Drug Client Peer Wellbeing Advocates as Multi-level Change Operators: Issues for Usage Art of System Dissemination Media.

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Drug Client Peer Wellbeing Advocates as Multi-level Change Operators: Issues for Usage Study of System Dissemination Intercessions Margaret R. Weeks Jianghong Li Julia Dickson-Gomez Maria Martinez Mark Pass on.
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Drug User Peer Health Advocates as Multi-level Change Agents: Issues for Implementation Science of Network Diffusion Interventions Margaret R. Weeks Jianghong Li Julia Dickson-Gomez Maria Martinez Mark Convey Presented at the 2 nd Annual NIH Conference on the Science of Dissemination and Implementation, Washington , DC, January 28-29, 2009

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The Risk Avoidance Partnership (RAP) Program Goal To prepare dynamic heroin/cocaine clients as Peer/Public Health Advocates (PHAs) to scatter HIV, hepatitis, TB, and STD aversion data, materials and shows into medication utilizing systems and high-hazard medication utilization locales

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The Multi-level Risk Avoidance Partnership (RAP) Model Individual level: Curriculum to prepare dynamic medication clients to be Peer Health Advocates (PHAs) : concentrate on individual danger lessening and part displaying of counteractive action practices, and engagement in social activity . Companion system level : Trained PHAs scatter RAP Peer-conveyed Intervention to associates in their medication utilizing systems and others as a part of their groups, in light of damage lessening and wellbeing advancement approaches. Group level : Community Advocacy Group (CAG) gatherings backing prepared PHAs to take an interest in wellbeing support for their groups all alone sake and that of associates and relatives .

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Theoretical Framework of RAP Multilevel Intervention Social Ecological Theory *: interconnectedness of distinctive levels of social change, and the iterative and various impacts on the social setting : Diffusion of Innovations and Dynamic Social Impact Theories ** : procedure of reception/dismissal of advancements after some time, dependable change operators , likewise quality of communicator (close tie, compelling, suitable message); instantaneousness (social/physical closeness), number of associates rehashing message Health Promotion Theory ***: strengthening as a methodology for improving wellbeing, supporting for group cooperation in tending to wellbeing issues

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Multilevel Influence of RAP Interventions Drug tx organizations. Social Svc. organizations.  PHAs  Policy creators  Housing advo-cates  Contacts  Drug Use Settings Community

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Theoretically and Empirically Established Core Components of RAP Underlying qualities/ideas of associate wellbeing backing , strengthening, wellbeing advancement, hurt diminishment Formative group appraisal to comprehend social connection of medication utilize and medication client systems and to tailor and center intercession substance Experienced/steady staff who comprehend habit and know the nearby medication utilizing populaces Candidates to prepare as Peer Health Advocates why should likely have high potential system reach, likely maintenance, and companion impact Role displaying and intelligent engagement amid 10-session PHA preparing: 4 office sessions; 1-6 group sessions on aversion and wellbeing advancement conveyance

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Theoretically and Empirically Established Core Components of RAP (2) PHA preparing motivators to bolster maintenance and encourage view of PHA “work” as esteemed Guided institutionalized companion conveyed mediation that PHAs convey to their system individuals, including instruction , materials , show of their utilization PHA field manual to build constancy of mediation procurement through representation of standard intercession segments Community Advocacy Group gatherings to regroup with staff and with different PHAs for bolster/retraining and to restock with counteractive action supplies Alternatives to high-chance mediation areas for medication clients in treatment in spots outside of medication utilization settings

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Mixed Method Process and Outcome Evaluation Baseline & 6-month subsequent danger appraisals of PHAs and 2-3 PHA system Contact Referrals (CRs); measured danger practices, states of mind, individual system individuals, introduction to RAP and different mediations Ethnographic perceptions and meetings : developmental group appraisal in-office and staff-joined forces instructional meetings day by day drug-client exercises PHAs, CRs, others on RAP intercession dissemination Post intercession cross-sectional group review: test of Hartford medication clients to survey dispersion of PHA/RAP mediation and impacts

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Prior 30-day Risk Reduction Resulting from Talking with a PHA from RAP (%) PHAs CRs* Others* n=98 n=157 n=112 (p) Drug utilization hazard lessening : Reduced medication use 70.8 54.1 41.7 (.000) Started elastic tip use 70.4 45.0 33.0 (.000) Injection hazard decrease : Reduced syringe sharing 29.4 12.9 14.6 (.013) Stopped syringe sharing 16.9 6.0 10.7 (.060) Stopped works sharing 17.4 7.8 7.2 (.064) Stopped injecting 13.9 4.9 6.7 (.069) Sexual danger diminishment : Used condoms 54.0 43.8 37.0 (.064) Reduced # sex accomplices 64.5 41.3 39.1 (.001) * CRs incorporate members alluded into the study via prepared PHAs. Others incorporate untrained PHAs selected by staff, and contacts alluded into the study by untrained PHAs, who show up additionally to have been reached by RAP PHAs.

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Main Connected Network Component (n=346): Follow-up RAP Exposure  PHA (n=76)  Contacts (n=273) Health Talk * 9-13 talk things 6-8 talk things 2-5 talk things 1 talk thing 0 talk things (no postliminary) * List of 13 wellbeing related things drug clients have discussed with other medication clients in most recent 2 weeks, e.g., HIV, STD, TB, hepatitis, anticipation, drug treatment, and so on

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Broader Activities of PHAs in the Community Presented and upheld for the RAP venture at a few open gatherings Provided data to group individuals on lodging Demonstrated at authoritative workplaces in regards to proceeding with health advantages for urban unemployed, particularly sedate users Volunteered in sanctuaries and centers Worked with youth and ministers in places of worship Talked to associates in jail about PHA/RAP

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Challenges of RAP Implementation and Sustainability Connection in the middle of PHAs and RAP staff was discriminating and basic; staff turnover and undertaking decrease prompted lessened PHA action Need for ceaseless re-supply of PHAs with avoidance materials; wellsprings of subsidizing restricted Ongoing CAG meeting offered proceeded with open door for association with PHAs; needs program support for staffing and exercises Issues CAG raised to be tended to were too enormous for PHAs to have the capacity to determine, now and again prompting demoralization Addiction remains a hindrance for dynamic clients in spite of premium and self-inspiration

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Methodological Challenges for Multilevel RAP Implementation Reach: Assess degree to which RAP actualized in new settings trains viable PHAs and achieves the high-hazard drug client systems Efficacy: Assess whether RAP accomplishes comparable diminishment in danger practices among PHAs and their contacts in new usage connections (associations, groups) Adoption: Determine whether proper establishments can create limit and are willing to execute RAP Implementation: Balance loyalty to center segments with adjustment to fit new settings in usage crosswise over settings and by diverse staff leading project Maintenance: Sustain support for staff, PHAs, and project to guarantee proceeded with usage and danger lessening adequacy of RAP after some time in every setting

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Methodological Challenges for Multilevel RAP Implementation (2) Need to discover suitable accomplices in the group with the possibility to reach viable PHAs and others in the objective populace, learn and execute the RAP PHA preparing, bolster PHAs long haul, assess procedure and results Problems of group and multi-level intercessions identified with likely little n sizes of expository units Need for options, for example, subjective and observational studies and near contextual investigations , which address shortcomings of RCT in group mediations Comparison of likenesses and contrasts for the situation groups or settings and suggestions as these influence intercession adjustment and usage Because groups ARE distinctive, ought to ponder under what circumstances the mediation has the same impacts as the first study?

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How to Increase Implementation of RAP in New Community/Organizational Contexts Research is expected to see how to do interpret and execute multilevel intercessions like RAP; to comprehend components blocking or advancing appropriation, adjustment, usage and support of RAP in: facilities, CBOs, and so on. Need to take a gander at authoritative level issues and collaborations among hierarchical parts that influence the framework and execution/upkeep of new projects Must create instruments to lead group and hierarchical appraisals, subjective procedure and result assessment, consistent input, and so on., and utilization examination plans that suit different group settings

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RAP Research Team Institute for Community Research staff (in sequential order): Mark Convey Ethnographer Julia Dickson-Gomez Ethnographic Coordinator Michelle Garner Data Manager Julianna Gonzalez Outreach Interviewer Jianghong Li Co-PI/Statistician Maria Martinez Outreach/Intervention Coordinator Chris Ortiz Outreach/Intervention Facilitator Juan Restrepo Data Manager Kim Radda Project Director Jean J. Schensul Co-Investigator David Walker Outreach Interviewer Margaret R. Weeks Principal Investigator Oscar Woods Outreach/Intervention Facilitator Scott Clair, Ph.D., University of Iowa , Statistical Data Analyst Stephen Borgatti, Ph.D., Boston College , Networks Consultant FUNDER : National Institute on Drug Abuse Affiliated investigation of the Center for Interdisciplinary Research on AIDS , Yale University, ICR, HHC

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