“It’s difficult when everyone else is drinking, you don’t feel part of the tribe”: a Delphi study of barriers and enablers to alcohol reduction in mid-life women.

Objectives: Midlife women are an important group to target for alcohol reduction, but there is a lack of research on drinking behaviour in this population. To address the gap, this study applied the Behaviour Change Wheel framework, and identified barriers and enablers to alcohol reduction to inform the development of a novel intervention. Methods and measures: In a three round online Delphi study 310 women aged 40-65 years completed a survey including COM-B measures, and rated the acceptability of 12 clusters of BCTs; 33 women took part in focus group discussions, and 7 took part in a final workshop. Results: Automatic motivation (habits) and social opportunity (other people’s drinking) were the strongest correlates of current drinking behaviour. BCT clusters rated highly were substitution, goals and planning, and identity. Focus groups highlighted the challenges of being a non-drinker in an ‘alcogenic’ world. Workshop findings suggested an intervention should promote connection with others, and include real life stories from women to promote behaviour change. Conclusions: Midlife women who choose to change their drinking behaviour may face social pressure and stigma. Interventions need to support women and reduce feelings of judgement: using storytelling may be a way to address these challenges.