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


Autoři: Claire van der Westhuizen aff001;  Bronwyn Myers aff002;  Megan Malan aff001;  Tracey Naledi aff004;  Marinda Roelofse aff004;  Dan J. Stein aff006;  Sa’ad Lahri aff007;  Katherine Sorsdahl aff001
Působiště autorů: Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa aff001;  Alcohol Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa aff002;  Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa aff003;  Western Cape Department of Health, Cape Town, South Africa aff004;  School of Public Health Medicine & Family Medicine, University of Cape Town, Cape Town, South Africa aff005;  SA MRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry & Neuroscience Institute, University of Cape Town, Cape Town, South Africa aff006;  Department of Emergency Medicine, Stellenbosch University, Stellenbosch, South Africa aff007;  Khayelitsha Hospital Emergency Services, Cape Town, South Africa aff008
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
doi: 10.1371/journal.pone.0224951

Souhrn

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.

Klíčová slova:

Behavioral and social aspects of health – Critical care and emergency medicine – Employment – Global health – Health care policy – Health services administration and management – Randomized controlled trials – Social research


Zdroje

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