Voucher-based contingency management to promote treatment engagement in comorbid alcohol use disorder and alcohol-related liver disease: A pilot theory-informed qualitative study with service users

IF 3 Q2 SUBSTANCE ABUSE
Sofia Hemrage, Stephen Parkin, Nicola Kalk, Naina Shah, Paolo Deluca, Colin Drummond
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Abstract

Background

Effective interventions for the management of alcohol-related liver disease (ARLD) remain a gap in clinical practice, and patients' engagement with alcohol services is suboptimal. Based upon the principles of operant conditioning, contingency management (CM) is a psychosocial intervention th at involves gradual, increasing incentives upon completion of treatment-related goals such as treatment attendance.

Methods

A pilot feasibility trial was conducted with 30 adult patients recruited from an inpatient clinical setting. Consecutive sampling was used to recruit patients presenting comorbid alcohol use disorder (AUD) and ARLD. Participants were randomized to integrated liver care (ILC), receiving hepatology and AUD care, or ILC with a voucher-based CM intervention (intervention arm). A longitudinal qualitative approach was adopted to explore anticipated (Stage 1) and experienced acceptability (Stage 2). The Theoretical Framework of Acceptability (TFA) guided semi-structured in-depth interviews and deductive analysis.

Results

Thirty participants were enrolled in the pilot trial, and interviews were conducted with 24 participants at Stage 1 and seven at Stage 2. Over half of the cohort (54.2%, n = 13) presented decompensated liver disease, and an average of 179 units of alcohol were consumed per week. Overall positive views toward voucher-based CM were noted, and explanatory data emerged across five TFA domains (intervention coherence, ethicality, self-efficacy, perceived effectiveness, and affective attitude). The core aspects of the voucher-based CM intervention matched participants' preferences and needs. Participants regarded CM as having a symbolic value and strengthening the therapeutic alliance with healthcare providers.

Conclusion

The data support the scope of voucher-based CM intervention to promote engagement with treatment services, and its potential to address the gaps in the care continuum in ARLD. The findings are of practical significance for developing person-centered, tailored interventions for this clinical population. The outcomes of this investigation can inform decision-making among stakeholders and healthcare providers and improve health outcomes for this clinical population.

Abstract Image

以代金券为基础的应急管理,促进合并酒精使用障碍和酒精相关肝病患者参与治疗:以服务使用者为对象的试点理论定性研究。
背景:对酒精相关肝病(ARLD)进行有效干预仍然是临床实践中的一个空白,患者参与酒精服务的情况也不尽如人意。根据操作性条件反射原理,应急管理(CM)是一种社会心理干预措施,包括在完成治疗相关目标(如参加治疗)后逐步增加奖励:方法:对从住院临床环境中招募的 30 名成年患者进行了试点可行性试验。试验采用连续抽样的方式招募合并有酒精使用障碍(AUD)和急性酒精性肝病(ARLD)的患者。参与者被随机分配到综合肝病治疗中心(ILC),接受肝病和 AUD 治疗,或综合肝病治疗中心与基于代金券的中医干预(干预组)。研究采用纵向定性的方法来探讨预期的可接受性(第一阶段)和体验的可接受性(第二阶段)。可接受性理论框架(TFA)指导了半结构式深度访谈和演绎分析:30 名参与者参加了试点试验,在第一阶段对 24 名参与者进行了访谈,在第二阶段对 7 名参与者进行了访谈。超过一半的参与者(54.2%,n = 13)患有失代偿性肝病,平均每周饮酒 179 单位。受访者对以代金券为基础的中药治疗总体持积极态度,并在五个 TFA 领域(干预一致性、道德性、自我效能感、感知有效性和情感态度)出现了解释性数据。以代用券为基础的中医干预措施的核心内容符合参与者的偏好和需求。参与者认为中医具有象征性价值,并能加强与医疗服务提供者之间的治疗联盟:这些数据支持了以医疗券为基础的中药干预在促进参与治疗服务方面的作用,以及其在解决急性淋巴细胞白血病持续护理中的不足方面的潜力。研究结果对于为这一临床人群制定以人为本、量身定制的干预措施具有实际意义。这项调查的结果可为利益相关者和医疗服务提供者的决策提供参考,并改善该临床人群的健康状况。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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