional associations, and governmental structures. During field visits, we will observe how and in what settings patient consultations take place and how clinical practice is supported and strengthened.
The study is an implementation science project. This field examines how to translate effective ideas and methods into real-world practice—that is, not only “what works,” but also how to implement it, under what conditions it works, and how to adapt it to a specific country.
This project will use a structured theoretic frameworks that enable systematic analysis of organizational context, human factors, healthcare governance, and resources.
The project is fully aligned with Georgia’s national health priorities and strategic directions, as it contributes simultaneously to the development of the healthcare workforce, improvement of physicians’ professional qualifications, and strengthening of continuing professional education. In addition, the project aims to strengthen the primary care system by ensuring high-quality, patient-centered, and integrated services. Special attention is given to the prevention of non-communicable diseases and reduction of related risk factors, including alcohol and drug use, as well as the strengthening of mental health support, which is fully consistent with the country’s long-term health policy and action plans.

Summary:

This project is an important step toward strengthening primary care, equipping physicians with effective tools, and ensuring that patients receive timely and appropriate medical care.
The study aims not only to describe the problem but also to create real-world solutions that will be implemented in practice and benefit the population of Georgia.

Innovation:

This study introduces a novel, scalable approach to implementing Screening and Brief Intervention (SBI) in rural primary care in Georgia through a digitally delivered, culturally tailored continuing medical education (CME) intervention. It develops an interactive online training program using virtual patient simulations designed specifically for rural healthcare providers. While digital and simulation-based SBI training remains underutilized in low-resource and rural settings, this project addresses a key gap in implementation strategies for substance use interventions in primary care.
Unlike conventional CME, the intervention integrates culturally adapted virtual patient scenarios into a flexible online format tailored to rural clinicians’ needs and constraints. This approach reduces logistical barriers, increases engagement, and enhances the feasibility of SBI delivery in routine practice. By leveraging Georgia’s emerging telemedicine infrastructure, the intervention is designed to be scalable, cost-effective, and sustainable for underserved areas.
A key innovation is the use of a combined implementation science framework approach, integrating the Implementation Outcomes Framework (IOF) with the Consolidated Framework for Implementation Research (CFIR) to examine multi-level determinants of SBI adoption. This enables a comprehensive analysis of individual, organizational, and system-level factors to optimize implementation.
Finally, culturally tailored CME modules will be developed based on qualitative input from primary care providers and health system stakeholders, incorporating local language, clinical scenarios, and context-specific examples. This enhances relevance, acceptability, and potential for sustained implementation in Georgia and similar low-resource settings.

About the Fogarty Emerging Global Leader Award:

The purpose of these grants is to provide research funding and protected time for investigators from low- and middle-income countries (LMICs) who hold academic positions in their home institutions. The overall goal of the NIH Research Career Development Program is to ensure a highly skilled scientific workforce in biomedical, behavioral, and clinical research fields. The National Institutes of Health and its institutes support career development programs that promote the transition of new investigators toward independence and assist experienced investigators in achieving specific scientific goals.
The NIH K43 award is a hybrid mechanism that combines research implementation with structured support for the investigator’s career development.
The career development component of this project aims to strengthen knowledge and skills in implementation science, qualitative and mixed-methods research, and the design and evaluation of interventions in primary care systems. Planned activities include intensive mentorship, participation in specialized courses and trainings, and hands-on experience in research design, data collection, and analysis. The candidate will receive continuous mentorship support from multidisciplinary and international experts, which will facilitate the development of grant writing, scientific leadership, and dissemination skills. These activities will ensure the development of an independent investigator and sustainable capacity to conduct high-quality, locally relevant research in Georgia.