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Yimsaard P, Mootz JJ, Rungnirundorn T, Janamnuaysook R, Samitpol K, Phanuphak N, Wainberg ML. Assessing the acceptability of implementing a Screening, Brief Intervention and Referral to Treatment for alcohol use among transgender women in Bangkok, Thailand: A mixed-method pre-implementation study using the Consolidated Framework for Implementation Research. Addiction 2024; 119:863-874. [PMID: 38168887 PMCID: PMC11009091 DOI: 10.1111/add.16423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 11/19/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND AND AIMS Health inequities related to alcohol use exist for transgender individuals. While the Thailand Ministry of Public Health recently published a clinical guideline to implement a Screening, Brief Intervention and Referral to Treatment (SBIRT) in primary care, there has been no study regarding transgender women's (TGW) alcohol use and the acceptability of implementing SBIRT in a Thai context, a gap this study aimed to fill. DESIGN A mixed-method approach was used. In the first phase, TGW service users and health-care providers (HCPs) completed a survey on the acceptability of prospective implementation of SBIRT. TGW service users completed the Alcohol Use Disorder Identification Test-Consumption (AUDIT-C). In the second phase, TGW service users, HCPs, clinic administrators and national-level alcohol, HIV and transgender health policymakers participated in in-depth qualitative interviews. SETTING The Tangerine Clinic, a transgender-led sexual health clinic in Bangkok, Thailand. PARTICIPANTS In the first phase, TGW service users (n = 100) and HCP (n = 8) were surveyed. In the second phase, 22 stakeholders (n = 10 TGW service users; n = 8 HCP; n = 1 clinic administrator; n = 3 policymakers) were interviewed. MEASUREMENTS Simple proportions were calculated for each survey item. Differences in acceptability by various demographic factors were calculated using univariate analysis. The qualitative data were coded using thematic analysis and a deductive approach. The results were mapped to the Consolidated Framework for Implementation Research domains and constructs. The quantitative and qualitative results were triangulated to expand understanding. FINDINGS Fifty per cent of the TGW participants exhibited problematic drinking levels (AUDIT-C ≥ 4). Implementing SBIRT was highly acceptable, as more than 95% of participants reported agreeing or completely agreeing to receive SBIRT for alcohol use. Barriers, such as complexity, time constraint and lack of knowledge and skills, were anticipated. Adaptability, such as tailoring the content of brief intervention to suit TGW health needs and SBIRT to fit with existing clinic procedures, might facilitate successful implementation. CONCLUSION Screening, Brief Intervention and Referral to Treatment (SBIRT) for alcohol use has the potential to be successfully implemented in transgender-led sexual health clinic settings, with some adaptations to overcome anticipated barriers.
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Affiliation(s)
- Pongkwan Yimsaard
- Department of Psychiatry, King Chulalongkorn Memorial Hospital Thai Red Cross Society, Bangkok, Thailand
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Jennifer J. Mootz
- Columbia University Department of Psychiatry, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Teerayuth Rungnirundorn
- Department of Psychiatry, King Chulalongkorn Memorial Hospital Thai Red Cross Society, Bangkok, Thailand
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Rena Janamnuaysook
- Institute of HIV Research and Innovation, Bangkok, Thailand
- Center of Excellence in Transgender Health, Chulalongkorn University, Bangkok, Thailand
| | - Kritima Samitpol
- Institute of HIV Research and Innovation, Bangkok, Thailand
- Center of Excellence in Transgender Health, Chulalongkorn University, Bangkok, Thailand
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Scheer JR, Behari K, Schwarz AA, Cascalheira CJ, Helminen EC, Pirog SA, Jaipuriyar V, Sullivan TP, Batchelder AW, Jackson SD. Expressive writing treatments to reduce PTSD symptom severity and negative alcohol-related outcomes among trauma-exposed sexual minority women and transgender/nonbinary people: Study protocol for a mixed-method pilot trial. Contemp Clin Trials Commun 2023; 35:101197. [PMID: 37671246 PMCID: PMC10475481 DOI: 10.1016/j.conctc.2023.101197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 07/21/2023] [Accepted: 08/18/2023] [Indexed: 09/07/2023] Open
Abstract
Background Sexual minority women (SMW) and transgender and/or nonbinary (TNB) individuals report an elevated prevalence of posttraumatic stress disorder (PTSD) symptoms and negative alcohol-related outcomes compared to heterosexual women and cisgender people. SMW and TNB individuals also face barriers to utilizing treatment, which can result in delayed or missed appointments. Accessible, feasible, and effective treatment approaches, such as web-based expressive writing (EW) treatments, are needed to address PTSD and negative alcohol-related outcomes in these populations. Method We describe the design of a mixed-method pilot randomized controlled trial which will compare an EW treatment adapted for SMW and TNB people (stigma-adapted EW) and trauma (i.e., non-adapted) EW with an active (neutral-event) control to determine acceptability and feasibility of a future fully powered randomized controlled trial. The sample will include 150 trauma-exposed SMW and TNB individuals from across the United States who will be randomly assigned to stigma-adapted EW (n = 50), trauma EW (n = 50), or control (n = 50). Participants will be assessed before treatment, one-week after the first writing session, and three-months after the first writing session. This paper identifies steps for evaluating the acceptability and feasibility of the proposed study and determining changes in outcomes resulting from adapted and non-adapted EW treatments to inform refinements. This paper also highlights our strategy for testing theory-driven mediators and moderators of treatment outcomes. Conclusions This mixed-method pilot trial will inform the first fully powered, self-administered, brief web-based treatment to reduce PTSD symptom severity and negative alcohol-related outcomes among trauma-exposed SMW and TNB individuals.
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Affiliation(s)
- Jillian R. Scheer
- Department of Psychology, Syracuse University, Syracuse, NY, 414 Huntington Hall, Syracuse, NY, 13244, USA
| | - Kriti Behari
- Department of Psychology, Syracuse University, Syracuse, NY, 414 Huntington Hall, Syracuse, NY, 13244, USA
| | - Aubriana A. Schwarz
- Department of Psychology, Syracuse University, Syracuse, NY, 414 Huntington Hall, Syracuse, NY, 13244, USA
| | - Cory J. Cascalheira
- Department of Counseling and Educational Psychology, New Mexico State University, Las Cruces, NM, 88003, USA
- VA Puget Sound Health Care System, Seattle, WA, 98108, USA
| | - Emily C. Helminen
- Department of Psychology, Syracuse University, Syracuse, NY, 414 Huntington Hall, Syracuse, NY, 13244, USA
| | - Sophia A. Pirog
- Department of Psychology, Syracuse University, Syracuse, NY, 414 Huntington Hall, Syracuse, NY, 13244, USA
| | - Virinca Jaipuriyar
- Department of Psychology, Syracuse University, Syracuse, NY, 414 Huntington Hall, Syracuse, NY, 13244, USA
| | - Tami P. Sullivan
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, 06501, USA
| | - Abigail W. Batchelder
- Harvard Medical School, Harvard University, Boston, MA, 02114, USA
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, 02114, USA
- The Fenway Institute, Fenway Health, Boston, MA, 02115, USA
| | - Skyler D. Jackson
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, 06501, USA
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