Background: Opioid use disorder (OUD), prescription opioid misuse, and increased heroin use are major public health crises in the US. Excessive non-medical use of prescription opioids and illicit drugs can alter the brain, disrupt mental health, and increase the risk of blood-borne illnesses and bacterial infections. The CDC reported that opioids caused nearly 70% of the 67,367 overdose deaths in 2018. Rural areas have high prescription and illicit drug use rates, limited resources, and unique challenges. There is an emerging need to understand rural residents' perspectives on OUD and substance use disorder (SUD) in their community in order to implement efforts. A community-based participatory research (CBPR) approach addresses the need for a systematic participatory solutions, and reduces community opposition and promotes sustainable, culturally appropriate interventions that can reduce the health-related harms caused by substance abuse.
Methods: Two studies were conducted using CBPR principles to address the opioid crisis in a rural Southern Virginia community. Study I aimed to provide insight into community members' perceptions, knowledge, and experiences with OUD/SUD to inform community-led strategies. Study II assessed whether a virtual community platform with a Nominal Group Technique (NGT) can build consensus around Comprehensive Harm Reduction (CHR) in the same rural Southern Virginia community. Study II used the Community Readiness Model (CRM) and assessment tool. Stakeholder focus groups were conducted by a participatory research team, EM, as part of a larger project using the Stakeholder Engagement in quEstion Development (SEED) method. To assess the community's readiness to implement CHR using the CRM, Study II used semi-structured qualitative interviews with key stakeholders. The results of the readiness assessment were then used to inform a virtual community forum with members of a drug-free coalition. On the basis of CRM interview themes and findings, the forum used the NGT consensus-building technique.
Results: The primary themes identified in the analysis of the community stakeholder focus groups conducted for Study I included the importance of family dynamics and social networks as risk and resiliency factors, addressing hopelessness as a preventive strategy, the need for holistic approaches to treatment, childhood exposure resulting in intergenerational substance use, the needs of overburdened healthcare providers, the expansion of long-term rehabilitation programs, and the need for judicial reform towards those with OUD. Comprehensive methods to address OUD's complexity require specific and well-defined strategies. Understanding the factors that contribute to OUD in rural communities should be the first step in developing actions. The overall community readiness score for Study II was 4.07, indicating the community is still in the pre-planning stage for bring CHR to the community. The majority of key informants believe that leaders and community members recognize the problem of SUD/OUD harms and that something should be done to improve and integrate harm reduction efforts. The forum had 12 attendees. The community forum produced 13 topics and a list of action priorities that at least 80% of participants agreed on. The two areas of high priority included: (1) raising awareness of secondary harms of SUD/OUD and available resources to assist the community, and (2) reducing the stigma associated with CHR and appeal to people's sense of humanity in order to create an environment conducive to understanding and increase buy-in around CHR.
Implications: Both studies show rural stakeholders can help curb the drug epidemic. Their knowledge of internal community dynamics and needs allows them to prioritize actions to improve health outcomes. In addition, Study II demonstrated the effectiveness of the CR Model in determining community readiness to adopt CHR and the value of a virtual community forum in conjunction with an NGT process in fostering stakeholder consensus. / Doctor of Philosophy / Background: Opioid use disorder (OUD), prescription opioid misuse, and rising heroin use are major public health crises in the US. Taking too many prescription opioids or illegal drugs can be harmful. This can alter the brain, cause stress, and increase the risk of blood-borne illnesses and infections. Opioids caused nearly 70% of the 67,367 overdose deaths in 2018, according to the Centers for Disease Control and Prevention. Rural areas have high prescription and illicit drug use rates, limited resources, and unique issues. There is an emerging need to understand rural residents' perspectives on OUD and substance use disorder (SUD) in their community in order to implement efforts. Thus, this research which is based on the principles of Community-Based Participatory Research (CBPR) was conducted to help address this need. To reduce the health-related harms caused by substance abuse, CBPR promotes sustainable, culturally applicable interventions.
Methods: Two studies used CBPR to address the opioid crisis in rural Southern Virginia. The goal of Study I was to gain insight into community members' perspectives, knowledge, and experiences to inform community-led action. For the first study, a community-research team, EM, conducted group discussions with community members as part of a larger project that used a participatory approach to unite the community in actions to address OUD in their community. Study II used the Community Readiness Model (CRM) and an assessment tool to determine community readiness for comprehensive harm reduction (CHR). The study also wanted to see how a virtual community platform with a consensus building process could help build agreement around CHR. In Study II, key stakeholders were interviewed to assess the community's readiness for CHR. Then a virtual community forum with members of a drug-free coalition was held. The forum got responses and put them in order based on themes and results from CRM interviews.
Results: We learned from the first study, family dynamics, social networks, hopelessness, intergenerational substance use, and healthcare provider needs all influence risk and resilience. Long-term rehab programs should be expanded, and the justice system should treat OUD differently. Detailed methods to address OUD's complexity require specific and well-defined strategies. Understanding what causes OUD in rural communities should be the first step in finding solutions. Study II found that the community is still in the pre-planning stage, with a score of 4.07 out of 9, indicating that leaders and community members recognize that the harms associated with OUD are a problem and something should be done to improve and incorporate harm reduction efforts. The results of the community forum also show a list of important topics on which at least 80% of participants agreed. The two areas of high importance were: (1) raising awareness of secondary harms and available resources to help the community, and (2) lowering the stigma associated with CHR to make it easier for people to understand, but be deliberate in appealing to people's sense of humanity to get them to buy into CHR.
Conclusions: Both studies show that people who live in rural areas can help solve the local drug problem. Their understanding of how needs change within a community gives us a unique way to improve health outcomes. Study II found that using CRM and a virtual consensus-building process can aid stakeholders in reaching an agreement on how to address issues. Study II also showed how useful it is to use a virtual community forum and an NGT process to figure out if a community is ready for CHR.
| Identifer | oai:union.ndltd.org:VTETD/oai:vtechworks.lib.vt.edu:10919/110465 |
| Date | 07 June 2022 |
| Creators | Hargrove, Angelina J. |
| Contributors | Human Nutrition, Foods and Exercise, Rafie, Carlin, Stein, Jeffrey S., Deagle, Cornelia, Harden, Samantha M. |
| Publisher | Virginia Tech |
| Source Sets | Virginia Tech Theses and Dissertation |
| Language | English |
| Detected Language | English |
| Type | Dissertation |
| Format | ETD, application/pdf |
| Coverage | Virginia, United States |
| Rights | In Copyright, http://rightsstatements.org/vocab/InC/1.0/ |
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