Capacity for sustainment of recently established syringe service programs in Appalachian Kentucky: The central role of staff champions.
Capacity for sustainment of recently established syringe service programs in Appalachian Kentucky: The central role of staff champions.
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阿巴拉契亚肯塔基州最近建立的注射器服务计划的维持能力：员工拥护者的核心作用。
DOI：
10.1111/dar.13436
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发表时间：
2022
影响因子：
3.8
通讯作者：
Ibragimov,Umed
中科院分区：
文献类型：
--
作者：
Cooper,HannahLF;Gross,Skylar;Klein,Emma;Fadanelli,Monica;Ballard,April;Lockard,Scott;Batty,Evan;Young,April;Ibragimov,Umed
随着与毒品有关的流行病蔓延到农村地区，确保农村地区有足够的减害基础设施是当务之急。在此，我们探讨了肯塔基州阿巴拉契亚地区注射器服务项目(SSP)的持续能力。方法我们采用半结构化一对一定性访谈的方法，于2018-2019年访问了肯塔基州两个卫生区所有SSP的所有工作人员(n= 16)(n= 7)；当地卫生部门运营SSP。面谈领域包括：(1)建立社保计划；(2)日常运作、参与和对健康的影响；(3)可持续发展的预期；(4)对#1-#3的可预见的影响。我们使用主题分析方法对逐字记录进行分析；在分析过程中，Schell的“维持能力”结构被视为敏感的概念。结果大多数社区成员、执法部门和卫生署工作人员在SSP开业前反对SSP，原因是耻辱以及对赋权和针刺伤害的担忧；卫生署工作人员也反对SSP，因为他们认为SSP缺乏操作能力。培训、技术援助、项目对公众健康影响的明显证据，以及与SSP参与者的接触，使卫生署工作人员成为项目冠军。作为冠军，SSP的工作人员制定了具有很强的可持续能力的计划，正如谢尔所定义的那样(例如，可见的公共卫生影响、稳定的资金、政治支持)。工作人员报告说，SSP有很高的可持续发展前景。讨论和结论与几十年前在城市开设的SSP一样，这些农村地区新兴SSP的工作人员似乎已经成为这些有争议项目的关键拥护者，并可能成为在这些服务不足的地区更广泛地扩大减少危害规划的重要资源。
IntroductionEnsuring adequate harm reduction infrastructure in rural areas is imperative, as drug‐related epidemics expand into them. Here, we explore the capacity for sustainment of syringe service programs (SSP) in Appalachian Kentucky.MethodsWe interviewed all staff (n= 16) of all SSPs (n= 7) in two Kentucky health districts in 2018–2019 using semi‐structured one‐on‐one qualitative interviews; local departments of health (DOH) operated the SSPs. Interview domains encompassed: (i) SSP establishment; (ii) day‐to‐day operations, participation and health impacts; (iii) perceived prospects for sustainment; and (iv) perceived influences on #i–#iii. We analysed verbatim transcripts using thematic analytic methods; Schell's ‘capacity for sustainment’ constructs were treated as sensitising concepts during the analysis.ResultsMost community members, law enforcement and DOH staff opposed SSPs before they opened, because of stigma and concerns about enabling and needlestick injuries; DOH staff also opposed SSPs because they believed they lacked the capacity to operate them. Training, technical assistance, visible evidence of the programs' public health impact and contact with SSP participants transformed DOH staff into program champions. As champions, SSP staff developed programs that had strong capacity for sustainment, as defined by Schell (e.g. visible public health impact, stable funding, political support). Staff reported that the SSPs had high prospects for sustainment.Discussion and ConclusionAs in SSPs that opened in cities decades ago, staff in emerging SSPs in these rural areas appear to have become crucial champions for these controversial programs, and may serve as vital resources for expanding harm reduction programming more broadly in these underserved areas.