Planning a Multi-Level Intervention to Reduce Substance Use Stigma in HIV Prevention and Care
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 51
- 试验地点
- 1
- 主要终点
- Provider-based Stigma (Social Distance Scale (SDS) Measure)
研究概览
简要总结
This is a community-engaged research project that aims to identify and pilot test interventions that may reduce substance use stigma among professionals at primary care sites serving patients who might be exposed to HIV or are living with HIV. Our goal is to develop a multi-level substance use stigma intervention that leverages 1) education and 2) organizational policy to address structural drivers of stigma and the stigmatizing professional attitudes and behaviors that affect patients. Hypothesis: the results of the trial pilot research and are expected to provide scientific evidence demonstrating feasible and potentially effective substance use stigma reduction interventions that go beyond simple individual-level professional training. We plan to build on the data from this pilot trial study to then further test the multi-level intervention in another larger trial study with primary care organizations to determine whether the intervention addresses multiple complex drivers of substance use stigma that influence HIV prevention and care outcomes among people who use drugs.
详细描述
This planning project aims to develop and pilot test elements of a multi-level substance use stigma reduction intervention. This study builds on past research indicating educational interventions can meaningfully reduce provider stigma related to substance use by examining the extent to which educational interventions may be enhanced by organizational policies addressing structural drivers of stigma toward people who use drugs operating in the health sector. The ultimate goal of this pilot study is to identify feasible and potentially effective substance use stigma reduction interventions that go beyond simple individual-level professional training and that could be tested in a larger subsequent trial study.
This project will use a community-engaged approach with federally-qualified health centers (FQHCs) and other primary care sites to generate pilot data and establish protocols that not only measure self-reported changes in attitudes among health professionals but also use patient surveys and electronic medical records to measure the effect of educational and policy interventions on changes to clinical practice and patient outcomes.
Initial planning will focus on developing and pilot testing an educational curriculum (Aim 1) that addresses key drivers of provider-based stigma and FQHC facility recruitment and participation in policy development to address structural stigma (Aim 2). The latter half of the planning process will focus on refining and finalizing the trial design, survey instruments, data collection and management procedures, and drafting the trial protocol (Aim 3).
For Aim 1, the project team will design a curriculum addressing stigma related to substance use among the primary care workforce. The study team will prepare a 2-hour interactive curriculum to be used in an education session for individuals in any professional role (providers, other clinical support staff, and receptionists). The lead PI, Dr. Madden, will co-teach the course with a community consultant who has firsthand experience with SUD and harm reduction work. Including a co-teacher with such firsthand experience provides a contact-based approach to reducing stigma, which has been shown to reduce stigmatizing professional attitudes in several past studies. The curriculum will be piloted with ~35 primary care professionals, including physicians, other clinical support staff, and reception staff to assess changes to attitudes and intended behaviors that are indicative of substance use stigma. These changes will be assessed using validated surveys of provider-based stigma and new survey measures using the Theory of Planned Behavior to assess factors influencing professional behavior. A focus group with 6-10 pilot participants will be used to obtain qualitative feedback on the curriculum in order to refine and revise the training for the subsequent trial. The focus group will follow a Qualitative Description Approach, a methodology used in health services research to explore perspectives and experiences among people directly involved in a health/social phenomenon.
For Aim 2, FQHCs and other primary care sites providing HIV prevention and care services will be identified and approached in year 1 by the PIs. PIs will meet with interested FQHC administrators to explain the trial planning project and those administrators who agree to participate in trial planning will be asked to allow administrators and personnel to volunteer for qualitative interviews regarding facility policies and practices affecting stigma and HIV prevention and care for people who use drugs. In-depth semi-structured interviews with 15-20 FQHC professionals will be conducted in order to identify a suitable stigma policy to test in a larger subsequent trial study. Interviews will also be guided by the Qualitative Description Approach. Analyses will occur simultaneously with data collection and use thematic analysis. A policy proposal based on the qualitative analysis will be provided to FQHCs, and revised based on their feedback.
研究设计
- 研究类型
- Interventional
- 分配方式
- Na
- 干预模型
- Single Group
- 主要目的
- Health Services Research
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •Employed at a federally qualified health center (FQHC) or other primary care site
- •For training and focus group participants (primary outcomes), volunteer is involved in direct interaction with patients
- •For interview and trial feasibility survey participants (secondary outcomes), volunteer is a decision-maker at the FQHC and/or directly interacts with patients
排除标准
- •Not formally employed at a primary care facility (e.g., volunteer position at the site)
研究组 & 干预措施
Training group
Professionals working at a primary care site who has direct interaction with patients. They receive a one-time 2-hour interactive in-person training focused on improving care for patients who use drugs and reducing provider-based stigma. Their baseline attitudes and intended actions are compared to their post-intervention answers to questions in the same domains. Thus, the participants act as their own comparison group, where baseline answers are compared to post-intervention answers.
干预措施: Substance use stigma training (Behavioral)
结局指标
主要结局
Provider-based Stigma (Social Distance Scale (SDS) Measure)
时间窗: Change from baseline SDS score (measured 0-28 days prior to training) at 0-7 days post-training (pre/post design)
This measure assesses how much "social distance" (level of contact/closeness they would prefer in social situations) that a respondent wants to have from a group of people. Four items from the social distance scale (SDS) adapted to people who use drugs. As reported in surveys taken by primary care professionals. Higher score= less social distance and less stigma. Minimum score on each SDS scale= 4; maximum score= 20. The intervention sought to promote higher scores (less desire for social distance, less stigma).
Provider-based Stigma (Medical Condition Regard Scale (MCRS) Measure)
时间窗: Change from baseline MCRS score (measured 0-28 days prior to training) at 0-7 days post-training (pre/post design)
This measure assesses how positively healthcare professionals perceive a group of patients. Items from the Medical condition regard scale (MCRS) were adapted to patients who use drugs. As reported in surveys taken by primary care professionals. Higher score= more acceptance of the patient and lower stigma. Minimum score=7; maximum score=35. The intervention sought to promote higher scores (more acceptance, less stigma).
Provider-based Stigma (Planned Behavior Measure Assessing Intention to Help Patients Who Use Drugs)
时间窗: Change from baseline planned behavior score (measured 0-7 days prior to training) at 0-7 days post-training (pre/post design)
This measure used a single questions asking their level of agreement with the statement, "I intend to engage with patients who use drugs and help them to get evidence-based services over the next 3 months." This was reported in surveys taken by primary care professionals to assess planned stigmatizing actions based on the Theory of Planned Behavior. Higher score= more intention to help people who use drugs and less stigma. Maximum value=5; minimum value=1. The intervention sought to promote higher scores (more intention to help).
Number of Participants Who Completed Focus Groups on Training Feasibility
时间窗: up to 5 months after the training
The feasibility of the training was qualitatively assessed in focus groups using verbal feedback from participants. There was no quantification of this outcome other than counting how many participants provided feedback in the focus groups, and instead the feasibility of the training was assessed using thematic analysis, in which verbatim transcripts are read through and assigned brief analytic "codes" that briefly qualitatively summarize the content of participant feedback.
次要结局
- Number of Participants Who Completed Qualitative Interviews on Policy Feasibility(One-time interview lasting 45-60 minutes per participant)
研究者
Erin F. Madden
Assistant Professor
Wayne State University