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Rationale, design and methods of the <i>Cul-CM</i> study: a protocol for cultural adaptation of contingency management in adults with stimulant use disorder.

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Tracking implementation determinants over time using the IFASIS: multi-site analysis of opioid treatment programs

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Digital contingency management (CM) shows promise for stimulant use, but implementation faces challenges. This study found internal organizational factors became barriers over time, while patient engagement issues shifted perceptions of recipient and intervention factors.

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Area of Science:

  • Addiction treatment research
  • Digital health implementation science
  • Healthcare organizational behavior

Background:

  • Contingency management (CM) is highly effective for stimulant use disorder but often underutilized due to implementation difficulties.
  • Digital CM platforms offer potential solutions to implementation barriers, yet factors influencing their sustained delivery require further investigation.
  • Understanding longitudinal changes in implementation determinants is crucial for optimizing digital CM platform uptake in opioid treatment programs (OTPs).

Purpose of the Study:

  • To longitudinally measure changes in implementation determinants affecting the uptake of a digital CM platform in OTPs serving stimulant users.
  • To assess how external context, internal context, intervention factors, and recipient factors evolve over a 6-month implementation period.
  • To identify key barriers and facilitators impacting the sustained delivery of digital CM in real-world clinical settings.

Main Methods:

  • A longitudinal study involving five OTPs in Rhode Island implementing a digital CM platform.
  • Utilized the Inventory of Factors Affecting Successful Implementation and Sustainment (IFASIS) tool, assessing 27 items rated for impact and importance at baseline and 6 months.
  • Employed mixed methods, combining quantitative ratings from OTP staff with qualitative analysis of transcribed interview rationales.

Main Results:

  • Internal organizational factors, including leadership commitment and policies, were increasingly perceived as barriers over the 6-month period.
  • Staff capacity remained a stable facilitator despite staff turnover, while recipient and intervention factors shifted from perceived facilitators to neutral or barrier perceptions.
  • Unanticipated challenges in patient referral and engagement significantly contributed to the observed shifts in implementation determinant ratings.

Conclusions:

  • Implementation determinants for digital CM platforms are dynamic and complex, necessitating ongoing monitoring.
  • Recipient and intervention factors require particular attention during digital CM implementation, as initial perceptions may not reflect long-term realities.
  • OTP staff need support in setting realistic expectations regarding patient identification and engagement processes for digital CM.