Alcohol-Related Brain Damage: A Delphi Consensus Study and the Development and Pretesting of a Novel Screening Tool

Alcohol-Related Brain Damage (ARBD) remains under-recognised within UK health and social care services despite evidence that early identification and intervention can improve outcomes. Identification is currently reliant on non-specific cognitive measures or informal clinical judgement, with no standardised ARBD-specific screening tools available. This PhD aimed to address this gap by exploring service-provider perspectives on ARBD and developing a novel screening instrument to support earlier identification across diverse services.<br/><br/>A multi-phase mixed-methods design was employed. A Delphi study was conducted with experienced practitioners and explored current service provision, clinical characteristics, barriers to identification, and recommendations for ARBD screening. Codebook thematic analysis generated key domains relating to knowledge gaps, characteristics and predictors and the navigation of ARBD in NHS and third-sector services. The second and third rounds employed consensus questionnaires to refine and quantify agreement on screening-relevant items. Thirty-one of thirty-five items reached consensus, forming the evidence base for tool development. A draft ARBD screening tool was subsequently constructed using the Boateng et al. (2018) framework as guidance, integrating alcohol history, service involvement, nutrition, delayed recall, behavioural observation and collateral information.<br/><br/>The final phase involved a pretest of the tool with 38 service providers to evaluate acceptability, clarity, feasibility and perceived utility. Findings demonstrated strong endorsement of the need for an ARBD-specific screening tool, with high agreement that the tool was relevant, appropriately worded, feasible for use across services, and capable of supporting earlier identification and potentially reducing misdiagnosis. Practitioner feedback informed refinements to the layout, guidance, and screening eligibility criteria.<br/><br/>This PhD makes an original contribution by providing the first service-informed ARBD-specific screening tool designed for use by non-specialist practitioners. The findings highlight the central role of stigma, service barriers and fragmented pathways in delayed identification, and position structured screening as a mechanism for improving awareness, equity of access and early intervention. Further piloting with service users and psychometric evaluation are recommended to establish reliability, validity and implementation outcomes.<br/>

Name dc:type.qualificationname

Doctoral Thesis

Level dc:type.qualificationlevel

Student thesis

Year dc:date.issued

2026

Author dc:creator

• Cassley, Harriet

Advisors dc:contributor.advisor

• Roderique-Davies, Gareth
• John, Bev
• May, Richard

Language dc:language

eng

Identifier

oai:pure.atira.dk:studenttheses/60f7872b-e809-48de-8e69-0dba15cdc48e

OAI identifier oai:identifier

oai:pure.atira.dk:studenttheses/60f7872b-e809-48de-8e69-0dba15cdc48e