Horizon Interdisciplinary Journal (HIJ). ISSN: 2992-7706
Volume 2 (2): e27. July-September. 2024.
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Original Article
Explanatory Model of Alcohol Consumption in
Health Care Personnel.
Edgar Omar Vázquez-Puente
1
, Karla Selene López-García
2*
, Julia Lizeth Villarreal-
Mata
2
, Francisco Rafael Guzmán-Facundo
2
y Adriana Patricia Castillo-Méndez
2
.
1
Escuela de Enfermería Christus Muguerza - Universidad de Monterrey, Nuevo León,
México.
2
Facultad de Enfermería. Universidad Autónoma de Nuevo León. Monterrey, Nuevo León,
México.
*Corresponding author: Karla Selene López- García
1
, Facultad de Enfermería. Universidad
Autónoma de Nuevo León. Monterrey, Nuevo León, México. E-mail:
kslg2001@hotmail.com ORCID: https://orcid.org/0000-0002-9462-7140
Sent: 02/03/2024 Accepted: 06/28/2024 Published: 09/05/2024
Abstract: This article presents a proposal for the conceptual-theoretical-empirical
substructuring strategy, resulting in the construction of an explanatory model that shows
factors related to alcohol consumption among healthcare personnel, based on the Socio-
Ecological Model of McLeroy et al. (1988) and empirical evidence. This model is useful in the
nursing profession to gain insight into the healthcare personnel population and, in the
future, continue research by implementing alcohol consumption prevention actions.
Keywords: Explanatory model, Alcohol consumption, Health personnel.
1. Introduction
Alcohol consumption represents a major
public health problem, both due to causing
human losses and deteriorating quality of
life
1
. Regarding the first effect mentioned,
the World Health Organization (WHO)
identifies this substance as the second
behavioral risk factor for death in men and
the fifth in women. This organization also
highlights how alcohol causes organ
damage, provokes aggressive behaviors, and
even contributes to triggering mental
disorders
2
.
Addressing the issue of alcohol
consumption among healthcare personnel
is of great importance due to the pressure
nurses and doctors endure. Reasons include
their exposure to contagious diseases,
especially during the COVID-19 pandemic,
or workload overload in a job that involves
constant attention and care. This often
leads to physical and mental exhaustion
3
, as
well as mental health disorders such as
anxiety, depressive symptoms, or burnout
syndrome
4
. Consequently, the consumption
of substances, notably alcohol, is common
as a way to cope with the issues arising from
their work routines
5
.
Various countries have reported alcohol
consumption among healthcare personnel:
in the United States, 80% of nurses reported
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consumption, of which 67.3% were at low
risk
6
; in France, 35.7% of doctors reported
dangerous consumption, with 15% engaging
in this behavior daily
7
; in Mexico,
consumption has been identified to range
between 41.2% and 79.8%, with higher
consumption among healthcare personnel
aged 18 to 33 years
4,8
.
Several studies have focused on isolated
factors that may influence alcohol
consumption among healthcare personnel
9-
12
. However, there is a scarcity of
multifactorial research offering an
explanation for alcohol consumption in
healthcare personnel
13
. Regarding
multifactorial explanations, it has been
found that mental disorders impact the
sociopolitical and family spheres of
healthcare personnel, leading to decreased
productivity, achievement of personal and
family goals, and adequate performance of
social, educational, and work roles.
In this context, social ecology studies the
effect of the relationship between its
dimensions of analysis on behavior and
health; thus, the health behavior of nursing
and medical personnel is influenced by the
sum of individual, interrelational,
organizational, political, and cultural
aspects
14
. However, some models focus only
on the individual and the process of change,
without considering the interpersonal,
social environment, and cultural factors that
influence behavior
15
.
The literature review identifies scarce
evidence on the models used in studying the
socio-ecological factors that can provide a
comprehensive explanation for alcohol
consumption in this population sector
16
. To
date, available references on ecological
models have focused on adolescents and
university students with substance use
problems
17-19
.
Since no model or theory has been
identified related to alcohol consumption
among healthcare personnel and their
various social interactions, it is necessary to
use theoretical models that allow
understanding and explaining this issue
through a new interpretation of the
concepts of the reference theoretical
model. Therefore, the implementation of
the conceptual-theoretical-empirical (C-T-
E) structure is useful in the present study, as
it analyzes the components of a structure
and the content of a theory, with the aim of
showing what a conceptual model indicates
based on the identification of concepts,
their classification, the identification of
propositions, their hierarchical ordering,
and the construction of the resulting
diagram
20
.
Consequently, the objective of the study is
to present a proposal for constructing a
socio-ecological model that explains alcohol
consumption among healthcare personnel
through the implementation of the
conceptual-theoretical-empirical (C-T-E)
substructuring method.
2. Method
To develop the Explanatory Model, the C-T-
E Structure method was used. This method
aims to identify the concepts and
propositions that constitute the model, thus
obtaining a structure that clearly, concisely,
and representatively reflects these
components. Achieving this requires
reflective and analytical thinking as well as
careful planning
20
.
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To obtain the C-T-E Structure, five steps
were employed: 1) identification of
concepts, 2) classification of concepts
within the explanatory model, 3)
identification and classification of
propositions, 4) hierarchical arrangement of
propositions, and 5) construction of the
diagram.
2.1 Analysis of McLeroy and Colleagues
Socio-Ecological Model
The Socio-Ecological Model (SEM) has been
widely used in health promotion,
considering behavior as the object of study
and determined by levels of social influence.
The SEM takes into account individual,
social, and environmental factors to impact
health promotion. This model posits that
behavior affects and is influenced by social
levels, which include the individual and
characteristics such as knowledge, skills,
self-concept, and self-confidence
(intrapersonal level); social relationships,
including family and friendship ties and
connections (interpersonal level);
organizational influences and workplace
factors (organizational level); community
aspects (community level); and legislation,
policies, and taxes (public policy level)
15
.
Additionally, Simons-Morton and
colleagues propose adding norms, beliefs, or
values held by the individual regarding a
certain phenomenon (cultural level)
14
.
3. Results and discussion
3.1 Concepts of the Explanatory Model of
Alcohol Consumption in Health Personnel
(MECAPS)
The central concepts of the SEM considered
for this work are: level 1) intrapersonal, 2)
interpersonal, 3) organizational, 4) public
policy, and 5) culture. For the present study,
the community level will be excluded as it
does not aim to address health personnel
outside the hospital institution; hence,
aspects related to the neighborhood will not
be investigated
15
.
Regarding the first level, aspects related to
cognitions that affect a person's behavior
are addressed, which are generated as a
result of work overload, long working
periods without rest, and the excess of
patients attended to
14
.
The second level addresses aspects that
influence interpersonal relationships,
focusing on behavioral influences, including
influences from family and friends, who
provide important mediating components
in life and general well-being
14
.
At the third level, organizational aspects are
related to consumption due to the
characteristics of the organization where
the health personnel work; these
organizations can influence health behavior,
for example, by providing direct services
against alcohol consumption
14
.
At the fourth level, aspects related to public
policy also influence alcohol consumption
through legislation, taxes, and regulatory
agencies, as well as the subjective
appreciation of local, state, and federal
policies
14
.
Finally, at the fifth level, cultural aspects can
affect habits and practices that increase or
decrease health risks. Here, attitudes
toward consumption can be accepted and
measured in terms of attitudes, beliefs, and
perceptions toward alcohol consumption
15
.
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3.2 Classification of Concepts of MECAPS
The concepts presented are classified using
Kaplan's observability continuum, which
represents a phenomenon as a directly
observable empirical referent
21
. At the
intrapersonal level, individual
characteristics of a person are included.
These include age, gender, education,
anxiety, depressive symptoms, and burnout
syndrome. The literature indicates that
certain factors are attributable to alcohol
consumption, notably age, as it has been
identified that health personnel who begin
alcohol consumption at a younger age are
more likely to exhibit abuse or dependence
on this substance in adulthood
22
.
Gender is another attributable factor, with
males consuming greater amounts of
alcohol. However, female consumption has
been considered an alternative to counter
traditional masculine codes by
incorporating more masculine practices
23
.
Regarding the education level of health
personnel, fewer years of academic training
influence their perception of the health
consequences of alcohol consumption
24
.
Another variable of interest is anxiety, as
health personnel with this condition may
develop substance use disorders such as
alcohol in an attempt to self-regulate
symptoms, with a higher prevalence
observed among female nursing staff
3,25
.
Additionally, early alcohol consumption
during adolescence can foster the
development of depressive symptoms in
adulthood
26
. Burnout syndrome is another
influential factor, affecting job satisfaction,
health, and well-being. Health personnel are
reported to be three times more likely to
develop burnout when there is alcohol
consumption on four or more occasions per
week
27
.
At the interpersonal level, the influences of
the individual's environment through social
support are included. Having social support
such as family or friends generates a
beneficial influence to cope with stress-
inducing situations
28
. Having a support
network or company that can provide
assistance or counseling when needed can
be vital for overall health, as it encourages
rejection of alcohol consumption
29
.
However, health personnel who perceive
alcohol consumption by peers are more
likely to adopt this behavior, regardless of
the amount and frequency of
consumption
30
.
At the organizational level, the
organizational health climate is included
through the subjective and socially shared
perceptions that workers have about the
characteristics of the organization and the
work environment. A favorable
organizational climate for health personnel
provides achievements, productivity, unity,
and peer support, motivation, among other
factors. Conversely, a negative climate
manifests through maladaptation, high staff
turnover, absenteeism, and low
productivity, which are associated with
alcohol consumption, leading to poor
performance, unexcused absences, and
workplace accidents, resulting in greater
work-related problems compared to those
who do not consume these substances
31,32
.
At the public policy level, the perception of
public policies by health personnel is
included. Policies are designed to
strengthen associations that contribute to
creating environments that favor the
generation or expansion of health responses
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against alcohol consumption by generating
a protective effect against alcohol
consumption and related harms
15
. Measures
such as restricting availability, marketing,
and increasing prices are favorable for
reducing consumption
33
.
Finally, at the cultural level, attitudes
toward consumption are included,
represented by actions taken to address
health problems through cultural attitudes
and norms regarding alcohol intake. For
example, during adolescence, parental
norms are overridden by the influence of
peers' more permissive norms toward
alcohol consumption, leading to risky
consumption practices in adulthood
34
.
3.3 Identification of Propositions of
MECAPS
The SEM does not contain theoretical
assumptions; however, a central
proposition can be identified through its
content, which states that the behavior or
conduct of health personnel is established
based on the five social levels: intrapersonal,
interpersonal, organizational, public policy,
and culture.
Based on the above, a central proposition in
the present investigation indicates that
alcohol consumption behavior in health
personnel has multiple influences across
the five social levels
15
.
3.4 Hierarchical Arrangement of
Propositions of MECAPS
This model proposes relationships between
the concepts included in the five social
levels, which influence the outcome
behavior (alcohol consumption):
Age, gender, education, anxiety, depressive
symptoms, and burnout syndrome influence
alcohol consumption in health personnel.
Social support affects alcohol consumption
in health personnel.
The organizational health climate predicts
alcohol consumption in health personnel.
The perception of public policies affects
alcohol consumption in health personnel.
Attitudes toward consumption predict
alcohol consumption in health personnel.
The relationship between intrapersonal,
interpersonal, organizational, public policy,
and cultural social levels influences alcohol
consumption.
The six propositions mentioned above
indicate a link between two or more
concepts, so they can be categorized as
relational proposals
20
.
3.5 Construction of MECAPS Diagram
Figure 1 shows the relationship of the four
social levels (intrapersonal, interpersonal,
organizational, public policy) from McLeroy
et al.'s (1988) SEM and the social level
(cultural level) added by Simons-Morton et
al. (2012), which were used to guide the
structural composition. Therefore, the
integrated concepts in the SEM are
proposed, grouped into five levels, as well as
the evaluation instruments that will be used
to measure each of the concepts of the
Explanatory Model of Alcohol Consumption
in Health Personnel.
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Figure 1. Theoretical substructure of MECAPS.
4. Conclusions
In disciplinary nursing research, McLeroy
and colleagues' Socio-Ecological Model has
been used in the Mexican context to direct
research studies among high school
adolescents16 and university students
32
related to drug use. However, there is no
empirically proven evidence identified in
health personnel associated with alcohol
consumption, nor the implementation of
the social level of culture to address the
issue holistically.
Therefore, the present proposal of a
substructured model represents an
alternative to explain the relationship of
factors that can influence alcohol
consumption through different social
levels. In this regard, MECAPS was
developed through the technique of
theoretical substructuring based on
McLeroy and colleagues' SEM, with the
cultural level proposed by Simons-Morton
and colleagues. MECAPS addresses five
social levels of intrapersonal,
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interpersonal, organizational, public policy,
and culture, which can positively or
negatively influence alcohol consumption
in health personnel.
The development of the Explanatory Model
enriches the nursing discipline and
provides knowledge for understanding
alcohol consumption, which can be used as
a foundation to implement promotion and
prevention actions regarding alcohol
consumption among health personnel.
5. Declarations
5.1 Author Contributions
Conceptualization: EOVP; Methodology:
KSLG; Validation: JLVM; Formal Analysis:
FRGF., APCM; Investigation: EOVP;
Resources: EOVP; Data Curation: FRGF.,
APCM; Writing – Original Draft: EOVP;
Writing – Review & Editing: KSLG., JLVM;
Visualization: JLVM., APCM; Supervision:
EOVP., KSLG; Project Administration:
EOVP.
5.2 Conflict of Interest
The authors declare that there is no
conflict of interest regarding the
development of this study.
5.3 Funding
This study was conducted during the
doctoral studies of the first author, who
received a scholarship for postgraduate
studies from the National Council of
Humanities, Sciences and Technologies
(CONAHCYT) of Mexico.
5.4 Acknowledgements
To the National Council of Humanities,
Sciences and Technologies (CONAHCYT).
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Copyright © Edgar Omar Vázquez Puente, Karla Selene López García, Julia Lizeth
Villarreal Mata, Francisco Rafael Guzmán Facundo and Adriana Patricia Castillo Méndez
2024
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