Attitudes and beliefs of doctors prescribing methadone to addicts in the Westfalen‐Lippe region of Germany

Gerlach, Ralf; Caplehorn, John R. M.

doi:10.1080/09595239996590

Cited by 14 publications

(5 citation statements)

References 23 publications

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“…The instrument was developed in NSW, Australia, in 1996 [ 7 ]. The instrument had been used in several other studies in Australia [ 8 - 11 ], USA [ 12 - 15 ], Netherlands [ 16 ], Germany [ 17 ], and Spain [ 18 ]. Items tailored towards the country's OMT system were added when the instrument was used outside of Australia [ 12 - 18 ].…”

Section: Introductionmentioning

confidence: 99%

Cross-cultural adaptation of research instruments: language, setting, time and statistical considerations

Gjersing

Caplehorn

Clausen

2010

BMC Med Res Methodol

588

515

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BackgroundResearch questionnaires are not always translated appropriately before they are used in new temporal, cultural or linguistic settings. The results based on such instruments may therefore not accurately reflect what they are supposed to measure. This paper aims to illustrate the process and required steps involved in the cross-cultural adaptation of a research instrument using the adaptation process of an attitudinal instrument as an example.MethodsA questionnaire was needed for the implementation of a study in Norway 2007. There was no appropriate instruments available in Norwegian, thus an Australian-English instrument was cross-culturally adapted.ResultsThe adaptation process included investigation of conceptual and item equivalence. Two forward and two back-translations were synthesized and compared by an expert committee. Thereafter the instrument was pretested and adjusted accordingly. The final questionnaire was administered to opioid maintenance treatment staff (n=140) and harm reduction staff (n=180). The overall response rate was 84%. The original instrument failed confirmatory analysis. Instead a new two-factor scale was identified and found valid in the new setting.ConclusionsThe failure of the original scale highlights the importance of adapting instruments to current research settings. It also emphasizes the importance of ensuring that concepts within an instrument are equal between the original and target language, time and context. If the described stages in the cross-cultural adaptation process had been omitted, the findings would have been misleading, even if presented with apparent precision. Thus, it is important to consider possible barriers when making a direct comparison between different nations, cultures and times.

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Section: Introductionmentioning

confidence: 99%

Cross-cultural adaptation of research instruments: language, setting, time and statistical considerations

Gjersing

Caplehorn

Clausen

2010

BMC Med Res Methodol

588

515

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“…This barrier was evidenced in Article I, where the setting (Gävleborg) which reported more access to abstinence-oriented treatment services also had lower acceptance for the harm reduction philosophy, as well as less willingness to implement certain harm reduction services. This pattern aligns with other research, which indicates that care providers with an abstinence orientation are less inclined to recommend or provide harm reduction services such as OST, NSP, and overdose prevention (Brown, 2022;Gerlach & Caplehorn, 1999;.…”

Section: Shaping the Care That Providers Can Offer And How Clients Re...supporting

confidence: 88%

“…A review by Brown (2022) found that education on OST, exposure to OST in clinical settings, and a clinical treatment orientation were the most important factors enhancing willingness to provide OST. A variety of studies have demonstrated that, for instance, lower knowledge about the evidence of methadone as a treatment option is correlated to stronger support for abstinence-oriented policies (Aletraris et al, 2016;Gerlach & Caplehorn, 1999;Russell et al, 2011). Similarly, found that substance use professionals who reported prioritizing abstinence, and who reported lack of knowledge of certain interventions, were less supportive of harm reduction measures such as NSP, OST, and overdose prevention sites.…”

Section: Service Provider Attitudes and Care Experiencesmentioning

confidence: 99%

Varying drug policies and unequal access to harm reduction: Experiences, mobility, and risk management of people who use drugs

Holeksa

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Sweden has a history of a restrictive drug policy, with a national policy focus on achieving a “drug free society.” This has led to a relatively slow development of “harm reduction” services, those services which aim to reduce risk and vulnerability for people who use drugs (PWUD), without requiring drug abstention. The harm reduction services which do exist are inequitably distributed across the country. In this context, this project aims to explore the attitudes of social work professionals (SWP) towards harm reduction, and the experiences of Swedish PWUD. The data consist of a survey of SWP (208 responses), interviews with PWUD in an area of limited harm reduction (11), and interviews with PWUD who had travelled to Denmark, a country with a less restrictive drug policy approach (17). Article I utilizes survey data to explore the perspectives of Swedish SWP regarding the philosophy of harm reduction and specific harm reduction initiatives. The study reveals a generally positive attitude towards harm reduction, albeit with significant geographical variances. There were low levels of support concerning the adoption of newer harm reduction strategies. Less positive attitudes and negativity regarding new interventions were significantly associated with SWP in areas with lesser exposure to harm reduction practices. Article II examines how PWUD in a small urban center handle the absence of local harm reduction services. The participants’ experiences are interpreted using the theoretical concept of “risk environment” which highlights how various environmental factors interact to produce risk of drug-related harm. Strategies ranged from traveling to external needle exchange programs, relying on unofficial secondary distribution, to risk behaviours such as stealing, reusing, or sharing injection equipment. Many were homeless, articulating a continuous struggle to find temporary shelter. They injected drugs in unsafe places, such as public toilets, increasing risk of overdose or infection. They also expressed 10 feeling stigmatized and excluded from society which compounded their stress, risk of disease transmission and overdose, and poor overall wellbeing. Article III explores the motivations behind the mobility of PWUD from Sweden to Denmark. The “risk environment” framework was used to contextualize decision-making and risks, based on the physical, social, policy, and economic environments. The study identifies harm reduction service availability, stigma, social networks, the drug scene, and policing practices, as key drivers for relocation. Despite the perceived benefits of moving, such as improved access to harm reduction services, participants also reported exposure to new risks, including violence, potential exclusion from a range of services, and exposure to new drugs. Article IV analyzes the reflections of PWUD on their experiences in Sweden and Denmark in the context of each nation’s drug policy. The analysis explored experiences of stigma and coupled these to concepts of identity and social exclusion. In daily interactions, participants felt ignored and dehumanized in Sweden’s zero-tolerance environment, whereas in Denmark, a country with a harm reduction approach, they felt visible and valued as individuals. This, combined with more developed services and a less punitive policing approach, led participants to feel included in society in Denmark. Contrasts between experiences in the two countries were also echoed in participants’ interactions with the healthcare system, relating to feeling controlled in Sweden, or being given autonomy and trust over their care in Denmark. Collectively, this thesis highlights the interplay between drug policies, care formats, policing practices, social interactions, the attitudes of SWP, and the lived experiences of PWUD. While overall positive, the attitudes towards care goals and interventions differ between different areas, among professionals who provide care to PWUD. PWUDs’ movement to and experiences in different settings can be used to offer an insight into their own policy preferences. The project demonstrates the role of constructions, and resulting drug policy, in how they influence PWUDs’ experiences of stigma and exclusion, and their risk environments.

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“…Knapp 57% der Opioidabhängigen befinden sich in einer Substitutionsbehandlung. Gegenüber der Opioidsubstitution bei Inhaftierten war lange Jahre international und auch in Deutschland eine deutliche Skepsis zu beobachten 2 . In den letzten Jahren hat, auch durch das EGMR-Urteil vom 01.09.2016 3 , ein Einstellungswandel begonnen, das Thema Sucht und Haft erfährt zunehmende wissenschaftliche und öffentliche Aufmerksamkeit und die Substitutionsquoten steigen langsam an.…”

Section: Introductionunclassified

“…Die regional unterschiedliche, teils schleppende Etablierung der Substitution in Haft ist einerseits strukturell begründet, beispielsweise durch Unterschiede in der Personalausstattung, der Gefangenenpopulation und der externen Versorgungsstruktur 4 6 7 . Aber auch das Wissen und die Einstellungen des behandelnden Personals beeinflussen die Indikationsstellung maßgeblich 2 4 8 9 10 . Kouyoumdjian et al 9 befragten 27 kanadische Haftärztinnen und -ärzte zur Behandlungspraxis bei opioidabhängigen Inhaftierten.…”

Section: Introductionunclassified

Behandlung opioidabhängiger Inhaftierter – Einstellungen und Behandlungspraxis des medizinischen Personals in bayerischen Justizvollzugsanstalten

et al. 2021

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Zusammenfassung Zielsetzung Die vorliegende Studie untersucht die Versorgungspraxis und die Einstellungen des medizinischen Personals bezüglich der Behandlung opioidabhängiger Inhaftierter in bayerischen Vollzugsanstalten. Methodik Medizinische Mitarbeitende aus 18 bayerischen Haftanstalten (n=20) wurden im Rahmen teilstrukturierter Leitfadeninterviews zur Substitutionspraxis in den Anstalten und zu ihren Einstellungen hierzu befragt. Ergebnisse In Bezug auf die Behandlungspraxis bei opioidabhängigen Inhaftierten zeigte sich ein gemischtes Bild, ebenso wie bei den Einstellungen des medizinischen Personals. Die Behandlungsentscheidung hängt aus Sicht der Befragten vom Patientenwunsch, von der Schwere und Dauer der Abhängigkeit, von der Strafdauer und von organisatorischen Faktoren ab. Problematisiert wurden insbesondere die Versorgungssituation innerhalb und außerhalb der Haftanstalten und Schwierigkeiten im Übergangsmanagement. Schlussfolgerungen Substitutionstherapie wird mittlerweile in den Haftanstalten als Standard-Behandlungsmethode angesehen, wenn auch deren Nachteile (z. B. Weitergabe des Substituts) problematisiert wurden. Das Abstinenzziel wird zwar von einem Teil der Befragten grundsätzlich positiv bewertet, aber als wenig realistisch eingestuft. Besonderes Augenmerk sollte im Rahmen des Entlassmanagements auf die Kontinuität der gewählten Behandlungsstrategie gelegt werden.

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Attitudes and beliefs of doctors prescribing methadone to addicts in the Westfalen‐Lippe region of Germany

Cited by 14 publications

References 23 publications

Cross-cultural adaptation of research instruments: language, setting, time and statistical considerations

Cross-cultural adaptation of research instruments: language, setting, time and statistical considerations

Varying drug policies and unequal access to harm reduction: Experiences, mobility, and risk management of people who use drugs

Behandlung opioidabhängiger Inhaftierter – Einstellungen und Behandlungspraxis des medizinischen Personals in bayerischen Justizvollzugsanstalten

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