Evidence-informed decision-making by professionals working in addiction agencies serving women: a descriptive qualitative study

Substance Abuse Treatment, Prevention, and Policy

Alison Niccols³  Ellen L Lipman³  Sandy Brooks¹  Gabriela Novotna³  Wendy Sword¹  Maureen Dobbins¹  Susan M Jack² 

[1] School of Nursing, McMaster University, Hamilton, Ontario, Canada;Offord Centre for Child Studies, Hamilton, Ontario, Canada;Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada

关键词: research utilization;    evidence-informed decision-making;    knowledge translation;    Substance use;   

Others  :  834555
DOI  :  10.1186/1747-597X-6-29

 received in 2011-06-09, accepted in 2011-11-07,  发布年份 2011

【 摘 要 】

Background

Effective approaches to the prevention and treatment of substance abuse among mothers have been developed but not widely implemented. Implementation studies suggest that the adoption of evidence-based practices in the field of addictions remains low. There is a need, therefore, to better understand decision making processes in addiction agencies in order to develop more effective approaches to promote the translation of knowledge gained from addictions research into clinical practice.

Methods

A descriptive qualitative study was conducted to explore: 1) the types and sources of evidence used to inform practice-related decisions within Canadian addiction agencies serving women; 2) how decision makers at different levels report using research evidence; and 3) factors that influence evidence-informed decision making. A purposeful sample of 26 decision-makers providing addiction treatment services to women completed in-depth qualitative interviews. Interview data were coded and analyzed using directed and summative content analysis strategies as well as constant comparison techniques.

Results

Across all groups, individuals reported locating and using multiple types of evidence to inform decisions. Some decision-makers rely on their experiential knowledge of addiction and recovery in decision-making. Research evidence is often used directly in decision-making at program management and senior administrative levels. Information for decision-making is accessed from a range of sources, including web-based resources and experts in the field. Individual and organizational facilitators and barriers to using research evidence in decision making were identified.

Conclusions

There is support at administrative levels for integrating EIDM in addiction agencies. Knowledge transfer and exchange strategies should be focussed towards program managers and administrators and include capacity building for locating, appraising and using research evidence, knowledge brokering, and for partnering with universities. Resources are required to maintain web-based databases of searchable evidence to facilitate access to research evidence. A need exists to address the perception that there is a paucity of research evidence available to inform program decisions. Finally, there is a need to consider how experiential knowledge influences decision-making and what guidance research evidence has to offer regarding the implementation of different treatment approaches within the field of addictions.

【 授权许可】

   
2011 Jack et al; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Greenfield SF, Back SE, Lawson K, Brady KT: Substance abuse in women. Psychiatr Clin North Am 2010, 33:339-355.
• [2]Hernandez-Avila CA, Rounsaville BJ, Kranzler HR: Opioid-, cannabis-, and alcohol-dependent women show more rapid progression to substance abuse treatment. Drug Alcohol Depend 2004, 74:265-272.
• [3]Hans SL: Demographic and psychosocial characteristics of substance-abusing pregnant women. Clin Perinatol 1999, 26:55-74.
• [4]Kelley SJ: Stress and coping behaviors of substance-abusing mothers. J Soc Pediatr Nurs 1998, 3:103-110.
• [5]World Health Organization: Principles of Drug Dependence Treatment. Geneva, World Health Organization; 2008.
• [6]U.S.Department of Health and Human Services: 1998 Annual Report to Congress on the Evaluation of the Comprehensive Community Mental Health Services for Children and Their Families Program. Rockville, MD, HHS Substance Abuse and Mental Health Service Administration; 1999.
• [7]Dunn MG, Tarter RE, Mezzich AC, Vanyukov M, Kirisci L, Kirillova G: Origins and consequences of child neglect in substance abuse families. Clin Psychol Rev 2002, 22:1063-1090.
• [8]Howell EM, Chasnoff IJ: Perinatal substance abuse treatment: Findings from focus groups with clients and providers. J Subst Abuse Treat 1999, 17:139-148.
• [9]Milligan K, Niccols A, Sword W, Thabane L, Henderson J, Smith A: Birth outcomes for infants born to women participating in integrated substance abuse treatment programs: A meta-analytic review. Addict Res Theory 2011, 1-14.
• [10]Milligan K, Niccols A, Sword W, Thabane L, Henderson J, Smith A: Length of stay and treatment completion for mothers with substance abuse issues in integrated treatment programs. Drugs: Educ Prev Policy 2011, 18:219-227.
• [11]Milligan K, Niccols A, Sword W, Henderson J, Smith A, Liu J: Maternal substance use and integrated treatment programs for women with substance abuse issues and their children: a meta-analysis. Subst Abuse Treat Prev Policy 2010, 5:1-14. BioMed Central Full Text
• [12]Niccols A, Milligan K, Sword W, Thabane L, Henderson J, Smith A, Liu J, Jack SM: Maternal mental health and integrated programs for mothers with substance abuse issues. Psychol Addict Behav 2010, 24:466-474.
• [13]Glasner-Edwards S, Rawson R: Evidence-based practices in addiction treatment: Review and recommendations for public policy. Health Policy 2010, 97:93-104.
• [14]Garner BR: Research on the diffusion of evidence-based treatments within substance abuse treatment: A systematic review. J Subst Abuse Treat 2009, 36:376-399.
• [15]Roman P, Abraham AJ, Rothrauff TC, Knudsen HK: A longitudinal study of organizational formation, innovation adoption, and dissemination activities within the Clinical Trials Network of the National Institute on Drug Abuse. J Subst Abuse Treat 2010, 38:S44-S52.
• [16]Willenbring ML, Hagedorn H, Postier A, Kenny M: Variations in evidence-based clinical practices in nine United States Veterans Administration opioid agonist therapy clinics. Drug & Alcohol Dependence 2004, 75:97-106.
• [17]Lavis JN, Robertson D, Woodside JM, McLeod CB, Abelson J: How can research organizations more effectively transfer research knowledge to decision makers? Milbank Q 2003, 81:221-248.
• [18]Haynes B: Of studies, synthesis, synopses, summaries and systems: The 5 S's evolution of information services for evidence-based healthcare decisions. Evid Based Nurs 2007, 10:6-7.
• [19]Marinelli-Casey P, Domier CP, Rawson RA: The gap between research and practice in substance abuse treatment. Psychiatr Serv 2002, 53:984-987.
• [20]Dobbins M, Jack SM, Thomas H, Kothari A: Public health decision makers' informational needs and preferences for receiving research evidence. Worldv Evid-Based Nu 2007, 4:156-163.
• [21]Lapelle NR, Luckmann R, Simpson EH, Martin ER: Identifying strategies to improve access to credible and relevant information for public health professionals: A qualitative study. J Acad Gen Dent 2006., 6
• [22]Ciliska D, Hayward S, Underwood J: Transferring public health nursing research to health system planning: Assessing the relevance and accessibility of systematic overviews. Can J Nurs Res 1999, 31:23-36.
• [23]Kothari A, Birch S, Charles C: "Interaction" and research utilisation in health policies and programs: Does it work? Health Policy 2005, 71:117-125.
• [24]Ball S, Bachrach K, DeCarlo J, Farentinos C, Keen M, McSherry T, Polcin D, Snead N, Sockriter R, Wrigly P, Zammarelli L, Carroll K: Characteristics, beliefs, and practices of community clinicians trained to provide manual-guided therapy for substance abusers. J Subst Abuse Treat 2002, 23:309-318.
• [25]McGovern MP, Fox TS, Xie H, Drake RE: A survey of clinical practices and readiness to adopt evidence-based practices: Dissemination research in an addiction treatment system. J Subst Abuse Treat 2004, 26:305-312.
• [26]Wilson MG, Lavis JN, Travers R, Rourke SB: Community-based knowledge transfer and exchange: Helping community-based organizations link research to action. Implementation Science 2010, 5:33. BioMed Central Full Text
• [27]Kothari A, Armstrong R: Community-based knowledge translation: Unexplored opportunities. Implementation Science 2011, 6:59. BioMed Central Full Text
• [28]Connections: Knowledge Exchange for Women with Substance Use Issues [http://connectionscanada.ca/] webcite 2010.
• [29]Lomas J, Culyer T, McCutcheon C, McAuley L, Law S: Conceptualizing and combining evidence for health system guidance. Ottawa, ON, Canadian Health Services Research Foundation; 2005.
• [30]Sandelowski M: Whatever happened to qualitative description? Res Nurs Health 2000, 23:334-340.
• [31]Jack SM, Brooks S, Furgal CM, Dobbins M: Knowledge transfer and exchange processes for environmental health issues in Canadian aboriginal communities. Int J Env Res Public Health 2010, 7:651-674.
• [32]Jack SM, Dobbins M, Tonmyr L, Dudding P, Brooks S, Kennedy B: Research evidence utilization in policy development by child welfare administrators. Child Welfare Journal 2010, 89:83-100.
• [33]Patton MQ: Qualitative evaluation and research methods. 2nd edition. Newbury Park, CA: Sage Publications Inc; 1990.
• [34]Dobbins M, Ciliska D, Cockerill R, Barnsley J, DiCenso A: A framework for the dissemination and utilization of research for health-care policy and practice. Online J Knowl Syn Nurs 2002, 9:7.
• [35]Hsieh H, Shannon SE: Three approaches to qualitative content analysis. Qual Health Res 2005, 15:1277-1288.
• [36]Hewitt-Taylor J: Use of constant comparison analysis in qualitative research. Nurs Stand 2001, 15:39-42.
• [37]Krefting L: Rigor in qualitative research: The assessment of trustworthiness. AJOT 1991, 45:214-222.
• [38]Carter CS: Perinatal care for women who are addicted: Implications for empowerment. Health & Social Work 2002, 27:166-174.
• [39]Washington OGM, Moxley DP: Promising group practices to empower low-income minority women coping with chemical dependency. Am J Orthopsychiatry 2003, 73:109-116.
• [40]van Wormer K, Davis DR: Addiction treatment: A strengths perspective. 2nd edition. Belmont, CA; 2008.
• [41]Beyer JM, Trice HM: The utilization process: A conceptual framework and synthesis of empirical findings. Adm Sci Q 1982, 27:591-622.
• [42]Weiss CH: The many meanings of research utilization. Public Adm Rev 1979, 39:426-431.
• [43]Buffet C, Ciliska D, Thomas H: Can I use this evidence in my program decision? Assessing applicability and transferability of evidence. Hamilton, ON, National Collaborating Centre for Methods and Tools; 2007.
• [44]Enkin MW, Jadad AR: Using anecdotal information in evidence-based health care: Heresy or necessity? Ann Oncol 1998, 9:963-966.
• [45]Reay T, Hinings CR: Managing the rivalry of competing institutional logics. Organ Stud 2009, 30:629-652.
• [46]Scheid TL: Tie a knot and hang on: providing mental health care in a turbulent environment. New York: Walter de Gruyter, Inc; 2004.
• [47]Ferri M, Amato L, Davoli M: Alcoholics Anonymous and other 12-step programmes for alcohol dependence. Cochrane Database Syst Rev 2006.
• [48]Morgenstern J: Effective technology transfer in alcoholism treatment. Subst Use Misuse 2000, 35:1659-1678.
• [49]Oliver C: The antecedants of deinstitutionalization. Organ Stud 1992, 13:563-588.
• [50]Ogborne AC, Graves G: Optimizing Canada's addiction treatment workforce: Results of a national survey of service providers. Ottawa, ON, Canadian Centre of Substance Abuse; 2005.
• [51]Flodgren G, Parmelli E, Doumit G, Gattellari M, O'Brien M, Grimshaw J, Eccles MP: Local opinion leaders: effects on professional practice and health care outcomes. Cochrane Database Syst Rev 2007.
• [52]Rogers E: Diffusion of innovations. 5th edition. Toronto, ON: Free Press; 2003.
• [53]Dobbins M, DeCorby K, Twiddy RN: A knowledge transfer strategy for public health decision makers. Worldv Evid-Based Nu 2004, 1:120-128.
• [54]Booth SH, Booth A, Falzon LJ: The need for information and research skills training to support evidence-based social care: a literature review and survey. Learning in Health and Social Care 2003, 2:191-201.
• [55]Dixon GD: Moving science into service: Preparing your agency to adopt evidence-based practice. Tallahassee, FL, Southern Coast Addiction Technology Transfer Center; 2006.
• [56]Dobbins M, Hanna S, Ciliska D, Manske S, Cameron R, Mercer SL, O'Mara L, DeCorby K, Robeson P: A randomized controlled trial evaluating the impact of knowledge translation and exchange strategies. Implementation Science 2009, 4:1-16. BioMed Central Full Text
• [57]Russell DJ, Rivard JM, Walter SD, Rosenbaum PL, Roxborough L, Cameron D, Darrah J, Bartlett DJ, Hanna SE, Avery LM: Using knowledge brokers to facilitate the uptake of pediatric measurement tools into clinical practice: A before-after intervention study. Implementation Science 2010, 5:1-17. BioMed Central Full Text
• [58]Haynes RB, Devereaux PJ, Guyatt G: Clinical expertise in the era of evidence-based medicine and patient choice. Vox Sang 2002, 83:383-386.
• [59]Dicenso A, Cullum N, Ciliska D: Implementing evidence-based nursing: some misconceptions. Evid Based Nurs 1998, 1:38-40.
• [60]Ciliska D, Thomas H, Buffet C: An introduction to evidence-informed public health and a compendium of critical appraisal tools for public health practice. Hamilton, ON, National Collaborating Centre for Methods and Tools (NCCMT); 2008.
• [61]Regehr C, Stern S, Shlonsky A: Operationalizing evidence-based practice: The development of an institute for evidence-based social work. Res Social Work Prac 2007, 17:408-416.
• [62]Scott S: Getting research into practice: Which strategies work? Nurs Womens Health 2008, 12:204-207.