Why is it hard to ask about drinking in primary care?
Asking about drinking and providing tailored brief intervention are recommended in primary care settings. However, this does not always take place in a routine way. Among Aboriginal and Torres Strait Islander peoples, colonisation and experiences that followed such as racism, fear of adverse consequences (including child removal), feelings of shame and competing health priorities may further hinder alcohol screening and care. Previous studies have shown how health workers do not feel comfortable or equipped to ask people about their drinking or to offer a brief intervention. Even when screening occurs, accuracy may be an issue. Working out how much alcohol is consumed can be challenging if ‘non-standard’ containers are used (e.g. pannikin, sports or soft drink bottle), if drinks are shared, or if there is no ‘regular’ pattern of drinking.
Digital tools could have a role in asking about drinking
Digital tools have been shown as an option for culturally informed alcohol screening among Aboriginal and Torres Strait Islander peoples. One such tool is the Grog App, an accurate and acceptable screening tool for Aboriginal and Torres Strait Islander peoples to describe their drinking [1]. Using interactive visual functionality, the Grog App helps participants describe their drinking using their preferred alcohol type and container, converts their consumption to standard drinks, and provides a tailored brief intervention [2]. However, the Grog App was developed as a community survey tool and so is too long for routine use in primary care.
Efforts to shorten the Grog App for use in primary care
To shorten the Grog App for use in primary care, we conducted a three-round Delphi study. The Delphi panel consisted of 12 experts from around Australia, two-thirds of the panellists were Aboriginal and/or Torres Strait Islanders, with an average of 18 years of experience working in primary care, 15 years in drug and alcohol, and 20 years working with Aboriginal and Torres Strait Islander peoples.
What did the Delphi panellists tell us?
The panel agreed that the ‘Grog Check’ app should be brief (less than 5 minutes) while still providing clinically relevant information. Overall, consensus was reached on 17 of the 24 proposed items. Some items endorsed for inclusion include asking about:
1. Pregnancy status
2. Alcohol-related harms (if the person has worries about their drinking)
3. Dependence (if the person has symptoms of dependence)
4. Context of drinking (if the person drinks more when happy, sad, alone, with others)
5. Dry periods (if the person has periods of not drinking)
6. Concurrent risk behaviours (if the person uses prescription medicines, illicit drugs or gambles while drinking)
Panellists also endorsed the inclusion of a ‘cheat-sheet’ for clinicians to guide interpretation of results and next steps.
What’s next?
These findings will inform the development of Grog Check, a culturally informed digital screening tool for us with Aboriginal and Torres Strait peoples attending primary care. Future research [3] will evaluate the validity, acceptability and implementation of Grog Check in primary care.
Prepared on behalf of the investigator team by Mustafa Al Ansari and Kylie Lee
The full paper is available Open Access:
M. Al Ansari, A. Dawson, M. Dzidowska, et al., “Adapting ‘The Grog App’ to Ask Aboriginal and Torres Strait Islander Peoples About Their Drinking in Primary Healthcare: A Delphi Study,” Drug and Alcohol Review45, no. 5 (2026): e70171, https://doi.org/10.1111/dar.70171.
References
- Lee K, Conigrave J, Al Ansari M, Wilson S, Perry J, Zheng C, et al. Acceptability and feasibility of a computer-based application (‘App’) to help Aboriginal and Torres Strait Islander Australians to describe their alcohol consumption. Journal of Ethnicity in Substance Abuse. 2019;20(1):16-33.
- Lee K, Conigrave JH, Wilson S, Perry J, Hayman N, Chikritzhs T, et al. Deeper understandings of patterns of drinking among Aboriginal and Torres Strait Islander Australians: Informing policy and practice. Health Promotion Journal of Australia. 2023;34(4):883-8.
- Dzidowska M, Conigrave JH, Wilson S, Hayman N, Cook J, Gu L, et al. Adapting the Grog survey app for alcohol screening and feedback in aboriginal and Torres Strait Islander health services: a mixed methods study protocol. Addiction Science & Clinical Practice. 2025;20(1):70.