Effective dissemination: An examination of the costs of implementation strategies for the AOD field.

This document is Part Two of a 3-part series by the National Centre for Education and Training on Addiction (NCETA) examining the effectiveness, costs and theories related to dissemination and implementation of research into practice. Part One is a systematic literature review that evaluated the effectiveness of 16 different dissemination strategies for facilitating the implementation of new research, programs and treatments to improve outcomes for clients with alcohol and other drug-related problems. Part Two involves an examination of the costs associated with using such strategies, and Part Three is an examination of the theories and models of change underlying the use of strategies. In this Part, the costs of implementing innovations and the implications of using dissemination strategies for the alcohol and other drug (AOD) field are examined. Part One in this series is a systematic review of the effectiveness of dissemination and implementation strategies (Bywood, Lunnay, & Roche, 2008). However, evidence related to economic considerations was not based on a systematic search using relevant terms associated with economic analysis. Rather, it is a summary of the evidence from the systematic review on effectiveness that also contained data on costs of using an implementation strategy. All studies in Part One that showed evidence that a particular strategy was effective in changing practitioners’ behaviour or improving organisational efficiency were scrutinised to determine whether an economic analysis had also been undertaken. These studies then formed the evidence base for the present report. An implementation strategy can be effective, without being cost-effective. Thus, from an economic perspective, the key question is whether certain dissemination and implementation activities involve a more efficient use of limited resources compared to other activities. The key research questions for this study were: 1. What are the economic considerations for the use of effective dissemination and implementation strategies? 2. Which implementation strategies provide an efficient and cost-effective means by which to facilitate uptake of innovations by the AOD field? The key findings from this review are: • CME was generally effective and cost-effective, although formats differed substantially • Educational outreach showed mixed results on cost-effectiveness • Educational materials were relatively cheap, but had little effectiveness • Multi-faceted approaches differed substantially in context and content, making it difficult to make meaningful comparisons on the basis of cost • The evidence base of studies containing good quality economic analyses was limited (only 9 of the 16 strategies were evaluated for costs) • Studies that reported on costs of implementation strategies were heterogeneous, reporting of details and quality of methodology was poor, and data collection was incomplete • Few studies evaluated costs of implementation strategies in the AOD field • There is a need for future evaluation studies to examine efficiency through use of economic evaluation

Ideas of early division prior to formal instruction

Often young children develop ideas of mathematics before they formally meet them at school. Such is the case with early counting concepts. However, little is known about children’s early ideas of division. The study reported here investigated the ideas of 114 children (5-6-years old) before they had received any formal instruction about division in their first year at school. A pencil and paper test comprising worded problems with diagrams was read aloud by the teacher. We analysed children’s drawings on the diagrams. Results indicate that 74% of children could conceive of at least one division situation prior to any instruction. Some children (20%) could interpret quotitive and partitive division problems. Children drawing on diagrams can provide evidence of their conceptual interpretation of division problems

Effective dissemination: a systematic review of implementation strategies for the AOD field

Innovations, such as treatment interventions, programs and therapies, may be costly to develop and evaluate and there is increasing political and financial pressure to ensure that effective and cost-effective health care and professional services are available where needed. Eeven when practitioners are aware of the evidence for best practice and are willing to change their behaviour, making the required changes in the context of long established patterns of behaviour can be difficult, particularly if the organisational environment is not conducive to change. Moreover, innovations are not self-executing. Even simple programs that require only small changes may benefit from an effective implementation strategy. The National Centre for Education and Training on Addiction undertook a systematic literature review of the most commonly used strategies designed to increase the uptake of innovations into professional practice. Analyses were undertaken to evaluate their effectiveness and to determine their relevance and applicability for use in the alcohol and other drugs (AOD) field. By evaluating and synthesising the evidence from a wide range of sources, NCETA aimed to identify the key factors underlying successful dissemination strategies and develop a framework for dissemination and implementation of innovations in the AOD field

Alcohol education for Australian schools: What are the most effective programs?

A scientific approach to understanding what works and what does not, by using the best available evidence, can lead to policy and implementation decisions that are more effective in achieving desired outcomes. A systematic review was undertaken to assist schools to effectively utilise the evidence in order to decide on appropriate school alcohol education programs. A systematic review is a method of assessing whether a program is effective or not by collating all the research on a specific question and looking at the whole body of evidence together. Within each program type, the available studies were examined in detail by two researchers and assessed for both the quality of the research and the outcomes for students. Three programs, CLIMATE Schools (Australia), Project ALERT (USA) and All Stars (USA) had enough evidence to support their general use in schools. Four programs showed some evidence of good outcomes and may be suitable for use by some schools where those outcomes are high priority (Life Skills Program, SHAHRP, Unplugged EU-DAP, and Life Skills Training) especially if outcomes are monitored within the school. One program showed no evidence of positive effect (DARE) and two showed negative outcomes (such as increases in drinking) (Peer Acceleration Social Network (Project TND) and Take Charge of Your Life) and are not recommended for use in Australian schools. The remaining 29 programs showed inconclusive results (i.e. those with poor quality research, inconsistent effects, or only one available study) and are also not recommended for schools until further research is conducted. Common elements of effective programs included: accurate evidence based information about alcohol; a focus on social norms; an interactive presentation style; clear, achievable and measureable goals and objectives; teacher training and support; and a whole of school approach

Which Australian secondary school students are at risk of illicit drug use?

This is the peer reviewed version of the following article: [Freeman, T., White, V., & Roche, A.M. (2011) Which Australian secondary school students are at risk of illicit drug use? : A nationwide survey. Drug and Alcohol Review, 30, 589-596], which has been published in final form at [DOI: 10.1111/j.1465-3362.2010.00246.x]. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.Introduction and aims: Over recent years, numerous school-based preventive strategies have been explored as possible options to address illicit drug use by young people. However, there is scope to extend current knowledge of which school students are most at risk of illicit drug-related harm. To investigate potential differential risk, the prevalence and patterns of illicit drug use of Australian secondary school students were examined according to demographic, school, economic, and licit drug use factors. Design and methods: Analyses were conducted on the 2005 Australian Secondary Students’ Alcohol and Drug (ASSAD) survey. A total of 21,805 secondary school students aged 12-17 from 376 schools completed the pencil and paper classroom questionnaire. Results: The greatest risk factors for students using illicit drugs were tobacco and alcohol use. Students with self-rated below average academic achievement, with more than $20 a week of disposable income, and who were Indigenous were more likely to report illicit drug use. Discussion and conclusions: While causal pathways could not be examined in the current data, and these relationships are likely to be complex and multi-directional, the findings indicate potentially at-risk populations who warrant extra support to address illicit drug-related harm

The health and well-being of Indigenous drug and alcohol workers: Results from a national Australian survey

The increasing demand for alcohol and other drug (AOD) treatment services among the Australian Indigenous population, complex organisational challenges and limitations, and high unemployment rates are likely to negatively impact Indigenous AOD workers\u27 health and well-being. Building the capacity of Indigenous AOD workers is vital, as they play a crucial role in the delivery of treatment services and offer essential support to their communities. A national online survey was conducted to examine organisational, workplace and individual factors that might contribute to levels of stress and well-being among workers who provide services to Indigenous clients. A total of 294 eligible surveys were completed; 184 (63%) from Indigenous and 108 (37%) from non-Indigenous AOD workers. Multiple regression models were conducted to assess the significant predictors of mental health and well-being, job satisfaction, emotional exhaustion, and turnover intention. Indigenous AOD workers typically experienced above average levels of job satisfaction and relatively low levels of emotional exhaustion. However, 1 in 10 reported high levels of emotional exhaustion, a key predictor of turnover intention. Indigenous workers also experienced significantly lower levels of mental health and well-being and greater work/family imbalance, which was a significant contributor to emotional exhaustion. The findings highlight the importance of implementing workforce development strategies that focus on achieving culturally appropriate, equitable and supportive organisational conditions for Indigenous AOD workers. Preventing or managing levels of stress, ensuring adequate and equitable salaries and benefits, and providing more opportunities for career and personal growth may increase job satisfaction and reduce turnover intention among Indigenous workers in the drug and alcohol field

What Factors Need to be Addressed to Support Dental Hygienists to Assist Their Patients to Quit Smoking?

This is a pre-copyedited, author-produced PDF of an article accepted for publication in NICOTINE AND TOBACCO following peer review. The version of record [Freeman, T., Roche, A.M., Williamson, P., & Pidd K (2012). What factors need to be addressed to support dental hygienists to assist their patients to quit smoking? Nicotine & Tobacco Research, 14, 1040-1047.] is available online at: http://ntr.oxfordjournals.org/content/early/2012/02/16/ntr.ntr329Dental hygienists are well placed to assist their patients to quit smoking. Smoking affects oral health and dental treatments, and hygienists report greater time with patients than dentists with more focus on prevention. However, there has been little research into the extent to which hygienists assist patients to quit smoking, and strategies to support them in this role. Methods. A two stage survey of Australian dental hygienists was conducted. The first survey measured potential predictors of asking patients about smoking and assisting patients to quit smoking using the Theory of Planned Behaviour as a framework. The second survey measured these behaviours in the past week. Structural equation modelling was used to examine predictors of the two behaviours. Results. A total of 362 hygienists returned the first questionnaire. Intentions to ask and assist patients were high. The 273 hygienists who returned the second questionnaire assisted an estimated total of 1,394 patients to quit smoking in one week. Predictors within the Theory of Planned Behaviour framework explained significant variance in asking (11%) and assisting (29%) behaviours, with self-efficacy the most critical predictor in both cases (β =.27, .32 respectively). Conclusions. Dental hygienists may be a viable and willing avenue for addressing smoking. Hygienists may be best supported in this role through increasing skills and confidence around asking sensitively about smoking, building rapport, and assisting patients to quit smoking. . Incorporation of smoking status into general history taking and adoption of organisational policies on assisting patients to quit smoking could also be encouraged

Hazardous alcohol use interventions with emergency patients: Self-reported practices of nurses, and predictors of behaviour

This is the peer reviewed version of the following article: [Freeman, T., Roche, A.M., Williamson, P., & Pidd, K. (2011) Hazardous alcohol use interventions with emergency patients: Self-reported practices of nurses, and predictors of behaviour. Emergency Medicine Australasia, 23, 479-489.], which has been published in final form at [DOI:10.1111/j.1742-6723.2011.01416.x]. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.Objectives. This study examined Australian Emergency Department (ED) nurses’ practices in asking patients about alcohol and assisting them to manage their alcohol consumption. It also investigated strategies to support ED nurses in these interventions. Methods. A two stage survey was administered to ED nurses. The first questionnaire measured theoretical and organisational predictors of behaviour, and underlying beliefs, and the subsequent questionnaire explored rates of asking and assisting patients. Results. A total of 125 nurses returned the first questionnaire. Participants held generally positive attitudes, perceived norms, feelings of legitimacy, and perceived ability to ask about and intervene for alcohol, but lower role adequacy. The 71 ED nurses who completed the second questionnaire had intervened with almost 500 patients concerning alcohol in the previous week. Participants asked approximately one in four patients about alcohol (median = 26.3% of patients, 1095/4279 total patients asked). The Theory of Planned Behaviour did not predict rates of asking or assisting patients. Several strategies were identified that may increase rates: identify environmental factors that prevent nurses acting on their intentions to ask and intervene, raise confidence and skills, make asking about alcohol part of routine assessment, make supports such as drug and alcohol units or nurses available, and implement organisational policies on alcohol. Conclusions. Nurses appear positively disposed to engage with patients in regard to alcohol. However, greater support is needed to achieve the considerable significant public health benefits from this engagement. The findings point to several practical strategies that could be pursued to provide this support