1
|
dos Santos B, Farzan Nipun R, Maria Subic A, Kubica A, Rondinelli N, Marentette D, Muise J, Paes K, Riley M, Bhuiya S, Crosby J, McBride K, Salter J, Orkin AM. Virtual opioid poisoning education and naloxone distribution programs: A scoping review. PLOS DIGITAL HEALTH 2024; 3:e0000412. [PMID: 38848374 PMCID: PMC11161022 DOI: 10.1371/journal.pdig.0000412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 04/28/2024] [Indexed: 06/09/2024]
Abstract
The global opioid poisoning crisis is a complex issue with far-reaching public health implications. Opioid Poisoning Education and Naloxone Distribution (OPEND) programs aim to reduce stigma and promote harm reduction strategies, enhancing participants' ability to apply life-saving interventions, including naloxone administration and cardiopulmonary resuscitation (CPR) to opioid poisoning. While virtual OPEND programs have shown promise in improving knowledge about opioid poisoning response, their implementation and evaluation have been limited. The COVID-19 pandemic has sparked renewed interest in virtual health services, including OPEND programs. Our study reviews the literature on fully virtual OPEND programs worldwide. We analyzed 7,722 articles, 30 of which met our inclusion criteria. We extracted and synthesized information about the interventions' type, content, duration, the scales used, and key findings. Our search shows a diversity of interventions being implemented, with different study designs, duration, outcomes, scales, and different time points for measurement, all of which hinder a meaningful analysis of interventions' effectiveness. Despite this, virtual OPEND programs appear effective in increasing knowledge, confidence, and preparedness to respond to opioid poisoning while improving stigma regarding people who use opioids. This effect appears to be true in a wide variety of populations but is significantly relevant when focused on laypersons. Despite increasing efforts, access remains an issue, with most interventions addressing White people in urban areas. Our findings offer valuable insights for the design, implementation, and evaluation of future virtual OPEND programs.
Collapse
Affiliation(s)
- Bruna dos Santos
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Rifat Farzan Nipun
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Anna Maria Subic
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Alexandra Kubica
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Nick Rondinelli
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Heart to Heart First Aid CPR Services Inc., Toronto, Canada
| | - Don Marentette
- Canadian Red Cross Opioid Harm Reduction Advisory Council, Canada
| | | | | | | | | | | | - Keely McBride
- Canadian Red Cross Opioid Harm Reduction Advisory Council, Canada
- The Canadian Red Cross Society, Canada
| | - Joe Salter
- Canadian Red Cross Opioid Harm Reduction Advisory Council, Canada
- The Canadian Red Cross Society, Canada
| | - Aaron M. Orkin
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
- Li Ka Shing Knowledge Institute of Unity Health Toronto, Toronto, Canada
- Department of Emergency Medicine, Unity Health Toronto, Toronto, Canada
| |
Collapse
|
2
|
Edwards GF, Mierisch C, Mutcheson B, Strauss A, Coleman K, Horn K, Parker SH. Developing medical simulations for opioid overdose response training: A qualitative analysis of narratives from responders to overdoses. PLoS One 2024; 19:e0294626. [PMID: 38547079 PMCID: PMC10977769 DOI: 10.1371/journal.pone.0294626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 11/06/2023] [Indexed: 04/02/2024] Open
Abstract
Medical simulation offers a controlled environment for studying challenging clinical care situations that are difficult to observe directly. Overdose education and naloxone distribution (OEND) programs aim to train potential rescuers in responding to opioid overdoses, but assessing rescuer performance in real-life situations before emergency medical services arrive is exceedingly complex. There is an opportunity to incorporate individuals with firsthand experience in treating out-of-hospital overdoses into the development of simulation scenarios. Realistic overdose simulations could provide OEND programs with valuable tools to effectively teach hands-on skills and support context-sensitive training regimens. In this research, semi-structured interviews were conducted with 17 individuals experienced in responding to opioid overdoses including emergency department physicians, first responders, OEND program instructors, and peer recovery specialists. Two coders conducted qualitative content analysis using open and axial thematic coding to identify nuances associated with illicit and prescription opioid overdoses. The results are presented as narrative findings complemented by summaries of the frequency of themes across the interviews. Over 20 hours of audio recording were transcribed verbatim and then coded. During the open and axial thematic coding process several primary themes, along with subthemes, were identified, highlighting the distinctions between illicit and prescription opioid overdoses. Distinct contextual details, such as locations, clinical presentations, the environment surrounding the patient, and bystanders' behavior, were used to create four example simulations of out-of-hospital overdoses. The narrative findings in this qualitative study offer context-sensitive information for developing out-of-hospital overdose scenarios applicable to simulation training. These insights can serve as a valuable resource, aiding instructors and researchers in systematically creating evidence-based scenarios for both training and research purposes.
Collapse
Affiliation(s)
- G. Franklin Edwards
- Graduate Program in Translational Biology, Medicine, and Health, Virginia Tech, Blacksburg, Virginia, United States of America
| | - Cassandra Mierisch
- Department of Basic Science Education, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, United States of America
| | - Brock Mutcheson
- Office of Assessment and Program Evaluation, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, United States of America
| | - Allison Strauss
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia, United States of America
| | - Keel Coleman
- Department of Emergency Medicine, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, United States of America
- Department of Emergency Medicine, Carilion Clinic, Roanoke, Virginia, United States of America
| | - Kimberly Horn
- Department of Population Health Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, Virginia, United States of America
- Fralin Biomedical Research Institute at VTC, Roanoke, Virginia, United States of America
| | - Sarah Henrickson Parker
- Fralin Biomedical Research Institute at VTC, Roanoke, Virginia, United States of America
- Department of Health Systems and Implementation Science, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, United States of America
| |
Collapse
|
3
|
Giordano NA, Febres-Cordero S, Baker H, Pfeiffer KM, Walsh LM, Gish A, Axson SA. Opioid-involved overdose trainings delivered using remote learning modalities. Nurs Open 2023; 10:4132-4136. [PMID: 36681653 PMCID: PMC10170917 DOI: 10.1002/nop2.1615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/27/2022] [Accepted: 01/10/2023] [Indexed: 01/23/2023] Open
Abstract
AIM This education-focused study examined changes in nursing students' knowledge and attitudes towards responding to opioid-involved overdoses following participation in trainings delivered using remote learning modalities. DESIGN This pre-post study examined learning outcomes among 17 nursing students. METHODS Participants completed the Opioid Overdose Attitude Scale and Opioid Overdose Knowledge Scale to assess attitudes and knowledge, respectively. Trainings were delivered to two separate groups, one via virtual reality immersive video and another over video conferencing. RESULTS Attitude scores increased by an average of 12.2 points and knowledge scores increased by 1.65 points. Within the virtual reality group, attitude scores increased by an average of 10 points, while no significant changes were observed in knowledge scores. The video conferencing group improved in both attitude and knowledge scores, by an average of 16.2 points and 2.1 points, respectively. CONCLUSIONS These hypothesis generating results illustrate the utility of remote learning approaches to deliver trainings, while maintaining social distance during the ongoing COVID-19 pandemic.
Collapse
Affiliation(s)
- Nicholas A Giordano
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Sarah Febres-Cordero
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Helen Baker
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Katherine M Pfeiffer
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Lisa Marie Walsh
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Andy Gish
- Independent Harm Reduction Expert, Atlanta, Georgia, USA
| | - Sydney A Axson
- National Clinician Scholars Program, Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, Connecticut, USA
| |
Collapse
|
4
|
Swartz JA, Lin Q, Kim Y. A measurement invariance analysis of selected Opioid Overdose Knowledge Scale (OOKS) items among bystanders and first responders. PLoS One 2022; 17:e0271418. [PMID: 36240201 PMCID: PMC9565426 DOI: 10.1371/journal.pone.0271418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 09/27/2022] [Indexed: 11/18/2022] Open
Abstract
The Opioid Overdose Knowledge Scale (OOKS) is widely used as an adjunct to opioid education and naloxone distribution (OEND) for assessing pre- and post-training knowledge. However, the extent to which the OOKS performs comparably for bystander and first responder groups has not been well determined. We used exploratory structural equation modeling (ESEM) to assess the measurement invariance of an OOKS item subset when used as an OEND training pre-test. We used secondary analysis of pre-test data collected from 446 first responders and 1,349 bystanders (N = 1,795) attending OEND trainings conducted by two county public health departments. Twenty-four items were selected by practitioner/trainer consensus from the original 45-item OOKS instrument with an additional 2 removed owing to low response variation. We used exploratory factor analysis (EFA) followed by ESEM to identify a factor structure, which we assessed for configural, metric, and scalar measurement invariance by participant group using the 22 dichotomous items (correct/incorrect) as factor indicators. EFA identified a 3-factor model consisting of items assessing: basic overdose risk information, signs of an overdose, and rescue procedures/advanced overdose risk information. Model fit by ESEM estimation versus confirmatory factor analysis showed the ESEM model afforded a better fit. Measurement invariance analyses indicated the 3-factor model fit the data across all levels of invariance per standard fit statistic metrics. The reduced set of 22 OOKS items appears to offer comparable measurement of pre-training knowledge on opioid overdose risks, signs of an overdose, and rescue procedures for both bystanders and first responders.
Collapse
Affiliation(s)
- James A. Swartz
- Jane Addams College of Social Work, University of Illinois Chicago, Chicago, Illinois, United States of America
- * E-mail:
| | - Qiao Lin
- College of Education, University of Illinois Chicago, Chicago, Illinois, United States of America
| | - Yerim Kim
- Jane Addams College of Social Work, University of Illinois Chicago, Chicago, Illinois, United States of America
| |
Collapse
|
5
|
Galiher MV, Huffman M. Attitude changes following short-form opioid overdose video education: a pilot study. Harm Reduct J 2022; 19:114. [PMID: 36241995 PMCID: PMC9562080 DOI: 10.1186/s12954-022-00696-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 09/30/2022] [Indexed: 12/02/2022] Open
Abstract
Background Opioid overdose response training (OORT) and the need for its rapid expansion have become more significant as the opioid epidemic continues to be a health crisis in the USA. Limitation of funding and stigmatization often hinders expansion of OORT programs. Primarily due to the COVID-19 pandemic, there has been widespread transition from in-person to virtual communication. However, OORT programs may benefit from long-term use of this modality of education if it can be as effective. Objective To measure the change in participant attitude after a brief, virtual OORT. Methods A 6.5-min OORT video explained recognition of opioid overdose, appropriate response and proper administration of intranasal naloxone. Pre- and post-video scores from a 19-item survey were used to determine the video's impact on participants’ self-perceived competence and readiness to administer naloxone to a person with a suspected opioid overdose. Paired t tests were used in the analysis of pre- and post-video scores. Mann–Whitney U and Kruskal–Wallis H testing were used to compare variance between several demographic subgroups of interest. Results A sample of 219 participants had a significant mean difference of 15.12 (SD 9.48; 95% CI 13.86–16.39, p < 0.001) between pre- and posttest scores. Improvements were found to be greatest in content-naïve participants with lower levels of education and non-health care-related jobs than participants endorsing previous content awareness, formal naloxone training, masters, doctorate or professional degrees and health care-related jobs. Conclusion This pilot study demonstrated encouraging evidence that a brief, virtual, pre-recorded educational intervention improved participant-rated competence and readiness to administer intranasal naloxone in a suspected opioid overdose. Due to scalability and ability to overcome common healthcare accessibility barriers, short-form videos focused on key facts about naloxone and the benefits of its use could be part of a strategy for rapid expansion of OORT programs to mitigate opioid overdose fatalities.
Collapse
Affiliation(s)
- Mika V Galiher
- Meharry Medical College, 1005 Dr. D.B. Todd Jr. Blvd., Nashville, TN, 37208-3599, USA.
| | - Miranda Huffman
- Department of Family and Community Medicine, Meharry Medical College, 1005 Dr. D.B. Todd Jr. Blvd., Nashville, TN, 37208-3599, USA
| |
Collapse
|
6
|
Brandt L, Yanagida T, Campbell ANC, Jones JD, Schultes MT, Martinez S, Comer SD. Multi-informant Implementation and Intervention Outcomes of Opioid Overdose Education and Naloxone Distribution in New York City. GLOBAL IMPLEMENTATION RESEARCH AND APPLICATIONS 2021; 1:209-222. [PMID: 34622215 PMCID: PMC8450721 DOI: 10.1007/s43477-021-00021-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 07/23/2021] [Indexed: 11/28/2022]
Abstract
Overdose Education and Naloxone Distribution (OEND) is an effective public health intervention to reduce opioid overdose fatalities (McDonald and Strang, Addiction 111:1177-1187, 2016). However, we know little about OEND implementation outcomes (i.e., indicators of implementation success), specifically the fidelity of training delivery, and how these may relate to intervention outcomes (i.e., indicators of the success or effectiveness of an intervention), such as overdose knowledge and attitudes. This study evaluated 16 OEND trainings conducted at different Opioid Overdose Prevention Programs in New York City. Trainees (N = 75) completed the Opioid Overdose Knowledge and Attitude Scales before and after training (intervention outcomes). Implementation outcomes were fidelity (competence and adherence of the trainer, N = 10; modified Fidelity Checklist) and acceptability of OEND (Acceptability of Intervention Measure), assessed from multiple perspectives (trainees, trainers, and an independent observer). Trainees' overdose knowledge, t(71) = - 8.12, p < 0.001, 95% CI [- 6.54, - 3.96], and attitudes, t(65) = - 6.85, p < 0.001, 95% CI [- 0.59, - 0.33], improved significantly from pre- to post-training. Stepwise multiple regression models indicated that adherence of the trainer rated from the observer perspective added significantly to the prediction of changes in overdose knowledge, F(1, 67) = 9.81, p = 0.003, and explained 13% of the variance in outcome. However, fidelity measures from the perspective of trainees or trainers and acceptability of OEND were not associated with changes in trainees' overdose knowledge or attitudes. OEND implementation outcomes and their relationship with intervention outcomes differed depending on the role of the fidelity rater in relation to the intervention. Specifically, our findings indicate that fidelity should be measured from an independent perspective (i.e., an individual who is experienced with fidelity rating but not directly involved in the intervention). SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s43477-021-00021-4.
Collapse
Affiliation(s)
- Laura Brandt
- Division on Substance Use Disorders, Department of Psychiatry & New York State Psychiatric Institute, Columbia University Irving Medical Center, 1051 Riverside Drive, Unit #120, New York, NY 10032 USA
| | - Takuya Yanagida
- Department of Developmental and Educational Psychology, University of Vienna, Universitaetsstrasse 7 (NIG), 1010 Vienna, Austria
| | - Aimee N. C. Campbell
- Division on Substance Use Disorders, Department of Psychiatry & New York State Psychiatric Institute, Columbia University Irving Medical Center, 1051 Riverside Drive, Unit #120, New York, NY 10032 USA
| | - Jermaine D. Jones
- Division on Substance Use Disorders, Department of Psychiatry & New York State Psychiatric Institute, Columbia University Irving Medical Center, 1051 Riverside Drive, Unit #120, New York, NY 10032 USA
| | - Marie-Therese Schultes
- Department of Developmental and Educational Psychology, University of Vienna, Universitaetsstrasse 7 (NIG), 1010 Vienna, Austria
- Institute for Implementation Science in Healthcare, University of Zurich, Universitaetstrasse 84, 8006 Zurich, Switzerland
| | - Suky Martinez
- Division on Substance Use Disorders, Department of Psychiatry & New York State Psychiatric Institute, Columbia University Irving Medical Center, 1051 Riverside Drive, Unit #120, New York, NY 10032 USA
| | - Sandra D. Comer
- Division on Substance Use Disorders, Department of Psychiatry & New York State Psychiatric Institute, Columbia University Irving Medical Center, 1051 Riverside Drive, Unit #120, New York, NY 10032 USA
| |
Collapse
|