# Situation: The Rural Health Unit (RHU) nurse implements the municipal mental health and substance use program with the barangay health workers (BHWs). The nurse gives brief interventions for risky drinking using the FRAMES approach. Which list gives the elements of FRAMES in order?

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> subject: Nursing Practice I — Community Health Nursing

## 문제

Situation: The Rural Health Unit (RHU) nurse implements the municipal mental health and substance use program with the barangay health workers (BHWs).

The nurse gives brief interventions for risky drinking using the FRAMES approach. Which list gives the elements of FRAMES in order?

## 보기

1. Feedback, Responsibility, Advice, Menu, Empathy, Self-efficacy **✔ 정답**
2. Feedback, Responsibility, Advice, Motivation, Empathy, Self-efficacy
3. Feedback, Readiness, Advice, Menu, Empathy, Self-efficacy
4. Feedback, Responsibility, Assessment, Menu, Empathy, Self-efficacy

**정답: 1**

## 해설

FRAMES stands for Feedback on screening results, personal Responsibility, clear Advice to change, a Menu of options, Empathy, and Self-efficacy. Each distractor swaps one element for a commonly confused term: motivation is the aim of the intervention, readiness is a stage-of-change idea, and assessment comes before the intervention.

## 심화 해설

The FRAMES model is a structured communication framework used in brief interventions for risky substance use, including alcohol. It organizes the conversation into six sequential elements that help the patient move toward change without confrontation. The correct order is Feedback, Responsibility, Advice, Menu, Empathy, and Self-efficacy [4].

Each element serves a distinct purpose in the brief intervention. Feedback opens the conversation by sharing the screening result in a neutral, non-judgmental way, which gives the patient a concrete reason to reflect on their drinking. This is based on objective data such as the AUDIT score, not on the nurse’s personal opinion. In the Brazilian RCT, participants were eligible because they scored 8–19 on the AUDIT, meaning the nurse had a specific number to discuss as the starting point [2].

Responsibility emphasizes that the decision to change belongs to the patient. The nurse does not take ownership of the outcome. Advice then provides a clear, direct recommendation to reduce or stop drinking, tailored to the patient’s situation. Menu offers several options for how to change—such as cutting back, setting limits, or seeking further support—so the patient can choose what feels feasible. Empathy requires the nurse to listen reflectively and convey understanding, which reduces defensiveness. Finally, Self-efficacy reinforces the patient’s confidence in their ability to succeed, often by highlighting past successes or strengths [4].

The distractors in this question replace one element with a term that sounds plausible but belongs to a different concept. Watch out! Motivation is the overall goal of the intervention, not a step within FRAMES. Readiness comes from the stages-of-change model and describes where the patient is before the intervention, not a component of FRAMES. Assessment occurs before the brief intervention begins—it is the screening process that produces the Feedback, not a separate element of FRAMES itself.

The FRAMES model has been tested in primary care settings beyond alcohol. A cluster RCT in France used the exact FRAMES sequence—feedback, responsibility, advice, menu, empathy, self-efficacy—as the structure for a brief intervention targeting cannabis use among young people [4]. This supports the idea that FRAMES is a general framework for risky substance use, not limited to alcohol. In the Brazilian trial, the intervention was delivered by nurses over the telephone, demonstrating that FRAMES can be adapted to non–face-to-face formats while preserving its core sequence [2].

For nursing practice, the order matters because each element builds on the previous one. Starting with Feedback gives the patient a factual anchor, and ending with Self-efficacy leaves the patient with a sense of capability rather than guilt or pressure. Skipping Empathy or jumping directly to Advice can trigger resistance, which is why the sequence is taught as a fixed acronym rather than a pick-and-choose list .

| Element | Core action | Common confusion |
| --- | --- | --- |
| Feedback | Share screening results objectively | Not the same as giving a lecture |
| Responsibility | State that change is the patient’s choice | Not the nurse’s duty to fix |
| Advice | Give a clear recommendation to change | Not a vague suggestion |
| Menu | Offer multiple options for change | Not a single prescribed plan |
| Empathy | Listen and reflect understanding | Not sympathy or pity |
| Self-efficacy | Reinforce confidence in ability to change | Not praise for the nurse’s effort |

Key point! The acronym FRAMES is fixed in order: Feedback, Responsibility, Advice, Menu, Empathy, Self-efficacy. Any option that substitutes Motivation, Readiness, or Assessment is incorrect because those terms belong to different phases or models of behavior change [4].References (research sources)

- [2]Effectiveness of a nurse-led telephonic brief intervention to reduce risky alcohol use among women in primary care in Brazil: a randomized controlled trial.RCT/clinical trialLima AVC, De Oliveira Pinheiro Gaia JL, De Vargas D. (2026) · DOI: 10.1007/s00737-026-01772-5

- [4]Cannabis and Young Users-A Brief Intervention to Reduce Their Consumption (CANABIC): A Cluster Randomized Controlled Trial in Primary Care.RCT/clinical trialLaporte C, Vaillant-Roussel H, Pereira B, Blanc O, Eschalier B, Kinouani S (2017) · DOI: 10.1370/afm.2003

## 임상 시나리오

FRAMES Brief Intervention GuideSix sequential elements for risky alcohol use counseling
Feedback opens the conversation by sharing the AUDIT score neutrally, giving the patient objective data to reflect on their drinking.

Responsibility places the decision to change on the patient, not the nurse. Advice then provides a clear, direct recommendation to reduce or stop drinking.

Menu offers several options for change so the patient can choose what feels feasible. Empathy uses reflective listening to reduce defensiveness.

Self-efficacy reinforces the patient's confidence by highlighting past successes or strengths.

CautionDo not confuse Motivation or Readiness as FRAMES elements. Motivation is the goal of the intervention, and readiness is a stage-of-change concept.

## 핵심 개념

- **FRAMES** — Structured communication framework for brief interventions in risky substance use: Feedback, Responsibility, Advice, Menu, Empathy, Self-efficacy
- **Brief intervention** — Short, structured conversation to help patients reduce or stop risky substance use
- **Feedback** — Sharing screening results neutrally to give the patient a concrete reason to reflect on their behavior
- **Self-efficacy** — Reinforcing the patient's confidence in their ability to change successfully
- **AUDIT** — Alcohol Use Disorders Identification Test; a screening tool for risky drinking

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