Rural and Urban African American Cocaine Users' Perceived Need for Care

农村和城市非裔美国可卡因使用者对护理的感知需求

• 批准号: 8274834
• 负责人: Tyrone Finley Borders
• 金额: $ 13.85万
• 依托单位: UNIV OF ARKANSAS FOR MED SCIS
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-07-01 至 2012-11-05
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8274834
• 关键词: Address; African American; Arkansas; Awareness; Behavioral Model; Caring; Clinic; Cocaine; Cocaine Users; Communities; Data; Dental; Drug abuse; Drug usage; Environment; HIV; Health; Health Policy; Health Services; Health Services Accessibility; Health Status; Health system; Human immunodeficiency virus test; Illicit Drugs; Improve Access; Incentives; Interview; Kentucky; Knowledge; Location; Marijuana; Measures; Mediating; Mediator of activation protein; Medical; Methamphetamine; Methods; Minority; Natural History; Ohio; Participant; Pathway interactions; Perception; Persons; Pharmaceutical Preparations; Physicians; Policy Maker; Population; Privacy; Provider; Psyche structure; Public Health; Qualitative Methods; Recruitment Activity; Research; Resources; Respondent; Rural; Rural Health Services; Sampling; Services; Site; Source; Stigmata; Structure; Substance abuse problem; Testing; Variant; Work; base; behavioral health; design; health disparity; high risk; high risk sexual behavior; informant; insight; instrument; meetings; preference; programs; public health relevance; rural area; service utilization; social; social stigma; treatment program; treatment site; urban area

DESCRIPTION (provided by applicant): We seek to study the factors associated with rural/urban differences in perceived need for both drug abuse treatment and HIV testing because these are complementary services which could be integrated within formal drug abuse treatment programs or other locations to better meet the needs of African American cocaine users. We focus on perceived need among African American cocaine users because of their low rates of drug abuse treatment and HIV testing nationally as well as their demonstrated low perceived need for drug abuse treatment, high rates of risky sexual behaviors, and aversion to seeking HIV testing at local health departments in our prior research. Given that our prior natural history research did not include any urban areas, we do not know whether the low rates of drug abuse treatment and HIV testing among rural Arkansans are specific to rural residents (e.g., whether there is a disparity in access for rural African Americans) or whether urban African American cocaine users differ in other critical factors. To address these issues, we plan to conduct a community-based mixed methods study of African American cocaine users residing in rural and urban areas of Arkansas. Specifically, we propose a sequential mixed-method design, with qualitative key informant interviews conducted first (30 rural, 30 urban), followed by larger-scale, structured interviews (200 rural, 200 urban) using standardized instruments, pertinent measures from our prior rural health services and HIV research, and newly developed questions based on our initial qualitative work. Respondent-Driven Sampling (RDS), a variant of snowball sampling, will be used to identify and recruit participants. The primary aims of the study are: 1) Using qualitative methods, to describe rural/urban differences in pathways to drug use and drug use cultures, perceptions of access to drug abuse treatment and HIV testing, awareness and perceptions of what constitutes drug abuse treatment and HIV testing, and preferences for formal or informal drug abuse treatment and the site or location of HIV testing; 2) Using quantitative and qualitative methods, to compare and contrast rural and urban cocaine users' perceived need for drug abuse treatment and HIV testing and key predisposing, enabling, health, and other factors which could impede or facilitate perceived need; and 3) Using quantitative methods, to investigate whether rural/urban differences in perceived need for drug abuse treatment and HIV testing are mediated by key predisposing, enabling, and health factors as well as treatment and testing awareness and preferences. The knowledge gained from this project will enable health policy makers, treatment program managers, and providers to make more informed decisions about how to encourage and facilitate the utilization of drug abuse treatment and HIV testing among African American cocaine users in the Southern U.S., an underserved and high risk population. PUBLIC HEALTH RELEVANCE: Of public health concern are the low rates of drug abuse treatment and high rates of HIV among African American cocaine users, especially in the Southern U.S. The knowledge gained from the proposed research would enable managers of public and behavioral health systems to make more informed decisions about how to target and tailor culturally sensitive messages aimed at increasing awareness of the benefits of drug abuse treatment and HIV testing. The proposed research would also provide new insight into whether HIV testing should be integrated within drug abuse treatment facilities to better meet the needs of rural as well as urban African American cocaine users.

描述（由申请人提供）：我们试图研究与城乡对药物滥用治疗和艾滋病毒检测的感知需求差异相关的因素，因为这些是互补的服务，可以整合到正式的药物滥用治疗计划或其他地方，以更好地满足非洲裔美国可卡因使用者的需求。我们关注非洲裔美国可卡因使用者的感知需求，因为他们在全国范围内的药物滥用治疗和艾滋病毒检测率很低，而且在我们之前的研究中，他们对药物滥用治疗的感知需求很低，高风险性行为的比例很高，并且不愿在当地卫生部门进行艾滋病毒检测。鉴于我们之前的自然历史研究没有包括任何城市地区，我们不知道阿肯色州农村地区的药物滥用治疗和艾滋病毒检测率低是农村居民所特有的（例如，农村非洲裔美国人在获得药物治疗方面是否存在差异），还是城市非洲裔美国人可卡因使用者在其他关键因素上存在差异。为了解决这些问题，我们计划对居住在阿肯色州农村和城市地区的非裔美国可卡因使用者进行一项基于社区的混合方法研究。具体而言，我们提出了一种顺序混合方法设计，首先进行定性关键信息提供者访谈（30个农村，30个城市），然后使用标准化工具进行更大规模的结构化访谈（200个农村，200个城市），使用我们之前农村卫生服务和艾滋病毒研究的相关措施，以及基于我们最初定性工作的新开发问题。受访者驱动抽样（RDS）是滚雪球抽样的一种变体，将用于识别和招募参与者。本研究的主要目的是：1)使用定性方法，描述农村/城市在药物使用途径和药物使用文化方面的差异，对获得药物滥用治疗和艾滋病毒检测的看法，对药物滥用治疗和艾滋病毒检测构成的认识和看法，以及对正式或非正式药物滥用治疗的偏好以及艾滋病毒检测的地点或地点；2)使用定量和定性方法，比较和对比农村和城市可卡因使用者对药物滥用治疗和艾滋病毒检测的感知需求，以及可能阻碍或促进感知需求的主要易感因素、使能因素、健康因素和其他因素；3)采用定量方法，探讨城乡吸毒治疗和艾滋病毒检测感知需求差异是否受关键易感因素、使能因素、健康因素以及治疗和检测意识和偏好的调节。从该项目中获得的知识将使卫生政策制定者、治疗方案经理和提供者能够就如何鼓励和促进美国南部非洲裔可卡因使用者滥用药物治疗和艾滋病毒检测做出更明智的决定，这是一个服务不足和高风险的人群。