1. INTRODUCTION:

In 2016, the Alcohol Attributable Fraction (AAF) of all deaths across the world was 5.3% and was highest in the Europe (10.1%). In the same year in Thailand, the AFF for deaths from all causes was 7.4%, 57.4% from liver cirrhosis, 24.7% from road traffic accidents, and 5.5% from cancer¹.

The WHO has recommended using the Alcohol Brief Intervention (ABI) in primary care to identify risks of alcohol, smoking, and substance involvement in client and to provide counseling information to assist the client avoid having these substances cause serious health consequences^2,3. In Thailand, community pharmacists are primary health care workers in the private sector. They have expanded their public health roles to include screening for risk of cardiovascular disease, diabetes mellitus, and respiratory and metabolic diseases as well as providing sexual health services and smoking cessation support^4,5. However, unlike in countries such as the United Kingdom, Australia, and New Zealand community pharmacists in Thailand do not conduct ABI screening⁶. The ultra-rapid Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) was developed by Ali et al. (2013)⁷ for general medical settings. It comprises four questions for screening the drinking risk levels and can be completed in less than two minutes. This screening method is easier for practical application in the primary care setting than other methods and has acceptable accuracy and reliability. In 2016, in Thailand, 2.5% of all patients with substance-use disorders were screened using ASSIST during a primary care visit, which revealed that 29.6% and 3.4%, respectively, were in moderate- and high-risk groups⁸.

The use of the ABI service has been well accepted when offered at community pharmacies. However, ensuring the privacy of clients in a pharmacy environment presents a challenge. Providing appropriate remuneration to community pharmacists for providing ABI services is also a consideration. In addition, there may be challenges in scheduling appointments as pharmacists are generally occupied with other work⁹.

To improve the uptake, adherence, and efficiency of providing the ABI service, it is helpful to obtain an understanding of patient preferences regarding the implementation of such health interventions. The clients' preferences were used to characterize services that pharmacists provided to the patients¹⁰. Performing a discrete choice experiment (DCE) is a widely accepted approach to determining patient preferences in health economics^11,12. The DCE is a microeconomic research technique based on the characteristics demand theory (i.e., Lancaster's theory) and defined as those aspects of a product that characterize its usefulness to a customer¹³. Discrete choice experiments were initially used in marketing studies and later applied to transportation, environmental, and health economics¹¹. The International Society for Pharmacoeconomics and Outcome Research (ISPOR) has recommended seven steps for developing a new DCE. These steps are (1) attribute and attribute level identification, (2) attribute selection, (3) experimental design, (4) choice question formatting, (5) adding more questions to determine response quality and analysis requirements, (6) design data collection, and (7) statistical analysis¹². Attributes are the expected characteristics and/or properties of goods, services, or policies, and they have varying levels; for example, the attributes and levels of medications offered for treatment This medication is composed of three attributes, i.e., efficacy, side effect, and a mode of administration. Each attribute has three levels, e.g., the mode of administration: one tablet once per day, one subcutaneous injection per week, and one intravenous infusion per a month. The goal of the present study was to define the attributes and their corresponding levels for an ABI service that community pharmacists can provide. These development of attributes and levels are factors to the new health promotion service in Thailand performing DCEs to design the ABI service that the clients prefer.

2. METHODS:

The study received ethical approval and was conducted between July and October 2019 in Khon Kaen province, Thailand. A five-step process was used to define a group of attributes and corresponding levels to form an ABI service to be delivered by community pharmacists.

2.1 Step 1: Literature review and observation:

A literature review was first performed to identify the context for acceptability, facilitators, and barriers to client and community pharmacists' perspectives on the ABI. A second literature review was performed to identify the attributes and levels from others studies that used DCEs to elicit preferences for specialized community pharmacy services.

2.2 Step 2: Raw data collection:

A semi-structured interview was developed, comprising the attributes established in step 1. The content validity of the semi-structured questionnaire was evaluated by three experts using the Index of Item Objective Congruence (IOC). Seven independent pharmacies in Mueang district, Khon Kaen province, Thailand, were invited to participate. The clients recruited in these pharmacies varied in age, gender, and frequency of alcohol drinking and were administered the face-to-face semi-structured interviews (SSIs) by the researcher SM. At least 12 informants were invited to provide adequate information from the interviews until attributes were saturated and clearly described¹⁴.However, if the participants did not present a variety of gender and age according to the inclusion criteria, the researcher would ask the respondents to invite additional clients with alcohol drinking problems to participate in the study (snowball technique). Vass et al. (2017)¹⁵recommended one DCE choice set be proposed to the key informant at the end of the interview. The research designed two alternatives of service which varied by the levels of each attribute (Appendix A). The key informant was asked to select one service from two alternatives, i.e., service A, service B, or none of them. Then, the credibility of the data obtained from the face-to-face SSIs was compared with the reason for the informant's choice for being included in the DCE model.

Interviews were tape-recorded and fully transcribed. An iterative, constant comparative approach was used to analyze the data¹⁴. The data were interpreted through coding and identifying the themes or patterns using Microsoft Excel. One researcher (SM) coded and identified themes and sub-themes, and two researchers (SM and NK) to identified the findings' attributes and levels.

2.3 Step 3: Attributes selection:

The seven independent community pharmacists received a full day of training to provide the ABI service using a SSI. The attributes and their corresponding levels of pharmacy-based ABI service from step 2 were used to inform this focus group discussion with the purpose of selecting the ABI service attributes for the DCE model.

2.4 Step 4: Attribute exploration and confirmation of their wording:

The face-to-face SSI was conducted with four adult clients to explore the attributes further and confirm their wording. The data were collected until saturation, and the iterative constant comparative was used to analyze the data.

2.5 Step 5: Final attributes determined by the researchers:

The attributes and their levels from step 4 were adjusted by the two researchers' judgments based on the guidelines and suitable implementation. For example, the number of attributes within the context of specialized community pharmacy services ranged from three to eight^16-20. The number of attributes at each level was limited to three or four. The level should not be a range of numbers; it should be a one-digit number¹¹.

3. RESULTS:

3.1 Results from step 1:

Details of the literature search process and the relevant articles that were extracted are given in Appendix B. After screening and reading the full texts in two searches, twenty-one articles and then eight articles were identified in the first and second searches, respectively. These articles were included in the qualitative analysis. Researcher SM reviewed common themes in the literature relevant to ABI services and discussed with researcher NK to finalize the themes, which are defined in the following sections.

3.1.1 Acceptability:

The clients were satisfied with their experience and considered the process valuable in helping them become aware of the detrimental effects of alcohol abuse. They would recommend the service to others. Their opinions can be summarized in three main points: (1) the clients accepted and respected the role of community pharmacists as the providers of the ABI services, (2) the pharmacy was seen a suitable and accessible facility at which to provide ABI services, and (3) the clients were willing to participate in the ABI services with community pharmacists. Also, patients were satisfied with the accessibility of ABI with medicines use review that they were reviewed of their medication use. In addition, the community pharmacists were pleased to accept this new role in health promotion and were willing to advise the patients with alcohol addiction. The alcohol screening tools and brief intervention guidelines and the short duration of the training was well received by the community pharmacists. They understood the value of offering the ABI services at a pharmacy because they know it is difficult for clients to access ABI services with other healthcare providers. The new role represented added value for community pharmacists and challenged them to provide preferred ABI services to high-dependency drinkers. Moreover, all the stakeholders, which include pharmacy assistants, The Primary Care Trust alcohol services commissioners, and the alcohol treatment service staff, were happy to work together to provide the ABI service to the public.

3.1.2 Facilitators of implementation:

The resources provided by the community pharmacists to support the ABI services included: (1) a private consulting room and confidentiality,(2) a poster presentation to encourage clients with alcohol abuse to use the ABI service, (3) preliminary alcohol screening by a non-pharmacy staff prior to a full alcohol screening by a pharmacist, (4) ABI training to increase the knowledge, attitude, competency, and confidence of community pharmacists in providing the ABI service, and (5) promotion of the prestige and pride in offering the ABI service.

3.1.3 Barriers to implementation:

The following barriers to providing the ABI service included: (1) community pharmacists having limited knowledge for carrying out their new role, e.g., knowledge about how to calculate an acceptable weekly amount of alcohol consumptionand how to advise clients on reducing alcohol consumption (2) a lack of skills and confidence by some community pharmacists to provide the ABI service. For example, they may be uncomfortable asking the clients about their alcohol drinking behavior; in addition, they may be concerned about client dissatisfaction (3) the time constraints of both the clients and community pharmacists, (4) a lack of materials to support the service, such as leaflets or screening tools,(5)the required government support to promote awareness of the problem of alcohol drinking as well as a suitable remuneration for pharmacists providing the service, (6) the inability of the pharmacists to dispense drugs related to alcohol abuse rehabilitation to clients, (7) the need for more suitable alcohol screening tools and training, and(8) concerns about data privacy from the client, stakeholders, and community pharmacists.

The second literature review identified eight published studies relevant to providing ABI as a specialized community pharmacy service. Six overlapping attribute categories were identified: process-related, provider-related, time spent on services, health outcomes, risks, and monetary measures.

The literature reviews found that eight attributes were relevant to 'clients' participation in ABI services offered by community pharmacists. In addition, researcher SM observed that sometimes clients could not receive continuous counseling because seven community pharmacies did not have enough pharmacy staff; the community pharmacist needed to dispense medicine to other clients. Therefore, the researcher added continuous conversation for counseling into the attributes of the ABI service. Table 1 shows a list of the final nine attributes from step 1 that were used to guide the development of the client questionnaire to be used in interviews.

Table 1. The Attributes developed from step 1

Attributes	Definition
1. Characteristics of community pharmacist	Friendly, helpful, trusted professional; follows up with patients
2. Alcohol screening method	Interview conducted by the community pharmacist as well as self-reporting
3. Service setting for counseling	In person at the pharmacy; by telephone
4. Area of counseling	In a counseling room, semi-private area, or a counseling area next to the pharmacy counter
5. Duration of alcohol screening test	5–10 min.
6. Counseling session	5–30 min.
7. Continuous conversation	Continuous counseling by the community pharmacist or partially interrupted by the other clients in the pharmacy
8. Accessibility to the pharmacist	Making an appointment with a pharmacist or walk-in service with setting up a service available only one day per week
9. Cost of service	Fee for ABI service

3.2 Results from step 2:

The validity of a semi-structured interview comprising ten questions with content guided by three experts was tested. The score for seven of the questions was one, and the score for each of the other three questions was 0.67. Then, ten-question guides were edited by three experts until passing the IOC, as shown in Appendix C.

The first face-to-face SSI as conducted at a pharmacy. However, the informant was uncomfortable being interviewed there. Thus, a different place outside the pharmacy was chosen for the subsequent interviews, which was a private and safe place for both clients and researchers, such as a courtyard in the public school or the coffee shop that is near the informant's home.

Twenty clients and seven community pharmacists were recruited to participate in the study (Table 2). The pharmacists had been employed for 1 to 13 years (mean 5.57 years, SD 4.0 years). All participants were assured of anonymity and provided written consent of their willingness to participate. None of the clients had ever received ABI counseling service in the past. The researchers described the ABI service to the clients before the interview except for clarification of the wording of the interview items because one objective of the study was to determine a client's comprehension. The face-to-face SSI took an average of 21 minutes to administer, and the focus group discussion with the seven community pharmacists lasted one hour.

Table 2. Sociodemographic information of study participants

Key Informants

Step 1^a

Step 2^b

Step 3^a

Step 4^a

Gender

Male

Female

Age

18–19

20–24

25–44

45–59

60+

Frequency of alcohol drinking^c

Regular

Non-regular

N/A

Education

Primary

Secondary

High school

Bachelor's degree

Master's degree

Occupation

Housewife

Graduate student

Merchant

Employer

Business owner

Professional

Pensioner

Alcohol risk level^d

Low

Moderate

High

N/A

Average time of an interview/ discussion (minutes)

18.5

23.0

23.6

^aClients, ^bCommunity pharmacists, ^cRegular drinking means drinking alcohol every week or four times a month, non-regular drinking means drinking alcohol less than four times a month,^dASSIST-LITE was scored by 0-1 indicating Low-risk, 2 indicating moderate, and 3-4 indicating a high risk.

According to the methodological triangulation, two of ten clients had opinions inconsistent with their reason for choosing one of three alternatives in the DCE. One client chose Service A because they preferred free service even though they could afford to pay 200–300 Thai Baht (THB) for the service. Another client chose Service B because they were not concerned about speaking in an open area, even though they chose to pay 100 THB for the counseling room in the DCE. These results confirmed that the service cost should be no more than 200–300 THB and that a dedicated room should be available for clients who prefer more privacy (Table 3).

The researcher interpreted the results of the attribute definition confirmation and used the words "alcohol drinking risk assessment" to replace "alcohol screening" and "education and counseling for alcohol drinkers" to replace "alcohol brief intervention

3.5 The results from step 5: The Researchers' Conclusions of the Final Attributes:

Researchers SM and NK judged the properties of the attributes and levels in the DCE model. According to Reed Johnson et al. (2013)¹² and Marshall et al. (2010)²¹, there should be three to seven attributes with three to four levels each (Bridges, et al., 2011)¹¹. Also, the levels of the two attributes were adjusted. In particular, the costs of the service were adjusted to 0, 50, and 100 THB, which is consistent with the standard service fee for health promotion and dispensing health services (50–70 THB per visit). In addition, the results from step 2 confirmed that the cost of this service should be between 0 to 100 THB. The duration of the ABI service was adjusted to 10, 20, and 30 minutes. Because the service fee was lowered to less than 100 THB, the service duration had to be reduced to less than 30 minutes.

Unexpectedly, the coronavirus pandemic began in March 2020 before this study could be completed. Therefore, the researchers changed the mode of counseling from face-to-face interviews in a counseling room to "telephone counseling" in a DCE model and changed the attribute "the area of counseling" to "the mode of counseling". The final attributes and their levels as they relate to ABI service are presented in Table 6.

Table 6. The final attributes proposed for the DCE model

Attributes	Levels
1. Cost of service	0 THB, 50 THB, 100 THB
2. Counseling session	10 min, 20 min, 30 min
3.Alcohol screening methods	Interview by the community pharmacist Self-reporting
4. Mode of counseling	A semi-private area with a partition Counseling area next to the pharmacy counter Telephone
5.Continuous conversation	Continuous conversation Non-continuous conversation (may involve interruptions from other pharmacy clients purchasing medicine)

4. DISCUSSION:

Five steps were used to develop the attributes used in the proposed DCE study (DCEs have limitations on the number of attributes and their levels). Then, the finalized number of attributes and their levels were rigorously processed. The number of attributes found in this study is no more than those in our literature review and observations. In addition, this research increased the credibility of the attribute for eliciting the client's preferences by the DCE.

Potential attributes were developed using a combination of two approaches. First, by a systematic literature review study focused on qualitative and alternative methods, such as theoretical arguments for raw data collection or a nominal group technique for attributes selection²² and summarized the four steps for developing DCE attributes. These steps were 1) raw data collection, 2) data reduction, 3) removal of inappropriate attributes, and 4) attribute definition. Second, Coast & Horrocks (2007)¹⁴ proposed the iterative constant comparative approach to data collection, data reduction, and attribute definition confirmation. The latter approach is challenging, however, when studies are conducted in different languages²³.

The literature review showed that no other DCEs have been completed to determine the attributes of community pharmacy-based ABI services. Thus, the potential attributes to be used in the ABI interview were sourced from DCE literature relevant to other specialized community pharmacy services. Several alternative methods can be used to select the suitability and value of an attribute, such as the nominal group technique, an online structured prioritization exercise, or Delphi methods¹⁵.In the present study, seven community pharmacists participated in a focus group discussion. This method proved effective because it was very convenient for the pharmacists who have limited time. There are two main strengths of the present study. First, the study represents the initial steps in developing the first community pharmacy-based ABI service in Thailand. The defined attributes from this study will inform policymakers who are responsible for establishing a new ABI service. The attributes will also be used for designing a DCE study to determine the clients' preferences of the new service. Second, one of the attributes proposed for the DCE study, which was taken from the checklist used in the so-called Appraise the Reporting of Qualitative Research (ARQR) questionnaire developed by Vass et al. (2017)¹⁵, was added as the last question of the ABI interview. Although the attribute appears to be promising, it may be subject to change based on results from a proposed pilot study, as was reported by Obadha et al.(2019)²⁴.

This study has some limitations. First, the coronavirus pandemic began before this study could be completed, and it is still spreading around the globe. Thus, the attributes of the pharmacy-based ABI service, especially the semi-private area with partition for counseling, may not be suitable for a pandemic situation. Second, online pharmacy is involved in the health-care sector. It has pros and cons in pharmacy practices^25,26. Thus, this attribute level may be determined in the DCE model in the future. Finally, this research was conducted only at urban community pharmacies. Future research should be done to determine the attributes of pharmacy-based ABI services in rural areas.

There are some suggestions for the pharmacy-based ABI service implementation. First, many factors can contribute to the new service for community pharmacists, such as Nurfirda et al. (2019)²⁷ found that lack of competency, lack of skills training, lack of equipment, and high workload on conventional services. Future research should be done to determine readiness to provide ABI services among community pharmacists in Thailand. Second, the knowledge and interest of community pharmacists for ABI service is essential to expand the service, such as Kuma et al. (2021)²⁸found that the majority of pharmacists had limited knowledge for pharmacy-based tuberculosis referral programme, future research should assess the knowledge of them. Third, the outcomes of the pharmacy-based health promotion service found in various studies, such as cost-effectiveness of pharmacists counselling²⁹, the impact of pharmacist conducted health education to clients' knowledge³⁰, the effectiveness of the pharmacy-based educational intervention on quality of life³¹. Thus, the pharmacy-based ABI service should apply the methodology from these studies to inform policymakers. Finally, there are the interesting new role of community pharmacists in health promotion, such as prevention of type A influenza virus³², Dietary in sport performance³³, pre-menstrual syndrome³⁴, future DCE research should be determined the importance factors for providing these new health promotions in Thailand.

5. CONCLUSION:

The present study has enabled significant progress in developing the attributes and levels of a pharmacy-based ABI service in Thailand using a DCE to investigate clients' preferences for health-care service outside their primary provider's office. In particular, clients and community pharmacists participated in a five-step process to develop attributes for the DCE. The five attributes included the cost of service, counseling session, alcohol screening methods, mode of counseling, and continuous counseling. The creditability of the attributes was tested by methodological triangulation.

6. ACKNOWLEDGMENTS:

The support of the community pharmacists who participated in this study is gratefully acknowledged.

7. CONFLICT OF INTERESRT:

The authors have no conflict of interest to declare.

8. FUNDING:

The following organizations provided funding for this study: The Research and Training Center for Enhancing Quality of Life of Working-Age People, Faculty of Nursing, Khon Kaen University; The Center for Alcohol Studies; The Faculty of the Pharmaceutical Sciences and Graduate School, Khon Kaen University.

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APPENDIX A:

The DCE questionnaire provided to the key informant in step 1 after the interview

	Service A	Service B	Neither
Accessibility to the pharmacist	Making an appointment during pharmacy hours	Monday only (9:00 AM–4:00 PM)
Continuous conversation	A pharmacist sometimes stops the conversation to dispense medicine to other clients	A pharmacist provides continuous conversation until the service is concluded
Duration of ABI service	5 minutes	15 minutes
Location where counseling took place	Counseling area next to the pharmacy counter	Counseling room
Cost of service per time	0 THB	100 THB
Which ABI service are you willing to participate in?	q Service A	q Service B	q Neither

APPENDIX B:

Literature review

The first part of the literature review was performed in June 2018 using the following electronic databases: SCOPUS, Web of Science, PubMed, and CINAHL. The following terms were used in searches for article titles, abstracts, and keywords: "alcohol AND intervention AND community pharma*". English language and full-text articles published through 2018 were considered. Overall, the selected studies addressed ABI service by community pharmacists.

The second part of the literature review was performed in July 2018 using the following electronic databases: SCOPUS, Web of Science, PubMed, and EBSCO. The following terms were used in searches for article titles, abstracts, and keywords. These were "conjoint analysis" OR "conjoint analyses" OR "conjoint measurement" OR "conjoint study" OR "conjoint studies" OR "conjoint choice experiment*" OR "part-worth utility*" OR "functional measurement" OR "paired comparison*" OR "pairwise choices" OR "discrete choice experiment"* OR "discrete choice model*" OR ""discrete choice conjoint experiment*" OR "discrete choice" OR ""discrete choice analy*" OR "discrete-choice" OR "stated preference*" OR "stated choice" OR "choice experiment*" OR "choice behavi*" OR "choice experiment"" OR "choice-based" OR "choice model*" AND "community pharmacy" OR "community pharmacies" OR "retail pharmacy" OR "retail pharmacies" OR ""drug store*" OR "drug store*" OR "pharmacy store*" OR "pharmacy service*" OR "pharmaceutical service*" OR "pharmacy" OR "pharmacies" OR "pharmaceutical service*" OR "chemist warehouse*" OR "chemist store*" OR "chemist shop*" OR "medical store*". The literature consulted comprised full-text English language articles published through 2018. Overall, studies were selected that addressed applying a DCE in a community pharmacy service.

APPENDIX:

Interview guide

Day…………Start time of interview………… Stop time of interview………. Age............

Occupation.......Education.......... Smoking……… Number of cigarettes smoked per day ……

No.	Questions	IOC score
1	Have you ever taken part in an alcohol screening given information about drinking at other places of service, such as at a medical center, public hospital, or hospital? Was it of benefit to you or not?	1
2	Do you think a community pharmacy is the ideal location to conduct an alcohol screening experience to gain knowledge or advice about your drinking? Describe your opinions.	1
3	What characteristics should community pharmacists providing the alcohol screening, the ABI, and/or advice for what your drinking have?	0.67
4	What method of screening do you prefer? An in-person interview by community pharmacist or self-reporting?	0.67
5	Do you think the use of a private area in pharmacy for ABI or advice about alcohol usage is appropriate or not? If not, where should it take place? (What kind of private area is needed?)	0.67
6	Do you think that a screening time of 5–10 minutes is appropriate? For how long would you be willing to participate? Do you think 5–30 minutes is an appropriate amount of time for the ABI and/or advice about your alcohol usage? How much time would you be willing give for this experience?	1
7	Suppose there is only one pharmacist at the store who can provide the ABI service. In that case, the pharmacist may have to stop the conversation with you and dispense the medicine to other customers who enter the store. What do you think about this situation?	1
8	How much do you think the ABI service should cost? Are you willing to pay for it, or should the government support the expenses?	1
9	Where else in your community should ABI services be offered? Please name possible locations.	1

Look at an example of the DCE choice set. Which of the two services would you choose? You can choose "Neither Service" as an option. Why did you choose this service?

	Service 1	Service 2	Neither Service
Access to pharmacist	Make an appointment with a pharmacist	Service on Mondays between 9:00 A.M.–4:00 P.M.
Mode of continuous conversation	Non-continuous conversation (may interrupted by other clients purchasing medicines)	Continuous conversation
Duration of alcohol screening and brief intervention	5 min.	15 min.
Area of counseling	Counseling area next to the pharmacy counter	Counseling room
Cost of service	Free of charge	100 THB
Tick only one box	£ Service A	£ Service B	£ Neither service

Received on 13.09.2021 Modified on 25.10.2021

Research J. Pharm. and Tech. 2022; 15(5):1924-1932.

DOI: 10.52711/0974-360X.2022.00320

Key Informants^a	Interview Results	Service Choice	Triangulation result
A 29-year-old male with a ' 'bachelor's degree	He preferred continuous conversation and a private counseling room.	Service B	Congruous
A 47-year-old male with a ' 'bachelor's degree	He preferred to make an appointment with the pharmacist.	Service A	Congruous
A 46-year-old male with a primary education	He was willing to pay 200–300 THB per appointment.	Chose Service A because he preferred free service	Incongruous
A 23-year-old female with a primary school	She preferred to make an appointment with the pharmacist.	Service A	Congruous
A 19-year-old male with a high school	He preferred the free service.	Service A	Congruous
A 27-year-old male with a ' 'bachelor's degree	He preferred to make an appointment with the pharmacist.	Service A	Congruous
A 33-year-old female with a primary education	She was not concerned about receiving counseling in an open area.	Chose Service B and paid 100 THB for a counseling room	Incongruous
A 60-year-old female with a primary education	She preferred free service.	Service A	Congruous
A 54-year-old female with a primary education	She preferred to make an appointment with the pharmacist, preferred a short counseling time, and free service.	Service A	Congruous
A 19-year-old female with a high education	She preferred to make an appointment with the pharmacist for free service.	Service A	Congruous

	The Understanding of Key Informants
	1	2	3	4
Screening test for alcohol drinking	Screening to check client's health	-	-	-
Alcohol involvement screening test	-	Don't understand	Screening test for regular drinkers	Screening test for regular or heavy drinkers
Alcohol drinking behavior assessment	-	Don't understand	Evaluate one's alcohol drinking state	Evaluate behavior after drinking
Alcohol drinking risk assessment	Measure the risk of alcohol drinking	Drinking alcohol over the limit may increase chance of diseases	Understand the risk of alcohol consumption I like this wording because drinking seems risky.	What are the risks of drinking alcohol?
Alcohol brief intervention for alcohol risk drinkers	-	Receiving the alcohol addiction treatment	Want to stop drinking in the short term	-
Alcohol brief intervention for alcohol drinker	-	-	-	A fast method for the client who wants to abstain from drinking alcohol
Counseling for people at risk from drinking alcohol	-	Don't understand	-	-
Education and advice for alcohol risk drinking	-	Don't understand	-	-
Counseling for alcohol drinkers	-	-	-	Providing counseling or information to the clients who want to know about the alcohol-related harm
Education and counseling for alcohol drinkers	-	-	-	Providing knowledge about the good or bad aspects of drinking alcohol and why we do it. I like this wording.
Education and advice for alcohol drinkers	-	-	-	No differences from "Education and counseling for alcohol drinkers"

Rank Voting	Attributes	Levels
1	Cost of service	0 THB, 100 THB, 200 THB, and 300 THB
2	Counseling session	10 min, 20 min, 30 min, and 40 min
3	Alcohol screening method	Interviewed by the community pharmacist; Self-reporting
4	Area of counseling	A counseling room, a semi-private area with a partition, a counseling area next to the pharmacy counter
5	Continuous conversation	Continuous conversation Non-continuous conversation (may involve interruptions from other pharmacy clients purchasing medicine)