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
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).
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.
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.
Table 1 – Association between: satisfaction and readiness to implement alcohol clinical prevention practices
Table 2 – Association between: satisfaction and readiness to implement drug clinical prevention practices
OR (95% CI)
Satisfaction when working with people with unhealthy alcohol use
None
1.0
Some
4.8 ( )
A great deal
6.2 ( )
Satisfaction when working with people with unhealthy drug use -
5.0 ( )
12.0 ( )
OR (95% CI)
Satisfaction when working with people with unhealthy alcohol use
None
1.0
Some
1.4 ( )
A great deal
10.6 ( )
Satisfaction when working with people with unhealthy drug use
4.0 ( )
18.5 ( )
Contact:
CI = confidence interval OR = odds ratio
Process number: #
Process number: #2007/
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