SCALA Update: moving to a 4-arm study

The SCALA Study changes from a 2-arm to a 4-arm design

The project has taken the decision jointly to change the SCALA study design from 2 to 4 study arms, in order to be able to give more precise information about what works (and what doesn't) in increasing screening and brief interventions in primary care for alcohol and co-morbid depression.

The 4-arm study design will compare centres with and without municipal support and with a standard version vs a shorter version of the trainig and implementation programme.

The reasons for adopting a 4-arm study design in scala are the following:

  • One outcome of discussions with country partners (as part of tailoring and adaptation) was a request to simplify components of SCALA, including clinical package and training package;
  • Alignment with the objectives of SCALA, whose aim is to increase chances of scale-up in resource-constrained countries;
  • Provide for first time scientific answer to question of whether implementation and penetration of screening and advice and treatment programmes is higher when the package to be scaled is simpler and shorter rather than more complex and longer;
  • The decision is aligned with evidence that briefer advice programmes are as effective as longer ones.

The study arms will consequently be:

Arm 1: Control - no training or municipal action

Arm 2: Control with training (short version)

Arm 3: Intervention - Municipal action plan + short training/intervention package

Arm 4: Intervention - Municipal action plan + standard  training/intervention package