Community-based survey methodology for measuring alcohol use in a rural Indian village facing alcohol-associated stigma

Background: Alcohol abuse among men in rural India prevents accessing health and community development. Screening methodology for alcohol use exists for clinical and community settings; however, little work has adequately addressed stigma while screening. Here a method is reported for entering an alcohol-stigmatized community to survey alcohol use through a hypertension study administered with a local village health worker (VHW). Methods: To address alcohol-related stigma, a three stage intervention was conducted among men in a village of 291 households in Maharashtra state. First, a hypertension study, with embedded questions on exercise, diet, tobacco and alcohol use, mitigated stigma by directing attention toward blood pressure, creating trust via the VHW, and administration in patient's homes. Second, a community meeting reviewed data on hypertension and its relation to alcohol use through relatable graphs. Third, alcohol dependence was measured via AUDIT questionnaire and a follow-up meeting was organized for alcohol users to discuss intervention. Results: 262 men (median age 34 years) were surveyed and the methodology reduced stigma by creating a trusting environment. Data presented to the village highlighted alcohol's correlation with hypertension. 31.3% consumed alcohol with 47.6% of these drinking heavily (at least twice/day, seven days/week). 9.8% with normal BP, 12.7% with pre-hypertension, 27.3% with stage 1 hypertension, and 40.0% with stage 2 hypertension drank heavily. Conclusion: By utilizing a trusted VHW, integrating questions into a hypertension study, and mobilizing the community with results, alcohol-associated stigma was reduced. This methodology should be considered by others addressing alcohol use in rural settings.