- Title
- Increasing the provision of preventive care by clinicians within substance use treatment settings
- Creator
- Tremain, Danika Lea
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2019
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- People with substance use problems have significantly higher mortality and morbidity rates and reduced life expectancy compared to the general population. Part of this excess mortality and morbidity is attributable to substance use, however a significant proportion is due to higher rates of other preventable chronic illness. A high prevalence of additional modifiable health risk behaviours, specifically tobacco smoking, insufficient fruit and/or vegetable consumption and insufficient physical activity, contributes to such chronic disease levels. Substance use treatment settings are an opportunity for the delivery of preventive care to address modifiable health risk behaviours for people who have substance use problems. Despite this opportunity, relatively little is known about health risks behaviours and preventive care for people attending substance use treatment. Only very limited research has examined the prevalence of health risk behaviours for people with substance use problems; the provision of preventive care by substance use treatment clinicians; and clinical practice change strategies that may be effective in increasing the provision of such care within substance use treatment settings. To address this gap in the knowledge, the broad aims of this thesis were to: 1. Identify the prevalence of three chronic disease health risk behaviours (tobacco smoking, insufficient fruit and vegetable consumption, and insufficient physical activity) among clients of community substance use treatment services. 2. Examine the prevalence of preventive care provision (in the form of assessment, brief advice and referral) for such health risk behaviours in community substance use treatment settings. 3. Explore the potential association between clinician attitudes and beliefs with the provision of preventive care for such health risk behaviours. 4. Determine the effectiveness of a clinical practice change intervention in increasing community substance use treatment clinicians’ provision of preventive care (in the form of assessment, brief advice and referral) for three health risk behaviours (tobacco smoking, insufficient fruit and vegetable consumption, and insufficient physical activity) within community substance use treatment services. To address the above aims, a series of studies was undertaken from 2012 to 2014 within 15 community substance use treatment services in one local health district in New South Wales, Australia. These studies included: a cross-sectional survey of 386 community substance use treatment clients; a cross-sectional survey of 54 community substance use treatment clinicians; and a pre-post multi-strategic clinical practice change pilot intervention trial. The studies were evaluated utilising surveys of clients attending community substance use treatment services over a two-year period and surveys of community substance use treatment clinicians. In addition, a systematic review of the peer-reviewed literature that describes the prevalence of preventive care delivery in substance use setting was undertaken. This thesis contributes significantly to the limited research in this area in several ways. Firstly, this thesis reported a high prevalence of modifiable health risk behaviours (tobacco smoking, insufficient fruit and/or vegetable consumption, insufficient physical activity) in community substance use treatment clients and high client interest in modifying such behaviours. In addition, both community substance use treatment clinicians and clients reported favourable attitudes towards the provision of preventive care within substance use treatment settings. However, the provision of preventive care to address such behaviours was found to be suboptimal for all care elements (assess, advise, refer) for insufficient fruit and/or vegetable consumption and insufficient physical activity and referral for all health risk behaviours. The systematic review, although limited to tobacco smoking care, supported this finding. The review also highlighted a variety of measures currently utilised to record and report the provision of preventive care in substance use treatment settings. Secondly, the multi-strategic clinical practice change intervention that aimed to increase the provision of preventive care in substance use treatment settings had varying impact across elements of care and risk factors. Although an increase in the provision of care for insufficient fruit and/or vegetable consumption was indicated, the intervention had no impact on care for smoking and insufficient physical activity. This thesis identified a need for further research regarding the provision of preventive care for multiple health risk behaviours in substance use treatment settings. It is suggested that future research consider: how the provision of preventive care in substance use treatment settings is measured; the barriers and facilitators to the provision of preventive care; and the use of robust study designs when examining the effectiveness of interventions that aim to increase clinician provision of preventive care.
- Subject
- substance abuse treatment centre; tobacco smoking; nutritional status; physical activity; community healthcare
- Identifier
- http://hdl.handle.net/1959.13/1404535
- Identifier
- uon:35356
- Rights
- Copyright 2019 Danika Lea Tremain
- Language
- eng
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| Thumbnail | File | Description | Size | Format | |||
|---|---|---|---|---|---|---|---|
| View Details Download | ATTACHMENT01 | Thesis | 21 MB | Adobe Acrobat PDF | View Details Download | ||
| View Details Download | ATTACHMENT02 | Abstract | 469 KB | Adobe Acrobat PDF | View Details Download |