Integrating Reproductive and Sexual Health Education and Services Into Opioid Use Disorder Treatment Programs: A Qualitative Study
Integrating Reproductive and Sexual Health Education and Services Into Opioid Use Disorder Treatment Programs: A Qualitative Study
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DOI：
10.1097/adm.0000000000000657
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发表时间：
2020-09-01
影响因子：
5.5
通讯作者：
Jones, Hendree E.
中科院分区：
文献类型：
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作者：
Klaman, Stacey L.;Turner, Kea;Jones, Hendree E.
目的：在美国，阿片类药物使用障碍（OUD）的女性有生殖和性健康（RSH）不良结局的风险。这里介绍的定性研究是一个更大的混合方法研究的一部分。定性的组成部分采用了实施科学框架，调查供应商和工作人员的观点，在阿片类药物治疗计划（OTP）在北卡罗来纳州的生殖年龄妇女的RSH教育和服务的整合。方法：在2017年11月至12月期间，对9家OTP的提供者和工作人员进行了31次半结构化访谈。实施研究的综合框架（CFIR）被用来评估多层次的实施环境（如，患者，供应商，组织），以确定可能影响有效的干预措施的实施的障碍和促进因素。访谈录音，转录，编码和分析，以确定关键的主题。采用了演绎和归纳方法。结果如下：障碍包括交通、儿童保育和时间限制（病人一级）、提供者之间缺乏沟通（提供者一级）、缺乏政治意愿、相互竞争的优先事项以及可用资源短缺（组织一级）。促进者包括小组教育方法（患者层面）、强有力的沟通（提供者层面）和协作文化（组织层面）。结论：评估实施的决定因素是重要的RSH干预措施的发展。CFIR结构被认为是重要的影响，可以促进或阻碍有效的实施。RSH教育和服务的整合是一个过程，如果分阶段解决，可能是可行的。广泛的RSH教育和服务有可能对OUD妇女及其子女，家庭和社区的健康产生深远的影响。
Objectives: Women with opioid use disorder (OUD) in the USA are at risk for poor reproductive and sexual health (RSH) outcomes. The qualitative research presented here is part of a larger mixed methods study. The qualitative component used an implementation science framework to investigate provider and staff perspectives regarding the integration of RSH education and services for reproductive-age women in opioid treatment programs (OTPs) in North Carolina. Methods: Thirty-one semistructured interviews were conducted with providers and staff at 9 OTPs between November and December, 2017. The Consolidated Framework for Implementation Research (CFIR) was used to assess multilevel implementation contexts (eg, patient, provider, organizational) to identify barriers and facilitators that might influence effective intervention implementation. Interviews were audio-recorded, transcribed, coded, and analyzed to identify key themes. Deductive and inductive approaches were used. Results: Barriers included transportation, childcare, and time constraints (patient-level), lack of communication between providers (provider-level), lack of political will, competing priorities, and shortages of available resources (organizational-level). Facilitators included a group education approach (patient-level), strong communication (provider-level), and a culture of collaboration (organizational-level). Conclusions: Assessing determinants of implementation is important to the development of RSH interventions. CFIR constructs were found to be important influences that could facilitate or hinder effective implementation. Integration of RSH education and services is a process, and, when addressed in stages, might be feasible. A broad range of RSH education and services has the potential to have a profound impact on the health of women with OUD and their children, their families, and their communities.