Adapting ‘The Grog App’ to ask Aboriginal and Torres Strait Islander peoples about their drinking in primary healthcare: a Delphi study

Introduction: Alcohol screening in primary healthcare services, including Aboriginal Community Controlled Health Organisations, may encounter barriers. These include time constraints, competing health priorities and sensitivities about the topic. Digital tools like the Grog App, validated in population settings, offer potential opportunities to overcome these barriers. Methods: We conducted a three-round Delphi study to gain consensus on items to include in a digital alcohol screening tool for Aboriginal and Torres Strait Islander people accessing primary healthcare services (‘Grog Check’). Twelve Australian health experts, of whom a majority were Aboriginal or Torres Strait Islanders (67%, n = 8/12), evaluated the clinical importance of potential items (consensus level: 80%). Panellists had expertise in drug and alcohol, primary care, addiction medicine and Indigenous health. Results: Half of the 42 questions, relating to 24 items, reached consensus. Panellists agreed that the screening tool should be brief and culturally relevant. Of the 24 items, there was consensus on 17 including pregnancy, episodic drinking, harms and dependence. Panellists agreed on asking individuals about worries from their own drinking but were divided on asking about worries from others' drinking. There was consensus to ask about dependence, but no agreement if everyone should be asked or only high-risk individuals. Panellists endorsed including a ‘cheat-sheet’ to guide clinicians on interpretating results and next steps. Discussion and Conclusions: We identified questions for a digital alcohol screening tool (Grog Check). This app has the potential to support clinicians and enable safer ways for Aboriginal and Torres Strait Islander people to describe their drinking in primary healthcare settings.