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Table 1 CICA Matrix of potential unintended consequences

From: Communities in charge of alcohol (CICA): a protocol for a stepped-wedge randomised control trial of an alcohol health champions programme

Potential unintended consequences

How agencies and structures may interact in unintended ways

Comparative understanding across similar interventions

Consultation with individuals/groups with insights into local contexts and how interventions might operate within them (CICA Project Advisory Group)

Direct harms

None identified

Lack of depth of knowledge by lay health advisors could result in time delays or inconsistent advice for ‘in-need’ populations [48]

Concerns that volunteers recruited from recovering communities could be at increased risk of relapse of alcohol, drug or mental health problems

Psychological harms

None identified

Volunteers embedded within communities find it hard to ‘switch off’ [48]

Intervening in licensing could lead to negative reactions from local retailers

Dissatisfaction and disillusionment of volunteers [49]

Equity harms

Communities most in need are probably the least able to form a strong community group [50, 51]

Motivated individuals becoming health champions are likely to benefit from being a champion more so than those less motivated (who need the potential positive benefits more) [48]

Individual assets within communities excluded from participation due to barriers to recruitment/participation e.g. literacy, criminal record checks, worry about impact on benefits

Group and social harms

‘Communities’ chosen to be in charge of alcohol set by experts (normative needs) vs. self-identified communities (felt needs) [49]

Becoming a community champion could result in lack of acceptance by own community resulting in marginalising “do gooders” [48]

None identified

Current recovery dominated culture within alcohol service provision in UK influences the selection of volunteers from ‘recovery’ communities [52]

Opportunity cost harms

Commissioners may miss opportunities to invest in alternative public health interventions [53]

Missed opportunities to identify “at-risk” populations [54] due to stereotyping those ‘in need’ as only the most severe drinking patterns [55]

None identified