American Indian and Alaska Native substance use treatment: Barriers and facilitators according to an implementation framework.

Publisher: Elsevier Inc Country of Publication: United States NLM ID: 9918541186406676 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2949-8759 (Electronic) Linking ISSN: 29498759 NLM ISO Abbreviation: J Subst Use Addict Treat Subsets: MEDLINE

Original Publication: [New York] : Elsevier Inc., [2023]-

American Indian or Alaska Native* ; Substance-Related Disorders*/therapy ; Delivery of Health Care*; Humans ; Qualitative Research ; Telemedicine ; Healthcare Disparities

Introduction: Substance use disorder (SUD) and overdose deaths are higher in the American Indian and Alaska Native (AIAN) population than in other racial/ethnic groups. Multi-level gaps hinder SUD treatment for AIAN patients. Few studies have engaged front-line clinicians and administrators of SUD treatment programs serving AIAN patients to identify barriers and facilitators to improve the implementation of effective treatment.
Methods: We conducted key informant interviews with a diverse sample of providers and administrators of SUD treatment programs across California regarding barriers and facilitators to treatment for AIAN patients. An AIAN-majority community advisory board (CAB) guided the development of an interview guide and helped to recruit respondents from five types of SUD programs statewide. Using ATLAS.ti, the research team coded interviews and classified emergent themes as barriers and facilitators related to Outer, Inner, and Individual domains of the Consolidated Framework for Implementation Research (CFIR).
Results: Representatives of 13 of 15 invited SUD treatment programs participated and 9 of the 13 interviewed self-identified as AIAN. Related to Outer Setting barriers from coded interviews, a dominant barrier was policies that defund or underfund SUD treatment, especially detoxification centers. Outer Setting facilitators included consistent Indian Health Service (IHS) eligibility criteria, judicial system connections for direct treatment access, and community programs advocating SUD treatment. Key themes related to barriers for the Inner Setting were limited bed capacity, poor coordination of intake and care, and lack of telehealth technology. Facilitators integrated mental health, linkage to external resources, and culturally centered care. Individual-level barriers were negative attitudes such as SUD stigma, distrust of governmental programs, and lack of transportation while individual engagement was facilitated by programs addressing negative attitudes and providing telemedicine for remote care.
Conclusion: The public health threat of SUD for the AIAN population mandates the implementation of interventions and policies that facilitate care. This qualitative study with primarily AIAN clinical leaders of SUD treatment highlights opportunities to improve care at multiple CFIR levels, focusing on capacity, coordination, culturally congruent care, and community initiatives to promote engagement.
Competing Interests: Declaration of competing interest The authors have no conflicts of interest to disclose.
(Copyright © 2023 Elsevier Inc. All rights reserved.)

Keywords: American Indian and Alaska Native; Barriers to substance use treatment; CFIR; Framework implementation; Qualitative study; Substance use disorder

Date Created: 20230605 Date Completed: 20231113 Latest Revision: 20231113

20240628

10.1016/j.josat.2023.209095

37277023