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: 10030647
• 负责人: CHRISTINA S LEE
• 金额: $ 67.65万
• 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/10030647
• 关键词: Acculturation; Address; Adoption; Advocate; Aftercare; Alcohol consumption; Alcohol or Other Drugs use; 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; 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; design; drinking; effectiveness clinical trial; effectiveness implementation study; evidence base; experience; follow-up; health disparity; illicit drug use; implementation science; implementation strategy; improved; motivational enhancement therapy; population health; primary care setting; racial and ethnic; reduced substance use; social stigma; social stressor; stressor; 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 饮酒是拉丁裔的重大问题，因为身体危害的负担不成比例 与其他种族/族裔群体相对于物质使用相关的负面后果。因素 与与移民有关的压力有关，增加了使用物质的风险。理论上的 动机访谈（CAMI）的文化适应，特别整合了压力源的讨论 与移民有关（例如，歧视，污名，社会隔离）导致危害大大减少 与标准MI相比，与那些具有高歧视的拉丁裔饮酒者的酒精有关， 与MI相比，一年后焦虑和抑郁症状减轻。严格检查 理论上明明的对成瘾的有效干预措施的改编并不常见，但需要 提前实施科学是因为它们解决了成功的基础的问题 执行。拟议的杂种1型有效性实施研究是下一步的重要下一步 这一研究线，是为了研究在现实世界中实施CAMI干预的可行性 临床环境。关键问题是：CAMI在使用两者的个人中会产生积极影响 毒品和酒精？提供者如何看待这种干预？我们将与一个初级保健中心合作 为Latinx客户群体提供服务，以培训其社区健康拥护者（CWAS） Cami给饮酒者的患者。我们将对 在初级保健中实施CAMI - 两臂随机临床有效性试验将招募拉丁 在使用酒精（并可能使用其他药物）的初级保健中饮酒者（18岁或以上） - 并关注 干预后的12个月。具体目的是：（1）检查CAMI的影响以及 人的助推器会议（仅与评估）有关的结果：饮酒时间％％，酒精的频率 - 相关后果，抑郁/焦虑症状和非法吸毒天数，使用混合类型 1个有效性实施设计和（2）从多个收集实施结果指标 利益相关者使用混合方法方法。我们将遵循Curran的框架来评估 实施和监理者的框架来衡量实施结果：可接受性，采用， 干预适当性，可行性，整体成本（即CAMI与评估）和治疗保真度。 我们的研究，首先要研究基本护理中文化适应成瘾治疗的可接受性 设置，将回答有关为拉丁人实施基于证据的护理的基本问题，以改善 与药物使用有关的健康差异。长期目标是将我们的课程从提议中翻译 对更广泛社区的混合研究，专注于所有初级保健患者的人口健康。