Adapting AUDIT’s Quantity-Frequency questions

In my last post, I discussed in detail the challenges I had to face in the attempt of administering the AUDIT’s quantify-frequency question items.

I overcame these challenges successfully. And I have presented the adaptation process in many scientific fora in Sri Lanka and elsewhere such as the US and Thailand. In Canada, I presented it as a poster at the Canadian Society for International Health Conference in Ottawa held on the 29th October 2017 since I believed that it could be adapted to in cultural setting.

The steps I developed were as follows:

Step 1: Determine consumer-preferred alcoholic products, drinking containers, and drink sizes

Step 2: Determine representative beverage-group specific ethanol content and translate into grams

Step 3: Calculate the number of standard drinks in “consumer-preferred drink sizes”

Step 4: Replace “standard drinks” with “consumer- preferred drinks” in the AUDIT quantity-frequency questions and its responses

Steps in detail:

Step 1: Determine consumer-preferred alcoholic products, drinking containers, and drink sizes

First, I conducted a series of key informant interviews with members of my study population – adult married males in a village setting. The interviews aimed at determining their “preferred” alcoholic products, drink sizes, and containers. The key word here is the “preferred”.

My study participants preferred beer (two types: mild and strong); local arrack; whisky (and other foreign liquor), Toddy (a local licit product), and kassippu (a local illicit product). And, I found that their usual drink sizes and glasses and containers varied with the product type. Then, my professional photographer captured their “preferred” drink sizes. As you all are well aware of a large number of alcoholic products, I limited the number of products to six to make it manageable.

alcoholic products visual aids

Step 2: Determine representative beverage-group specific ethanol contents and translate into grams    

I determined the representative ethanol content for each beverage-specific group, multiplied it by ethanol’s specific gravity (0.8) to translate into grams, and approximated the value to the nearest number. During this process, I overcame my additional challenge of determining the representative ethanol content for illicit liquor using the median ethanol value from 12 samples collected from representative geographical locations of the study area.

coversion chart

Step 3: Calculate the number of standard drinks in “consumer-preferred drink sizes”

Using the above values, I calculated the number of grams in “consumer-preferred drink sizes” and the number of standard drinks in respondent preferred drinks. Keep in mind that I used the international standard drink size definition recommended in the AUDIT manual – an ethanol content containing 10 grams of ethanol.  (Note that North American standard drink refers to amounts containing 14 grams of ethanol).

coversion chart with grams and standard drinks

Step 4: Replace “standard drinks” with “consumer- preferred drinks” in the AUDIT quantity-frequency questions and its responses

Now, you can see the adapted AUDIT’s second and third questions and its responses. Compare these two with the original AUDIT second and third questions. ( I have cited below).  Note that the responses in the dark green line in the second question are equivalent to the original third question of the AUDIT – “6 drinks or more”.

adapted AUDIT Q2 and Q3

The following are the original AUDIT second and third questions and its responses.

original AUDIT Q2 AND 3
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Author: Prasantha De Silva

A specialist in Community Medicine board-certified in Sri Lanka and a research analyst in Canada

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