Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, 99202, USA.
BMC Health Serv Res. 2023 Aug 23;23(1):902. doi: 10.1186/s12913-023-09878-7.
Although considered one of the most effective interventions for substance use disorders (SUD), the widespread implementation of contingency management (CM) has remained limited. In more recent years there has been surge in the implementation of CM to address increasing rates of substance use. Prior studies at the provider-level have explored beliefs about CM among SUD treatment providers and have tailored implementation strategies based on identified barriers and training needs, to promote implementation of CM. However, there have been no implementation strategies that have actively sought to identify or address potential differences in the beliefs about CM that could be influenced by the cultural background (e.g., ethnicity) of treatment providers. To address this knowledge gap, we examined beliefs about CM among a sample of inpatient and outpatient SUD treatment providers.
A cross-sectional survey of SUD treatment providers was completed by 143 respondents. The survey asked respondents about their attitudes toward CM using the Contingency Management Beliefs Questionnaire (CMBQ). Linear mixed models examined the effect of ethnicity (non-Hispanic White and Hispanic) on CMBQ subscale (general barriers, training-related barriers, CM positive-statements) scores.
Fifty-nine percent of respondents to the CMBQ self-identified as non-Hispanic White and 41% as Hispanic. Findings revealed that treatment providers who identified as Hispanic had significantly higher scores on the general barriers (p < .001) and training-related barriers (p = .020) subscales compared to the non-Hispanic White treatment providers. Post-hoc analyses identified differences in the endorsement of specific individual scale items on the general barriers (e.g., CM interventions create extra work for me) and training-related (e.g., I want more training before implementing CM) subscales.
Dissemination and implementation strategies for CM need to consider equity-related factors at the provider-level that may be associated with the adoption and uptake of CM.
尽管被认为是治疗物质使用障碍（SUD）最有效的干预措施之一，但广泛实施的依情况而定的管理（CM）仍然有限。近年来，为了应对不断增加的物质使用率，CM 的实施呈激增趋势。先前在提供者层面的研究已经探讨了 SUD 治疗提供者对 CM 的信念，并根据确定的障碍和培训需求制定了实施策略，以促进 CM 的实施。然而，还没有任何实施策略积极寻求确定或解决可能因治疗提供者的文化背景（如种族）而受到影响的 CM 信念差异。为了解决这一知识空白，我们研究了一组住院和门诊 SUD 治疗提供者对 CM 的信念。
对 143 名受访者进行了横断面调查。该调查使用依情况而定的管理信念问卷（CMBQ）询问了受访者对 CM 的态度。线性混合模型检验了种族（非西班牙裔白人与西班牙裔）对 CMBQ 分量表（一般障碍、培训相关障碍、CM 正面陈述）得分的影响。
CMBQ 的 59%的受访者自我认定为非西班牙裔白人，41%的受访者自我认定为西班牙裔。研究结果表明，与非西班牙裔白人治疗提供者相比，自我认定为西班牙裔的治疗提供者在一般障碍（p<0.001）和培训相关障碍（p=0.020）分量表上的得分显著更高。事后分析确定了在一般障碍（例如，CM 干预措施给我带来了额外的工作）和培训相关障碍（例如，我希望在实施 CM 之前接受更多的培训）分量表上特定个体量表项目的认可差异。
CM 的传播和实施策略需要考虑提供者层面与 CM 的采用和采用相关的公平相关因素。
