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Perspectives in Outcome Measurement for Addiction Interventions Development of a questionnaire to survey stakeholders views on outcome measures SSA Conference 8th and 9th November 2012 Sarah Thurgood BSc (Hons) MSc MBPsS Researcher Leeds Addiction Unit The NIHR CLAHRC for Leeds, York and Bradford Why do we need this research? Result Outcome package designed by profession als Are measures meaningful and accessible to those who use them?
Consultatio n with LTLA and Leeds Researcher s Consultation Learning to Live Again (LTLA): A service user led aftercare programme Using a questionnaire design Participants have knowledge of addiction Leeds Researchers: A group of service users and carers who are interested in research 2 stage process to develop questionnaire 1. Exploring what are important outcome measures 2. Prioritising the outcomes for inclusion in questionnaire. Stage 1 Identifying outcome measures considered important to service users, their friends and family in recovery from addiction. Stage 1: Generating a list of items Stage 2: Producing questionna
ire Stage 3: Piloting the questionna ire Stage 4: Distributin g questionna ire Method Focus Group Agency Type Type of Activity Service Users Family and Friends FG1 NHS Treatment
7 4 FG2 NHS/3rd sector Drug Rehabilitation Requirement (DDR) 3 2 FG3 NHS/3rd sector Harm reduction 0 0 FG4 SMART group Recovery mutual aid 7 n/a
FG5 3rd sector Recovery Service Users only 7 n/a FG6 3rd sector Recovery Family & Friends only n/a 6 24 12 TOTAL Findings So if thats a craving, but youve got to deal with it... And you do find ways to get on and deal with it
Like everybody thinks youre a thief, everybody thinks youre dirty, everybody thinks that Being Better Process of change Positive life Improvements when Reasons for use Consequences of process use Aspects involved in the of Reasons forrecovered drink or drug use recovery Negative impact on life when addicted I know that my treatment is working when I get up every day
and just do the ordinary everyday things that people do, and I enjoy them. What happens when people have no money and things are getting worse, that's where they turn because they need that What is being better? Relationsh ips Friends and family Social Situation Bein g bett er Health Activities
Self awareness Abstinenc e Relationships FG5: I see my wife three times a week sometimes ya know compared with nine months ago I didnt see her at all FG2: have you got new friends, have you got, you know, have you got a social circle of nondrug users. FG6: she knows she cant go back to those people because shell probably well, I, god forbid, hopefully you know but she could use again.
Activities FG2: So theres something about your ability to look after yourself thats important, to take care of yourself FG3: Coz FG2: you you actually need get up on a something morning to fill the and do time and something that is a big and focus killer what your guna do and you go do it. FG2: Im at college doing two courses a week Im
doing cooking course, sewing courses Stage 2 Defining outcome measures in a way that is meaningful to service users, their friends and family. Stage 1: Generating a list of items Stage 2: Producing questionna ire Stage 3: Piloting the questionna ire Stage 4: Distributin g questionna ire Stage 2 Method
Service user meaningful Consultation definitions interviews Initial definitions Final definitions to be used for the pilot questionnaire Consultation feedback Having money Accommodation Having money in your pocket Having proper accommodation Having enough money to live comfortably Having suitable accommodation Whats next? Stage 3 Stage
4 Pilot questionnaire Incorporate feedback Distribution of final questionnaire Any questions? [email protected] 0113 29 51338 Research contribution: NIH R CLAHR C ARiA S Nine CLAHRCs Approx 10 million each Leeds/York/Bradford Addiction Research in Acute Settings (ARiAS) 1 of 5 themes Outcome measurement 1 of 6 strands This presentation is part of independent research funded by the National Institute of Health Research (NIHR)
through the NIHR Collaboration for Leadership in Applied Health Research and Care for Leeds, York and Bradford. The views expressed are those of the authors and not necessarily those of the NHS, NIHR or the Department of Health. The NIHR had no role in the study design, collection, analysis or interpretation of the data, writing the presentation, or the decision to submit for dissemination. Qualitative Analysis: Initial code generation The transcribed data was coded sentence by sentence across all five focus groups 1st level coding 1564 quotes Searching for themes 2nd level coding categories 3rd level coding categories 12 general 84 specific Reviewing themes 4th level coding main themes 4 Example of coding Improved relationships Social
Effect on relationships Twelve, 2nd level coding categories were created. Each of the these categories were further broken down to create a third level of coding Through inspecting the third level codes it was decided that they could be collapsed into four broader categories: being better, process of change, consequences of use and reasons for use. Being better Improvement in relationship with family and friends Mm, Ive got down getting on with family and friends, yeah. Following Thematic Analysis by Braun & Clarke (2006) What is Being better? Relationshi ps Friends and family
Social Situation Bein g bett er Health Activities Self awareness Abstinence Relationships o With friends and family improved o New friendships with non users o Staying away from users Social Situation o Money o Accommodation Self Awareness o Confidence o Self esteem o Trust o Optimism Abstinence o Not taking any medication o Stopping using Activities o Personal Care o Day to day tasks
o Alternative activities o Personal development Health o Mental Health o Physical Health o Sense of wellbeing Friends and family o Wellbeing of friends and family o Support for friends and family Process of change: Support oAwareness oRelapse oProfessional oSocial oPeer Coping oStrategies oGood addiction Stages of recovery oMaking the decision to change oBuilding confidence oInvolvement in own recovery Awareness of relapse oSigns of relapse oCycle of relapse Reducing amount used Treatment oFollow up oIndividual treatment oAddressing issues oPsychiatric treatment Activities oNon using activity
oGroup Activity oFilling time Barriers oNegative influences oHousing oConfidentiality oNon users understanding Support Coping strategie s Barriers Activitie s Treatme nt Proce ss of chang e Reducin g amount used Stages of recovery
Awarene ss of relapse Consequences of use: Social situation Effect on health Addiction Consequences Consequences Effect on Relationship s Self awareness Treatment by others Activities Social Situation o Availability of accommodation Addiction o Cravings o Dependence o Worry about relapse Self awareness
o Low confidence o Feeling ashamed o Making mistakes Activities o Effect on whole life o Negative behaviour when using o Not part of normal life o Using activity o Lack of personal care o Lack of motivation Treatment by others o Being judged o Treatment by the police o Social stigma o Media view o Penalties for drug use o Appearance of a drug user o Not being trusted Relationships o Exposure to other users o Effect on relationships with family and friends Effect on health o Psychological wellbeing o Physical health o Mental health o Pain masked Reasons for use: To forget about things To
escape proble ms Reaso ns for use Feeling misera ble To celebra te Suppre ss feeling s Mental Health Proble ms
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