Addressing Alcohol Use Related Health Disparities: A Hybrid Effectiveness Implementation Study of a Culturally Adapted MI for Latinx Alcohol and Drug Users

解决与酒精使用相关的健康差异：针对拉丁裔酒精和吸毒者的文化适应性 MI 的混合有效性实施研究

• 批准号: 10260640
• 负责人: CHRISTINA S LEE
• 金额: $ 64.81万
• 依托单位: BOSTON UNIVERSITY (CHARLES RIVER CAMPUS)
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-10 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10260640
• 关键词: Acculturation; Address; Adoption; Advocate; Aftercare; Alcohol consumption; Alcoholic beverage heavy drinker; Alcohols; Caring; Client; Clinical; Communities; Cost Analysis; Discrimination; Drug usage; Drug user; Effectiveness; Enrollment; Ethnic group; Evaluation; Frequencies; Future; Goals; Health; Heavy Drinking; Hybrids; Immigrant; Immigration; Individual; Intervention; Investigation; Knowledge; Latinx; Life; Measures; Mediator of activation protein; Medical; Mental Health; Methods; Minority; Modeling; Needs Assessment; Outcome; Outcome Assessment; Patient Care; Patients; Persons; Pharmaceutical Preparations; Phase; Population; Population Heterogeneity; Primary Health Care; Process; Protocols documentation; Provider; Public Health; Qualitative Research; Randomized; Randomized Clinical Trials; Research; Research Design; Risk; Science; Signal Transduction; Social isolation; Stress; Supervision; System; Testing; Training; Translating; Treatment outcome; addiction; alcohol related consequences; anxiety symptoms; arm; base; clinically significant; cost; depressive symptoms; drinking; effectiveness clinical trial; effectiveness implementation design; effectiveness implementation study; efficacious intervention; evidence base; experience; follow-up; health disparity; illicit drug use; implementation cost; implementation evaluation; implementation fidelity; implementation measures; implementation outcomes; implementation science; implementation strategy; improved; motivational enhancement therapy; population health; primary care setting; racial and ethnic; reduced substance use; social stigma; social stressor; stressor; substance use; treatment as usual; treatment response

Abstract Alcohol use is a significant problem among Latinxs because of the disproportionate burden of physical harms and negative consequences associated with substance use relative to other racial/ethnic groups. Factors associated with the stress related to being an immigrant increase risk for substance use. A theoretically-based cultural adaptation of motivational interviewing (CAMI) that specifically integrated discussion of stressors related to immigration (e.g., discrimination, stigma, social isolation) resulted in significant reductions in harms related to alcohol for those Latinx heavy drinkers with high discrimination compared to standard MI, and reduced anxiety and depressive symptoms one year later compared to MI. Rigorous tests that examine theoretically-informed adaptation of efficacious interventions for addictions are not common, yet are needed to advance implementation science because they address questions that are the basis for successful implementation. The proposed Hybrid Type 1 Effectiveness-Implementation study is an important next step in this line of research, which is to investigate the feasibility of implementing the CAMI intervention in a real-world clinical setting. The key questions are: Would CAMI have positive effects among individuals who use both drugs and alcohol? How do providers view this intervention? We will collaborate with a primary care center that serves a mainly Latinx client population to train their Community Wellness Advocates (CWAs) to deliver the CAMI to patients who are heavy drinkers. We will conduct a concurrent investigation on the process of implementing the CAMI in primary care - a two-arm randomized clinical effectiveness trial will enroll Latinx heavy drinkers (18 years or older) in primary care who use alcohol (and may use other drugs) - and follow them for 12 months after the intervention. Specific Aims are: (1) To examine the impact of CAMI plus an in- person booster session (vs. assessment only) on outcomes: % heavy drinking days, frequency of alcohol- related consequences, depressive/anxiety symptoms, and number of illicit drug use days, using a Hybrid Type 1 Effectiveness-Implementation design and (2) To gather indicators of implementation outcome from multiple stakeholders using a mixed-methods approach. We will follow Curran's framework to evaluate the process of implementation and Proctor's framework to measure implementation outcomes: acceptability, adoption, intervention appropriateness, feasibility, overall cost (i.e., CAMI vs. assessment only), and treatment fidelity. Our study, a first to examine the acceptability of culturally-adapted addiction treatments in primary care settings, will answer essential questions on implementing evidence-based care for Latinxs that can improve health disparities related to substance use. Long term goals are to translate our lessons from the proposed Hybrid study to the broader community to focus on population health for all primary care patients.

抽象的 饮酒是拉丁裔中的一个严重问题，因为造成的身体伤害负担过重 与其他种族/族裔群体相比，与药物使用相关的负面后果。因素 与移民相关的压力会增加药物使用的风险。一个有理论依据的 动机访谈的文化适应（CAMI）专门整合了压力源的讨论 与移民有关的问题（例如歧视、耻辱、社会孤立）导致伤害显着减少 与标准 MI 相比，那些拉丁裔重度饮酒者与酒精相关的歧视程度较高，以及 与 MI 相比，一年后焦虑和抑郁症状减轻。严格的测试检查 对成瘾的有效干预措施进行理论上的调整并不常见，但仍需要 推进实施科学，因为它们解决了作为成功基础的问题 执行。拟议的混合型 1 型有效性实施研究是下一步重要的一步 这一研究方向是调查在现实世界中实施 CAMI 干预的可行性 临床环境。关键问题是：CAMI 会对同时使用这两种方法的个人产生积极影响吗？ 毒品和酒精？提供者如何看待这种干预？我们将与初级保健中心合作 主要为拉丁裔客户群提供服务，培训他们的社区健康倡导者 (CWA)，以提供 CAMI 适用于酗酒者。我们将对该过程进行同步调查 在初级保健中实施 CAMI - 一项双臂随机临床有效性试验将招募拉丁裔 在初级保健中饮酒（并可能使用其他药物）的酗酒者（18 岁或以上） - 并遵循 干预后 12 个月。具体目标是： (1) 检验 CAMI 加上 in- 个人强化课程（与仅评估相比）的结果：酗酒天数百分比、饮酒频率- 使用混合类型的相关后果、抑郁/焦虑症状以及非法药物使用天数 1 有效性实施设计以及 (2) 从多个方面收集实施成果指标 利益相关者使用混合方法。我们将按照Curran的框架来评估这个过程 实施和 Proctor 衡量实施结果的框架：可接受性、采用率、 干预的适当性、可行性、总体成本（即 CAMI 与仅评估）和治疗保真度。 我们的研究首次考察了初级保健中适应文化的成瘾治疗的可接受性 设置，将回答有关对拉丁裔实施循证护理的基本问题，这些护理可以改善 与物质使用相关的健康差异。长期目标是将我们从提议中吸取的教训转化为经验教训 针对更广泛社区的混合研究，重点关注所有初级保健患者的人口健康。