SMART Family and Friends Mutual-Help Groups: Findings From a Mixed-Methods Formative Implementation Evaluation

Improving support for people affected by another's substance use disorder (affected family members [AFM]) is a priority, but implementation is challenging. This mixed-methods evaluation assessed the perceived effectiveness of SMART Family and Friends training and applied the Consolidated Framework for Implementation Research (CFIR) to examine program implementation.

N = 24 participants with professional or lived experience of supporting AFMs were recruited and trained to deliver groups. Training was evaluated using the Work Practice Questionnaire. Semi-structured interviews (n = 19) captured experiences of training and group delivery. Transcripts were analysed using iterative categorisation, informed by CFIR domains.

Participants felt equipped to deliver groups (M = 20.79, SD = 3.09) and found the training useful (M = 28.40, SD = 2.74) and relevant (M = 27.16, SD = 2.85). The approach, applicability and structure of the intervention (intervention characteristics) promoted engagement. Workplace characteristics influenced time and resources available to support implementation, with adequate staffing paramount (inner setting). Participants identified a clear need for the program, but practical and attitudinal barriers complicated engagement (outer setting). Lived experience promoted facilitator engagement and also raised wellbeing and training considerations (individual characteristics). Challenges associated with delivery modality and experiences facilitating groups (implementation process) were identified.

SMART Family and Friends has potential for scaled implementation by peers and providers within voluntary positions and those employed within existing AOD and community service programs, although service limitations and barriers around help-seeking may hinder delivery. Efforts to address training and infrastructure considerations, particularly among those with lived experience, are needed. Improved understanding of the support needs and preferences of AFMs is warranted.