Self-Efficacy. The Effect of Self-Efficacy on Treatment Outcomes of Clients Enrolled in a Methadone Treatment Program in Rural Maryland

Transcription

1 The Effect of Self-Efficacy on Treatment Outcomes of Clients Enrolled in a Methadone Treatment Program in Rural Maryland Bonnie A. Franckowiak, DNP, FNP, CARN-AP Self-Efficacy The belief in one s capabilities to organize and execute the courses of action required to manage prospective situations. - Albert Bandura, 1986

2 Self-Efficacy is belief in one s ability to succeed at tasks. General Self-Efficacy is belief in one s general ability to succeed at tasks. Specific Self-Efficacy refers to beliefs about one s ability to handle specific tasks. Why Study Self-Efficacy?

3 Addiction is a Medical Disease Addiction is a chronic, relapsing brain disease, which has implications not only as an individual health problem, but also as a public health problem. It impacts the drug abuser and the community on a physical, mental, psychological and social level. (Qureshi, Al-Ghamdy, & Al-Habeeb, 2000) Background: Opiate Addiction 24.6 million Americans used illicit drugs in 2013 (9.4%) National cost is approx. $700 billion annually >8,000 new users daily (SAMHSA, 2014)

4 Background (cont.) Public health problem with global implications Contributes to global mortality and morbidity (NIDA, 2011) Global Burden of Disease DALY = Disability Adjusted Life Years The number of years of potential life lost due to premature mortality and the years of productive life lost due to disability.

5 Global Burden of Substance Abuse Drug dependence responsible for 20 million DALYs in 2010 Opioid dependence was the largest contributor, with 9.2 million Highest burden in higher income countries Illustrates increased need for treatment (Degenhardt, et al. 2013) Treatment: A Research-based Guide (NIDA, 1999) No single treatment is appropriate for all individuals. Treatment must attend to multiple need of the individual, not just drug use. Remaining in treatment for an adequate period of time is critical for treatment effectiveness.

6 Medication assisted treatment (MAT) using Methadone Gold standard of opiate treatment Strict state and federal regulations Individualized according to need MAT (cont.) Pharmacology, counseling, and behavioral therapy Comprehensive approach; Individualized care Goal: return to a state of health and well-being, and function well in family and community Low cost, safe, and effective; Accepted world-wide

7 LITERATURE REVIEW Literature Review Retention in treatment Psychosocial support Behavior change Self-Efficacy Health Belief Model

8 Retention in Treatment Client satisfaction leads to improved outcomes. Kelly, O Grady, Mitchell, Brown & Schwartz; 2011 Chronic illness is best treated collaboratively by client and provider. VonKorff, Gruman, Curry & Wagner; 1997 Adequate methadone dosing, psychiatric care, and behavioral counseling are key to successful treatment. Ciraulo, Piechniczek-Buczek & Iscan; 2003 Individualized treatment plans are associated with better retention and outcomes. Hser, Evans, Huang & Anglin; 2004 Psychosocial Support Satisfaction and rapport with staff leads to a decrease in illicit drug use, better compliance with treatment, and improved outcomes. Joe, Simpson, Dansereau Rowan-Szal; 2001 Clients who felt that needs were met during treatment stayed abstinent longer at 1 year follow up. Zhang, Gerstein & Freidmann; 2008 Outcomes improve when psychosocial support is added to medication treatment, compared to medication alone. Amato, Minozzi, Davoli, Vecchi, Ferri & Mayet; 2009

9 Behavior Change Motivation is an important factor in behavior change Kelly, Zyzanski & Alemagno; Self-efficacy affects the decision whether or not to initiate behavior change. Stewart, Wolfe, Maeder & Hartz; 1996 Maintenance of new behaviors is related to self-efficacy. Scherbaum; 2008 Self- Efficacy Positive health behavior is related to high self-efficacy. Schwarzer & Fuchs; 1995 Efforts to improve self-efficacy lead to improved treatment outcome and retention. Bourbeau; 2008 : Senbanjo, Wolff, Marshall & Strang; 2009 Alcoholics with high self-efficacy resisted temptation to drink for longer time periods. Vielva & Iraurgi; 2001: Allsop,Saunders&Phillips;2000

10 Self-efficacy is a fluid, dynamic concept. Why is Self-Efficacy important? Past Performance Verbal Persuasion Vicarious Experience Psychological / Emotional States Self-Efficacy Feelings Thoughts Motivation Actions

11 Health Belief Model (HBM) One of the most widely accepted and frequently used models for study and implementation of behavior change. Harrison, Mullen & Green; 1992 Proven useful in improving patient compliance in many studies related to various chronic illnesses. HEALTH B Orel et al.; 2010: Ghaddar et al.; 2009: Koch; 2002 HBM (cont.) Four conditions for behavior change: The belief that one is at risk of developing a specific condition. The belief that the risk is serious and the consequences are undesirable. The belief that the risk will be reduced by behavior change. The belief that barriers to behavior change can be overcome and managed. (Janz & Becker, 1984)

12 Health Belief Model Demographic variables (age, sex, race, ethnicity, etc.) Sociopsychological variables Perceived benefits of preventive action minus Perceived barriers to preventive action Perceived Susceptability to Disease X Perceived Seriousness (Severity) of Disease X Perceived Threat of Disease X Likelihood of Taking Recommended Preventive Health Action Cues to Action Mass media campaigns Advice from others Reminder postcard from physician/dentist Illness of family member or friend Newspaper or magazine article Janz & Becker, 1984 METHODOLOGY

13 Purpose: To determine if measurement of self-efficacy can be a useful tool in treatment of the opiate addicted client. Research Questions 1. Are MAT and self-efficacy related? 2. Are self-efficacy and treatment outcomes related?

14 The General Self-efficacy Scale (GSE) 1. I can always manage to solve difficult problems if I try hard enough. 2. If someone opposes me, I can find the means to get what I want. 3. It is easy for me to stick to my aims and accomplish my goals. 4. I am confident that I could deal efficiently with unexpected events. 5. Thanks to my resourcefulness, I can handle unforeseen circumstances. 6. I can solve most problems if I invest the necessary effort. 7. I can remain calm when facing difficulties because I can rely on my coping abilities. 8. When I am confronted with a problem, I can usually find several solutions. 9. If I am in trouble, I can usually think of a solution. 10. Responses: I can usually 1= Not handle at all true. whatever 2 = Hardly comes true. my 3 way. = Moderately true. 4 = Exactly true. English version by Schwarzer & Jerusalem, 1995 Specific Self-efficacy Additional questions relating specifically to opiate dependence added by researcher. 11. If I ran into old friends who offered me pills or heroin, I could resist. 12. I can stay away from people I used to use with, and I feel strong. 13. If I was in a situation where people were using drugs, I would have the strength to leave. 14. I feel that I am able to cope with stress in ways other than using drugs. Responses: 1= Not at all true. 2 = Hardly true. 3 = Moderately true. 4 = Exactly true. Franckowiak, 2011

15 Variable s change in self-efficacy scores number of opiate-free urines monthly group attendance monthly individual counseling sessions STUDY DESIGN

16 The Study Admission process including GSE Initiate Standard MAT After 6 months +/- 4 days Obtain informed consent Repeat GSE Retrospective record review of outcome measures Study Site: Serenity Health, LLC Elkton, MD Site Demographics: 96% Caucasian, 3% African American 54% female, 70% unemployed, 4% disabled 80% Medicaid, 20% self-pay Average age 34 years

17 Analysis of Data QUESTION #1: Are MAT and self-efficacy related? Comparison of (Post- minus Pre-treatment) scores using Paired t-test QUESTION #2: Are self-efficacy and treatment outcomes related? Correlation of group and individual sessions, and number of opiate-negative urine screens using Pearson Correlation RESULTS

18 MEAN PRE-TREATMENT GSE SCORES BY GENDER Pre GSE (General) Pre GSE (Specific) Pre GSE (Total) Gender Mean N Std. Dev. Females Males Combined Females Males Combined Females Males Combined MEAN POST-TREATMENT GSE SCORES BY GENDER Post GSE (General) Post GSE (Specific) Post GSE (Total) Females Males Combined Females Males Combined Females Males Combined

19 COMPARISON OF PRE- & POST- TREATMENT GSE SCORES Post-Pre GSE score (general) Post-Pre GSE score (specific) Post-Pre GSE score (total) t p value Range Average Increase Research Question #1 Is MAT related to self-efficacy? In this study, MAT does appear to be related to self-efficacy.

20 CORRELATION OF GSE SCORES AND NUMBER OF OPIATE NEGATIVE URINE SCREENS Negative Urine Pre GSE (General) Pre GSE (Specific) Pre GSE (Total) Pearson Correlation Sig. (2-tailed) N CORRELATION OF GSE SCORES AND INDIVIDUAL AND GROUP SESSIONS Individual Sessions Group Sessions Pearson Correlation Sig. (2- tailed) Pearson Correlation Sig. (2- tailed) Pre GSE (General) Pre GSE Pre GSE (Specific) (Total) N

21 Research Question #2 Are self-efficacy and treatment outcomes related? No correlation was found between self-efficacy scores and any of the treatment outcomes measured. Descriptive Data High GSE scores yielded more opiate negative urine screens. Subjects with high GSE scores preferred groups. Subjects with low GSE scores preferred individual sessions. Five subjects had unchanged or lowered GSE scores. 28 of 50 subjects identified completed the study.

22 Transferred to other treatment facility 3 Moved out of area Medical issues / Hospitalization Incarceration Administrative discharge Referred to pain management Left AMA Unknown Participants who did not complete the study (n = 22) DISCUSSION & RECOMMENDATIONS

23 Strengths of the Study Homogeneity of sample All subjects received same MAT protocol Inter-rater reliability Met 6 month minimum for MAT Limitations of the Study Small sample size High attrition rate Did not control for additional group attendance Did not control for type of group attended

24 Recommendations for Research Replicate with larger sample size and longer duration. Add measure of stress level. Assess motivation for treatment. Control for other variables (onset of drug use, treatment history, and concurrent substance use). Add control group who receives an intervention to increase self-efficacy. Recommendations for Practice Repeat GSE at intervals throughout treatment, and incorporate into Relapse Prevention programs. Continue use of GSE testing as an aid in treatment planning and counselor assignment. Use GSE testing to strengthen patient assessment, and view of whole person.

25 Follow Up at One Year Of the 28 subjects who completed the original study, 22 remained in treatment.

26 Final thought... Self-belief does not necessarily ensure success, but selfdisbelief assuredly spawns failure. - Albert Bandura From Self-Efficacy: The exercise of Control, 1997

27 Questions & Discussion Thank you.