Barriers and facilitators of implementing Screening, Brief Intervention, and Referral to Treatment (SBIRT) in a Chinese tertiary hospital: a CFIR-informed qualitative study

Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence-based approach for identifying substance-related risks and facilitating access to appropriate interventions or treatment. However, evidence on its implementation in Chinese healthcare settings remains limited. This study explored barriers and facilitators to SBIRT implementation in a Chinese tertiary hospital. This qualitative descriptive study used focus group interviews with 18 healthcare professionals at a tertiary hospital in China. Data were analyzed thematically and mapped onto the Consolidated Framework for Implementation Research (CFIR). Although participants viewed screening favorably, implementation was constrained by a mismatch between SBIRT’s preventive orientation and the treatment-focused mission of the study hospital, limited referral resources and unclear referral pathways, funding constraints, heavy workloads, insufficient skills in delivering brief interventions, unclear professional roles, limited leadership engagement, absence of implementation champions, and staff turnover with inconsistent training, as well as concerns about patient trust and confidentiality. Facilitators included positive provider attitudes, potential benefits of integrating SBIRT into the electronic medical record (EMR), and interprofessional collaboration. SBIRT implementation at the study hospital was shaped by interconnected barriers and facilitators across multiple levels, with the structural tension between preventive and treatment priorities as the most distinctive barrier. These context-specific findings may inform implementation strategies for similar tertiary hospital settings in China.