Implementation of a screening, brief intervention and referral to treatment programme for risky substance use in South African emergency centres: A mixed methods evaluation study.
Journal
PloS one
ISSN: 1932-6203
Titre abrégé: PLoS One
Pays: United States
ID NLM: 101285081
Informations de publication
Date de publication:
2019
2019
Historique:
received:
10
07
2019
accepted:
24
10
2019
entrez:
16
11
2019
pubmed:
16
11
2019
medline:
24
3
2020
Statut:
epublish
Résumé
Screening, brief intervention, and referral to treatment (SBIRT) for risky substance use is infrequently included in routine healthcare in low-resourced settings. A SBIRT programme, adopted by the Western Cape provincial government within an alcohol harm reduction strategy, employed various implementation strategies executed by a diverse team to translate an evidence-based intervention into services at three demonstration sites before broader programme scale-up. This paper evaluates the implementation of this programme delivered by facility-based counsellors in South African emergency centres. Guided by the Consolidated Framework for Implementation Research, this mixed methods study evaluated the feasibility, acceptability, appropriateness and adoption of this task-shared SBIRT programme. Quantitative data were extracted from routinely collected health information. Qualitative interviews were conducted with 40 stakeholders in the programme's second year. In the first year, 13 136 patients were screened and 4 847 (37%) patients met criteria for risky substance use. Of these patients, 83% received the intervention, indicating programme feasibility. The programme was adopted into routine services and found to be acceptable and appropriate, particularly by stakeholders familiar with the emergency environment. These stakeholders highlighted the burden of substance-related harm in emergency centres and favourable patient responses to SBIRT. However, some stakeholders expressed scepticism of the behaviour change approach and programme compatibility with emergency centre operations. Furthermore, adoption was both facilitated and hampered by a top-down directive from provincial leadership to implement SBIRT, while rapid implementation limited effective engagement with a diverse stakeholder group. This is one of the first studies to address SBIRT implementation in low-resourced settings. The results show that SBIRT implementation and adoption was largely successful, and provide valuable insights that should be considered prior to implementation scale-up. Recommendations include ensuring ongoing monitoring and evaluation, and early stakeholder engagement to improve implementation readiness and programme compatibility in the emergency setting.
Sections du résumé
BACKGROUND
Screening, brief intervention, and referral to treatment (SBIRT) for risky substance use is infrequently included in routine healthcare in low-resourced settings. A SBIRT programme, adopted by the Western Cape provincial government within an alcohol harm reduction strategy, employed various implementation strategies executed by a diverse team to translate an evidence-based intervention into services at three demonstration sites before broader programme scale-up. This paper evaluates the implementation of this programme delivered by facility-based counsellors in South African emergency centres.
METHOD
Guided by the Consolidated Framework for Implementation Research, this mixed methods study evaluated the feasibility, acceptability, appropriateness and adoption of this task-shared SBIRT programme. Quantitative data were extracted from routinely collected health information. Qualitative interviews were conducted with 40 stakeholders in the programme's second year.
RESULTS
In the first year, 13 136 patients were screened and 4 847 (37%) patients met criteria for risky substance use. Of these patients, 83% received the intervention, indicating programme feasibility. The programme was adopted into routine services and found to be acceptable and appropriate, particularly by stakeholders familiar with the emergency environment. These stakeholders highlighted the burden of substance-related harm in emergency centres and favourable patient responses to SBIRT. However, some stakeholders expressed scepticism of the behaviour change approach and programme compatibility with emergency centre operations. Furthermore, adoption was both facilitated and hampered by a top-down directive from provincial leadership to implement SBIRT, while rapid implementation limited effective engagement with a diverse stakeholder group.
CONCLUSION
This is one of the first studies to address SBIRT implementation in low-resourced settings. The results show that SBIRT implementation and adoption was largely successful, and provide valuable insights that should be considered prior to implementation scale-up. Recommendations include ensuring ongoing monitoring and evaluation, and early stakeholder engagement to improve implementation readiness and programme compatibility in the emergency setting.
Identifiants
pubmed: 31730623
doi: 10.1371/journal.pone.0224951
pii: PONE-D-19-19391
pmc: PMC6858052
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e0224951Subventions
Organisme : Wellcome Trust
Pays : United Kingdom
Déclaration de conflit d'intérêts
The authors have declared that no competing interests exist.
Références
Implement Sci. 2016 May 17;11:72
pubmed: 27189233
Lancet Glob Health. 2016 Sep;4(9):e642-53
pubmed: 27539806
J Health Serv Res Policy. 2008 Apr;13(2):92-8
pubmed: 18416914
Trials. 2018 Mar 16;19(1):185
pubmed: 29548302
Addiction. 2016 May;111(5):783-94
pubmed: 26637990
BMC Public Health. 2013 Jul 31;13:699
pubmed: 23902931
Addiction. 2017 Feb;112 Suppl 2:110-117
pubmed: 28074569
Addiction. 2015 Jul;110(7):1082-91
pubmed: 25916993
Subst Abuse Treat Prev Policy. 2015 Nov 14;10:46
pubmed: 26576946
J Med Assoc Thai. 2010 Aug;93(8):992-7
pubmed: 20718176
Cochrane Database Syst Rev. 2013 Nov 19;(11):CD009149
pubmed: 24249541
Subst Abus. 2007;28(4):79-92
pubmed: 18077305
Public Health. 2013 Dec;127(12):1140-2
pubmed: 24275032
J Rural Health. 2018 Dec;34(1):48-62
pubmed: 28084667
Rev Saude Publica. 2009 Aug;43 Suppl 1:51-61
pubmed: 19669065
J Public Health (Oxf). 2011 Sep;33(3):412-21
pubmed: 21169370
Subst Abus. 2007;28(3):7-30
pubmed: 18077300
J Subst Abuse Treat. 2016 Jan;60:81-90
pubmed: 26297321
BMC Public Health. 2017 Jun 9;17(1):562
pubmed: 28599632
J Health Serv Res Policy. 2013 Oct;18(3 Suppl):27-39
pubmed: 24127358
J Trauma. 2005 Sep;59(3 Suppl):S80-7; discussion S94-100
pubmed: 16355071
Adm Policy Ment Health. 2009 Jan;36(1):24-34
pubmed: 19104929
Implement Sci. 2018 Feb 23;13(1):36
pubmed: 29475440
Implement Sci. 2008 Feb 15;3:8
pubmed: 18279503
Alcohol Alcohol. 2015 May;50(3):302-9
pubmed: 25731180
Acad Emerg Med. 2009 Nov;16(11):1054-9
pubmed: 20053222
BMJ Open. 2019 Jan 15;9(1):e024277
pubmed: 30647043
Public Health Rev. 2017 Dec 29;38:31
pubmed: 29450101
Implement Sci. 2018 Dec 12;13(1):149
pubmed: 30541596
Adm Policy Ment Health. 2016 Nov;43(6):957-977
pubmed: 27474040
PLoS One. 2014 Aug 14;9(8):e103754
pubmed: 25121789
Addiction. 2017 Feb;112 Suppl 2:23-33
pubmed: 28074571
Addict Sci Clin Pract. 2013 Feb 11;8:4
pubmed: 23399417
Addiction. 2014 May;109(5):754-65
pubmed: 24450612
Implement Sci. 2009 Aug 07;4:50
pubmed: 19664226
BMC Health Serv Res. 2019 Mar 25;19(1):189
pubmed: 30909897
Croat Med J. 2008 Jun;49(3):392-401
pubmed: 18581618
S Afr Med J. 2009 May;99(5 Pt 2):339-44
pubmed: 19588796
Health Policy Plan. 2019 Mar 1;34(2):132-140
pubmed: 30863845
Drug Alcohol Rev. 2016 Nov;35(6):702-709
pubmed: 27247085
S Afr Med J. 2017 Dec 13;108(1):33-39
pubmed: 29262976
Syst Rev. 2014 May 24;3:50
pubmed: 24887418
Bull World Health Organ. 2020 Mar 1;98(3):222-223
pubmed: 32132758
J Subst Abuse Treat. 2016 Jan;60:27-35
pubmed: 26297322
Syst Rev. 2018 May 5;7(1):72
pubmed: 29729669
J Subst Abuse Treat. 2016 Jan;60:21-6
pubmed: 26381929
Alcohol Alcohol. 2014 Jan-Feb;49(1):66-78
pubmed: 24232177
Adm Policy Ment Health. 2011 Mar;38(2):65-76
pubmed: 20957426
BMC Public Health. 2013 Jul 11;13:644
pubmed: 23844552
Addiction. 2017 Feb;112 Suppl 2:12-22
pubmed: 28074572
Adm Policy Ment Health. 2008 Mar;35(1-2):21-37
pubmed: 17990095
West J Emerg Med. 2017 Oct;18(6):1143-1152
pubmed: 29085549
BMC Infect Dis. 2014 Sep 12;14:500
pubmed: 25212696
Community Ment Health J. 2015 Nov;51(8):962-9
pubmed: 25744699
Adv Prev Med. 2012;2012:569153
pubmed: 23198159