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Challenges in implementing opioid agonist therapy in Lebanon: a qualitative study from a user's perspective.

ABSTRACT: BACKGROUND:Opioid agonist therapy (OAT) has been implemented for the treatment of individuals with opioid use disorders in Lebanon since 2011, but has not been evaluated yet. The aim of the study is to describe the implementation of the first pilot OAT program in Lebanon from the users' perspective. METHODS:Data collectors gathered data from male participants during June 2016-July 2016. Eighty-one out of 94 patients agreed to participate in the study. Data regarding access to treatment, satisfaction with the treatment protocol and treatment outcomes, patient-provider relationship, and misuse and diversion was collected through semi-structured qualitative interviews. Data saturation was reached after 81 interviews; once no new themes were reported. RESULTS:Findings showed inequalities in access to treatment and showed that OAT improved mental and social wellbeing among users who had financial access and complied with the program protocols. Registering in the program protected users from arrest and reduced their economic burden. Among the main encountered challenges were fear of dependence to buprenorphine, restricted geographical access to treatment, misuse and diversion of buprenorphine. CONCLUSION:Results implicate inequalities in access to OAT as one important gap to be tackled in the management of OAT in Lebanon. Further research should be done in order to understand the challenges in the implementation of the program from the providers' perspectives.

SUBMITTER: Ghaddar A

PROVIDER: S-EPMC5909215 | biostudies-literature | 2018 Apr

REPOSITORIES: biostudies-literature

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Challenges in implementing opioid agonist therapy in Lebanon: a qualitative study from a user's perspective.

Ghaddar Ali A Khandaqji Sanaa S Abbass Zeinab Z

Substance abuse treatment, prevention, and policy 20180419 1

<h4>Background</h4>Opioid agonist therapy (OAT) has been implemented for the treatment of individuals with opioid use disorders in Lebanon since 2011, but has not been evaluated yet. The aim of the study is to describe the implementation of the first pilot OAT program in Lebanon from the users' perspective.<h4>Methods</h4>Data collectors gathered data from male participants during June 2016-July 2016. Eighty-one out of 94 patients agreed to participate in the study. Data regarding access to trea ...[more]

PMID: 29673369

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Project description:Background Existing evidence marked a prevalent use of Complementary and Alternative Medicine (CAM) therapies in Lebanon that is concomitant with low rates of disclosure to health care providers and limited knowledge among the general public of safety and side effects of CAM use. Objectives To examine the perspectives of Lebanese CAM users, CAM providers, and health care providers (HCPs) regarding their understanding of CAM and of the Push and Pull factors that drive its use. Methods A qualitative research study was conducted using in-depth interviews, targeting Lebanese adults (CAM users; 18-65 years) (n=14), CAM providers such as yoga instructors, owners of CAM product outlets, herbalists, and religious figures (n=13); and HCPs including physicians, nurses, dietitians, and pharmacists (n=14). The topic guide covered, in addition to the understanding of CAM, the Push and Pull factors driving CAM use. The adults were recruited by convenient sampling, and CAM providers and HCPs using a purposive sampling approach. Interviews were audiotaped, transcribed, and translated into English. Analysis was performed using a qualitative thematic approach. Similarities and differences in the perceptions of the participants with regards to factors that influence CAM use were charted and contrasted, using a triangulated approach. Results The three study groups exhibited a similar understanding of CAM, referring to non-conventional therapies used to prevent/treat diseases or to enhance wellbeing. CAM users and CAM providers identified “distrust in HCPs”, “lack of patient-centered care in CM”, and “limitations and side effects of CM” as important Push factors. All study groups highlighted the limited CAM knowledge of HCPs as a main reason for the lack of patient-centered care. All three groups also underscored the affordability and the social and cultural support for CAM as main enablers of its prevalent use. Unlike HCPs who were skeptical about the safety and effectiveness of CAM, CAM users and CAM providers indicated that most of CAM therapies are safe and efficient. Conclusions The triangulation of perspectives (CAM users, CAM providers, and HCPs) in this study allowed a comprehensive appraisal of CAM use and its drivers. Improving the HCPs’ CAM-related knowledge, promoting patient-centered care and fostering an open dialogue between HCPs and CAM providers are among the recommendations of the study. Supplementary Information The online version contains supplementary material available at 10.1186/s12906-022-03685-z.

Project description:BackgroundThe Four Factor Personality Vulnerability model identifies four specific personality traits (e.g., sensation seeking [SS], impulsivity [IMP], anxiety sensitivity [AS], and hopelessness [HOP]) as implicated in substance use behaviors, motives for substance use, and co-occurring psychiatric conditions. Although the relationship between these traits and polysubstance use in opioid agonist therapy (OAT) clients has been investigated quantitatively, no study has examined the qualitative expression of each trait using clients' voice.MethodNineteen Methadone Maintenance Therapy (MMT) clients (68.4% male, 84.2% white, mean age[SD] = 42.71 [10.18]) scoring high on one of the four personality traits measured by the Substance Use Risk Profile Scale [SURPS] completed a semi-structured qualitative interview designed to explore their lived experience of their respective trait. Thematic analysis was used to derive themes, which were further quantified using content analysis.ResultsThemes emerging from interviews reflected (1) internalizing and externalizing symptoms, (2) adversity experiences, and (3) polysubstance use. Internalizing symptoms subthemes included symptoms of anxiety, fear, stress, depression, and avoidance coping. Externalizing subthemes included anger, disinhibited cognitions, and anti-social and risk-taking behaviors. Adverse experiences subthemes included poor health, poverty, homelessness, unemployment, trauma, and conflict. Finally, polysubstance use subthemes include substance types, methods of use, and motives. Differences emerged between personality profiles in the relative endorsement of various subthemes, including those pertaining to polysubstance use, that were largely as theoretically expected.ConclusionPersonality is associated with unique cognitive, affective, and behavioral lived experiences, suggesting that personality may be a novel intervention target in adjunctive psychosocial treatment for those undergoing OAT.

Project description:BackgroundWithin-consultation recruitment to primary care trials is challenging. Ensuring procedures are efficient and self-explanatory is the key to optimising recruitment. Trial recruitment software that integrates with the electronic health record to support and partially automate procedures is becoming more common. If it works well, such software can support greater participation and more efficient trial designs. An innovative electronic trial recruitment and outcomes software was designed to support recruitment to the Runny Ear randomised controlled trial, comparing topical, oral and delayed antibiotic treatment for acute otitis media with discharge in children. A qualitative evaluation investigated the views and experiences of primary care staff using this trial software.MethodsStaff were purposively sampled in relation to site, role and whether the practice successfully recruited patients. In-depth interviews were conducted using a flexible topic guide, audio recorded and transcribed. Data were analysed thematically.ResultsSixteen staff were interviewed, including GPs, practice managers, information technology (IT) leads and research staff. GPs wanted trial software that automatically captures patient data. However, the experience of getting the software to work within the limited and complex IT infrastructure of primary care was frustrating and time consuming. Installation was reliant on practice level IT expertise, which varied between practices. Although most had external IT support, this rarely included supported for research IT. Arrangements for approving new software varied across practices and often, but not always, required authorisation from Clinical Commissioning Groups.ConclusionsPrimary care IT systems are not solely under the control of individual practices or CCGs or the National Health Service. Rather they are part of a complex system that spans all three and is influenced by semi-autonomous stakeholders operating at different levels. This led to time consuming and sometimes insurmountable barriers to installation at the practice level. These need to be addressed if software supporting efficient research in primary care is to become a reality.

Project description:BackgroundResearch shows that interventions to protect the sensitive physiological process of birth by improving the birthing room design may positively affect perinatal outcomes. It is, however, crucial to understand the mechanisms and contextual elements that influence the outcomes of such complex interventions. Hence, we aimed to explore care providers' experiences of the implementation of a new hospital birthing room designed to be more supportive of women's birth physiology.MethodsThis qualitative study reports on the implementation of the new birthing room, which was evaluated in the Room4Birth randomised controlled trial in Sweden. Individual interviews were undertaken with care providers, including assistant nurses, midwives, obstetricians, and managers (n = 21). A content analysis of interview data was conducted and mapped into the three domains of the Normalisation Process Theory coding manual: implementation context, mechanism, and outcome.ResultsThe implementation of the new room challenged the prevailing biomedical paradigm within the labour ward context and raised the care providers' awareness about the complex interplay between birth physiology and the environment. This awareness had the potential to encourage care providers to be more emotionally present, rather than to focus on monitoring practices. The new room also evoked a sense of insecurity due to its unfamiliar design, which acted as a barrier to integrating the room as a well-functioning part of everyday care practice.ConclusionOur findings highlight the disparity that existed between what care providers considered valuable for women during childbirth and their own requirements from the built environment based on their professional responsibilities. This identified disparity emphasises the importance of hospital birthing rooms (i) supporting women's emotions and birth physiology and (ii) being standardised to meet care providers' requirements for a functional work environment.Trial registrationClinicalTrials.gov: NCT03948815, 14/05/2019.

Project description:BackgroundInternet-based dementia caregiver interventions have been shown to be effective for a range of caregiver outcomes; however, little is known about how to best implement them. We developed iGeriCare, an evidence-based, multimedia, web-based educational resource for family caregivers of people living with dementia.ObjectiveThis study aims to obtain feedback and opinions from experts and clinicians involved in dementia care and caregiver education about 1 iGeriCare and 2 barriers and facilitators to implementing a web-based caregiver program.MethodsWe carried out semistructured interviews with individuals who had a role in dementia care and/or caregiver education in several key stakeholder settings in Southern Ontario, Canada. We queried participants' perceptions of iGeriCare, caregiver education, the implementation process, and their experience with facilitators and barriers. Transcripts were coded and analyzed using a grounded theory approach. The themes that emerged were organized using the Consolidated Framework for Implementation Research.ResultsA total of 12 participants from a range of disciplines described their perceptions of iGeriCare and identified barriers and facilitators to the implementation of the intervention. The intervention was generally perceived as a high-quality resource for caregiver education and support, with many stakeholders highlighting the relative advantage of a web-based format. The intervention was seen to meet dementia caregiver needs, partially because of its flexibility, accessibility, and compatibility within existing clinical workflows. In addition, the intervention helps to overcome time constraints for both caregivers and clinicians.ConclusionsStudy findings indicate a generally positive response to the use of internet-based interventions for dementia caregiver education. Results suggest that iGeriCare may be a useful clinical resource to complement traditional face-to-face and print material-based caregiver education. More comprehensive studies are required to identify the effectiveness and longevity of web-based caregiver education interventions and to better understand barriers and facilitators with regard to the implementation of technology-enhanced caregiver educational interventions in various health care settings.

Project description:BackgroundUp to 95% of neonates exposed to opioids in utero experience neonatal opioid withdrawal syndrome at birth. Nonpharmacologic approaches (e.g., breastfeeding; rooming-in; skin-to-skin care) are evidence-based and should be implemented. These approaches, especially breastfeeding, rely on engagement of the neonates' mothers to help deliver them. However, little is known about the structural and social dynamic context barriers and facilitators to implementing maternal-delivered nonpharmacologic care.MethodsUsing a qualitative descriptive design, perinatal nurses from a Midwest United States hospital family birthing center, neonatal intensive care unit, and inpatient pediatric unit were interviewed. These units were involved in caring for mothers and neonates affected by opioid use. Telephone interviews followed a semi-structured interview guide developed for this study, were audio-recorded, and lasted about 30-60 min. Interviews were transcribed verbatim and independently analyzed by five investigators using the constant comparative method. Themes were discussed until reaching consensus and subsequently mapped to a conceptual model adapted for this study.ResultsTwenty-one nurses participated in this study (family birth center, n = 9; neonatal intensive care, n = 6; pediatrics, n = 6). Analysis resulted in four major themes: 1) Lack of education and resources provided to staff and mothers; 2) Importance of interdisciplinary and intradisciplinary care coordination; 3) Flexibility in nurse staffing models for neonatal opioid withdrawal syndrome; and 4) Unit architecture and layout affects maternal involvement. Minor themes supported each of the four major themes. All themes mapped to the conceptual model.ConclusionsThis study provides a more comprehensive understanding of the barriers and facilitators affecting implementation of maternal involvement in nonpharmacologic care of newborns with neonatal opioid withdrawal syndrome. Future efforts implementing nonpharmacologic approaches must consider the context factors affecting implementation, including structural and social factors within the units, hospital, and broader community.

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Challenges in implementing opioid agonist therapy in Lebanon: a qualitative study from a user's perspective.

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Challenges in implementing opioid agonist therapy in Lebanon: a qualitative study from a user's perspective.

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