a Massachusetts General Hospital/Harvard Medical School , Boston , Massachusetts , USA.
b Department of Psychology , University of Miami , Coral Gables , Florida , USA.
Subst Abus. 2018;39(2):162-166. doi: 10.1080/08897077.2017.1380743. Epub 2017 Oct 18.
In response to the lack of coverage for substance use treatment in the Western Cape province of South Africa, the local government expanded funding for evidence-based practices (EBPs) for treating substance use. Yet, little is known about provider and staff attitudes towards adopting EBPs in this setting, which is particularly relevant in this context where task shifting clinical care increases demands on paraprofessional providers. This study aimed to (1) assess attitudes towards adopting EBPs among a range of staff working in substance use treatment in Cape Town using a task shifting model; and (2) evaluate factors associated with openness towards adopting EBPs in this setting.
Staff (n = 87) were recruited from 11 substance use treatment clinics. Demographics and job-related characteristics were assessed. Staff perceptions of organizational factors were assessed using the TCU Organizational Readiness for Change (ORC) scale. The dependent variable, attitudes towards adopting EBPs, was assessed using the Evidence-Based Practice Attitude Scale (EBPAS).
This study is one of the first to administer the EBPAS in South Africa and found good internal consistency (total score: α = .82). In a multivariable model adjusting for site and factors associated with EBPAS total score at the bivariate level, only smaller caseload size was associated with greater openness to adopting EBPs (B = 1.61, SE = .73; t = 2.21; p<.05).
As pressure to scale up implementation of EBPs in South African substance use treatment services intensifies, additional efforts are needed to understand barriers to adopt EBPs in this setting. Supporting staff adoption of EBPs in resource-limited settings may require additional resources to limit staff caseloads in the context of task shifting.
为了弥补南非西开普省在物质使用治疗方面的不足，当地政府增加了对循证实践（EBP）的资金投入，以治疗物质使用问题。然而，在这种情况下，人们对提供者和工作人员采用 EBP 的态度知之甚少，这在临床护理任务转移增加对非专业提供者需求的情况下尤为重要。本研究旨在：（1）使用任务转移模型评估开普敦从事物质使用治疗的一系列工作人员对采用 EBP 的态度；（2）评估在这种情况下与开放性采用 EBP 相关的因素。
从 11 个物质使用治疗诊所招募了 87 名工作人员。评估了人口统计学和与工作相关的特征。使用 TCU 组织变革准备度（ORC）量表评估了工作人员对组织因素的看法。采用循证实践态度量表（EBPAS）评估了采用 EBP 的态度。
这是南非首次使用 EBPAS 的研究之一，发现其内部一致性良好（总分：α=0.82）。在调整了双变量水平上与 EBPAS 总分相关的站点和因素的多变量模型中，只有较小的病例数与更大的接受 EBP 的开放性相关（B=1.61，SE=0.73；t=2.21；p<.05）。
随着在南非物质使用治疗服务中扩大实施 EBP 的压力不断增加，需要进一步努力了解在这种情况下采用 EBP 的障碍。在资源有限的环境中支持工作人员采用 EBP 可能需要额外的资源来限制工作人员在任务转移背景下的病例数量。
