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Drug Free Moms and Babies: Qualitative and quantitative program evaluation results from a rural Appalachian state.

ABSTRACT: The main objective of this study is to present qualitative and quantitative results of the Drug Free Moms and Babies (DFMB) Project pilot program. The program was designed to integrate and evaluate treatment and recovery services for pregnant and postpartum women with substance use disorders. Qualitative assessment was conducted via interviews regarding programmatic design components (four West Virginia sites; 2012-2018). The quantitative assessment utilized a survey that included information on patients' (N?=?550) demographic, medical and substance use histories, health care services, and maternal and infant health outcomes. The qualitative results noted that program development for this population is time- and resource-intensive, and implementation requires collaborative team work. A dedicated staff position and team flexibility were critical towards programmatic success. For quantitative results, among the 393 participants that completed the program, urine drug screen data showed a significant reduction of non-prescribed positive screens from 81% (N?=?178) positive in the first trimester to 22% (n?=?86) positive at delivery, p?

SUBMITTER: Lilly CL

PROVIDER: S-EPMC6580012 | biostudies-literature | 2019 Sep

REPOSITORIES: biostudies-literature

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Drug Free Moms and Babies: Qualitative and quantitative program evaluation results from a rural Appalachian state.

Lilly Christa L CL Ruhnke Alice M AM Breyel Janine J Umer Amna A Leonard Cassie E CE

Preventive medicine reports 20190610

The main objective of this study is to present qualitative and quantitative results of the Drug Free Moms and Babies (DFMB) Project pilot program. The program was designed to integrate and evaluate treatment and recovery services for pregnant and postpartum women with substance use disorders. Qualitative assessment was conducted via interviews regarding programmatic design components (four West Virginia sites; 2012-2018). The quantitative assessment utilized a survey that included information on ...[more]

PMID: 31223561

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Project description:BackgroundEnrolling sufficient number of people who inject drugs (PWID) into syringe services programs (SSP) is important to curtail outbreaks of drug-related harms. Still, little is known about barriers and facilitators to SSP enrollment in rural areas with no history of such programs. This study's purpose was to develop a grounded theory of the role of the risk environment and individual characteristics of PWID in shaping SSP enrollment in rural Kentucky.MethodsWe conducted one-on-one semi-structured interviews with 41 clients of 5 SSPs that were established in rural counties in Appalachian Kentucky in 2017-2018. Interviews covered PWID needs, the process of becoming aware of SSPs, and barriers and facilitators to SSP enrollment. Applying constructivist grounded theory methods and guided by the Intersectional Risk Environment Framework (IREF), we applied open, axial and selective coding to develop the grounded theory.ResultsStigma, a feature of IREF's meso-level social domain, is the main factor hampering SSP enrollment. PWID hesitated to visit SSPs because of internalized stigma and because of anticipated stigma from police, friends, family and healthcare providers. Fear of stigma was often mitigated or amplified by a constellation of meso-level environmental factors related to healthcare (e.g., SSPs) and social (PWID networks) domains and by PWID's individual characteristics. SSPs mitigated stigma as a barrier to enrollment by providing low threshold services in a friendly atmosphere, and by offering their clients program IDs to protect them from paraphernalia charges. SSP clients spread positive information about the program within PWID networks and helped their hesitant peers to enroll by accompanying them to SSPs. Individual characteristics, including child custody, employment or high social status, made certain PWID more susceptible to drug-related stigma and hence more likely to delay SSP enrollment.ConclusionsFeatures of the social and healthcare environments operating at the meso-level, as well as PWID's individual characteristics, appear to enhance or mitigate the effect of stigma as a barrier to SSP enrollment. SSPs opening in locations with high stigma against PWID need to ensure low threshold and friendly services, protect their clients from police and mobilize PWID networks to promote enrollment.

Project description:BACKGROUND:An interprofessional medication adherence program (IMAP) for chronic patients was developed and successfully implemented in the community pharmacy of the Department of ambulatory care and community medicine (Lausanne, Switzerland). This study assesses the capacity of a physician and a nurse at the infectious diseases service of a public hospital and of community pharmacists in the Neuchâtel area (Switzerland) to implement the IMAP in their practice. METHODS:Mixed method, prospective, observational study. Quantitative and qualitative analyses of the implementation process were conducted following the RE-AIM model (reach, effectiveness, adoption, implementation and maintenance). RESULTS:Implementation started in November 2014. One physician, one nurse, and five pharmacists agreed to participate. Healthcare professionals perceived the benefits of the program and were motivated to implement it in their practice (adoption). Seventeen patients were included in the program; 13 refused to participate. The inclusion of naïve HIV patients was easier than the inclusion of experienced patients with difficult psychosocial issues (reach). Pharmacists were engaged in reinforcing patient medication adherence in 25% of interviews (effectiveness). Key facilitators expressed by healthcare professionals were patient inclusion by the physician and the nurse instead of the pharmacist and the organisation of regular meetings between all stakeholders. In contrast, the encountered barriers were the lack of time and resources, the lack of team uptake, and the lack of adoption by senior managers (implementation). Interviewed patients were all satisfied with this new program, encouraging healthcare professionals to scale it up. Structural changes allowed the hospital and one pharmacy to enter the maintenance stage (maintenance). CONCLUSION:The research team and collaboration between all professionals involved played an important role in this implementation. However, the dissemination of such a program to a larger scale and for the long term requires financial and structural resources as well as transitional external support.

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Drug Free Moms and Babies: Qualitative and quantitative program evaluation results from a rural Appalachian state.

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Drug Free Moms and Babies: Qualitative and quantitative program evaluation results from a rural Appalachian state.

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