Transcript Slide 1

Do attitudes about unhealthy substance use
impact primary care professionals’ readiness to
implement preventive care?
MB Amaral-Sabadini; R Saitz; MLO Souza-Formigoni.
BACKGROUND: Few studies about primary health care (PHC) professionals’
attitudes have addressed associations between attitudes towards unhealthy alcohol and
other drug (AOD) use (the spectrum from risky use through dependence) and readiness
to implement AOD clinical prevention practices.
AIM: To explore the association between PHC professionals’ attitudes about unhealthy
AOD use and their readiness to implement AOD clinical prevention practices.
HYPOTHESIS: Negative attitudes about unhealthy AOD use would influence PHC
professionals’ readiness to implement AOD clinical prevention practices.
METHODS: Physicians, nurses, nursing assistants and community health workers
from 5 PHC centers in Sao Paulo, Brazil, completed a questionnaire (in person) about:
* Prevention clinical practices
* Satisfaction when working with and readiness to work with people with unhealthy
AOD use
* Adapted Attribution Questionnaire (AAQ)
- Evaluates the presence of stigmatizing attitudes (9 items: pity, fear, blame
(responsibility for the causes of the problem), segregation, anger, help, avoidance,
dangerousness and control (over the problems’ solutions) about four vignettes (Alcohol
Risky Use (AR); Alcohol Abuse (AA); Alcohol Dependence (AD); and Drug Dependence
(DD)).
In logistic regression models, we tested the association between satisfaction and
readiness. Multiple Correspondence Analysis (MCA) was used to assess patterns of
associations between stigmatizing attitudes and readiness to implement clinical
prevention practices
FINDINGS: Of 160 PHC professionals surveyed, 96 (60%) completed it.
• Over half (56%) reported always or almost always implementing general clinical
prevention practices, but only 25% reported these practices for unhealthy AOD use;
• 53% felt only a little or not at all ready to implement clinical prevention practices for
unhealthy AOD use.
• Greater professional satisfaction when working with people with unhealthy AOD use
was associated with readiness to implement AOD clinical prevention practices
(Tables 1 and 2). For example, compared with none, having a great deal of
professional satisfaction when working with people with unhealthy alcohol use
increased the odds of readiness to implement alcohol prevention practices 6.2 times
and the odds of readiness to implement drug prevention practices 10.6 times.
Table 1 – Association between: satisfaction and
readiness to implement alcohol clinical prevention
practices
Satisfaction when
working with people
with unhealthy
alcohol use
Satisfaction when
working with people
with unhealthy drug
use
None
Some
OR (95% CI)
1.0
4.8 (0.9-26.2)
A great deal
6.2 (1.6-23.4)
None
Some
5.0 (1.0-24.1)
A great deal
12.0 (3.1-46.6)
Table 2 – Association between: satisfaction and
readiness to implement drug clinical prevention
practices
Satisfaction when
working with people
with unhealthy
alcohol use
Satisfaction when
working with people
with unhealthy drug
use
None
Some
OR (95% CI)
1.0
1.4 (0.1-16.6)
Figure 1 – MCA map of the associations between attitudes (AAQ) and health
professionals’ readiness to implement AOD clinical prevention practices.
* Each geometric figure and color (e.g. green triangle) represents the different
attitudes and readiness variables and their proximity indicates how closely they
are associated.
Patterns identified in the MCA suggested two groupings of
PHC professionals (Figure 1).
• Group 1: Professionals ready to work with people with unhealthy
AOD use, who attributed lower levels of dangerousness, blame
and segregation to such patients (suggesting less stigmatizing
attitudes).
• Group 2: Professionals not ready to work with people with
unhealthy AOD use, who attributed higher levels of
dangerousness, blame, control and segregation to such patients
(suggesting more stigmatizing attitudes).
LIMITATIONS: Results may be affected by non-response
(40%) bias. Generalizability may be limited; it is a small sample,
from one city in Brazil. Causality or directionality of the
associations cannot be determined from this cross-sectional
survey. Social desirability may have biased PHC professionals’
responses towards more positive attitudes.
DISCUSSION: Health professionals’ attitudes appear to
influence clinical practices, with more stigmatizing attitudes
associated with lower readiness to implement unhealthy AOD
clinical prevention practices. The way unhealthy AOD use is
perceived has implications for the relationship between patients
and health professionals and understanding these issues is likely
essential to facilitate implementation of preventive care, such as
screening and brief intervention for unhealthy AOD use.
A great deal 10.6 (2.2-49.6)
None
Some
1.0
4.0 (0.6-26.3)
Contact:
A great deal 18.5 (3.8-89.2)
CI = confidence interval OR = odds ratio
Supported by:
Process number:
#0389099
Process number:
#2007/07368-2
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