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Abstract
Abstract. Aims: The study examined how substance use treatment professionals managed problems and tensions in their work, and explored if the strategies varied by organisational features related to New Public Management (NPM). Methods: A total of 69 semi-structured interviews (2017–2018) with treatment staff in nine sampled local/regional areas formed the basis for constructing a web survey administered to staff across Sweden in 2019 (n=606). The means showed how often the different strategies were used. Regression analyses examined organisational differences, and central strategies were illustrated by the interview study. Results: Treatment professionals in general reported satisfactory freedom in their work. Staff in more NPM-like organisations were less likely to report autonomy and more inclined to report conflicting demands. When conflicts emerged, the staff used both passive strategies indicating adaptation or resignation, and active strategies including boundary spanning, protest, and liberty-taking. Some challenging strategies such as looking for other jobs or reporting one thing but doing another were more common in more NPM-like organisations. The opposite was found for customer orientation. Conclusions: While NPM features on customer orientation and steering methods appeared to create fewer problems, more NPM-like organisations appeared to be less favourable overall and should be applied with caution.
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Affiliation(s)
- Jessica Storbjörk
- Department of Public Health Sciences & Centre for Social Research on Alcohol and Drugs (SoRAD), Stockholm University, Sweden
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Guise A, Ndimbii J, Igonya EK, Owiti F, Strathdee SA, Rhodes T. Integrated and differentiated methadone and HIV care for people who use drugs: a qualitative study in Kenya with implications for implementation science. Health Policy Plan 2019; 34:110-119. [PMID: 30789208 PMCID: PMC6481284 DOI: 10.1093/heapol/czz002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2019] [Indexed: 11/13/2022] Open
Abstract
Integrating methadone and HIV care is a priority in many low- and middle-income settings experiencing a growing challenge of HIV epidemics linked to injecting drug use. There is as yet little understanding of how to integrate methadone and HIV care in these settings and how such services can be implemented; such a gap reflects, in part, limitations in theorizing an implementation science of integrated care. In response, we qualitatively explored the delivery of methadone after its introduction in Kenya to understand integration with HIV care. Semi-structured interviews with people using methadone (n = 30) were supplemented by stakeholder interviews (n = 2) and participant observation in one city. Thematic analysis was used, that also drew on Mol's logic of care as an analytical framework. Respondents described methadone clinic-based care embedded in community support systems. Daily observed clinic care was challenging for methadone and stigmatizing for HIV treatment. In response to these challenges, integration evolved and HIV care differentiated to other sites. The resulting care system was acceptable to respondents and allowed for choice over locations and approaches to HIV care. Using Mol's logic of care as an analytical framework, we explore what led to this differentiation in integrated care. We explore co-production and experimentation around HIV care that compares with more limited experimentation for methadone. This experimentation is bounded by available discourses and materials. The study supports continued integration of services whilst allowing for differentiation of these models to adapt to client preferences. Co-location of integrated services must prioritize clinic organization that prevents HIV status disclosure. Our analysis fosters a material perspective for theory of implementation science and integration of services that focuses attention on local experimentation shaped by context.
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Affiliation(s)
- Andy Guise
- Department of Medicine, University of California San Diego, San Diego, 9500 Gilman Drive, La Jolla, CA, USA
- School of Population Health and Environmental Sciences, King’s College London, London, UK
| | - James Ndimbii
- Kenya AIDS NGOs Consortium, Regent Management Suites, Argwings Kodhek Road, Nairobi, Kenya
| | - Emmy Kageha Igonya
- School of Medicine, University of Nairobi, Kenyatta National Hospital, Nairobi, Kenya
| | - Frederick Owiti
- School of Medicine, University of Nairobi, Kenyatta National Hospital, Nairobi, Kenya
| | - Steffanie A Strathdee
- Department of Medicine, University of California San Diego, San Diego, 9500 Gilman Drive, La Jolla, CA, USA
| | - Tim Rhodes
- Centre for Research on Drugs and Health Behaviour, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, UK
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Farrugia A, Fraser S, Dwyer R, Fomiatti R, Neale J, Dietze P, Strang J. Take-home naloxone and the politics of care. SOCIOLOGY OF HEALTH & ILLNESS 2019; 41:427-443. [PMID: 30710415 DOI: 10.1111/1467-9566.12848] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
'Take-home naloxone' refers to a life-saving intervention in which a drug (naloxone) is made available to nonmedically trained people for administration to other people experiencing an opioid overdose. In Australia, it has not been taken up as widely as would be expected, given its life-saving potential. We consider the actions of take-home naloxone, focusing on how care relations shape its uses and effects. Mobilising Science and Technology Studies insights, we suggest that the uses and effects of naloxone are co-produced within social relations and, therefore, this initiative 'affords' multiple outcomes. We argue that these affordances are shaped by a politics of care, and that these politics relate to uptake. We analyse two complementary case studies, drawn from an interview-based project, in which opioid consumers discussed take-home naloxone and its uses. Our analysis maps the ways take-home naloxone can afford (i) a regime of care within an intimate partnership (allowing a terminally ill man to more safely consume opioids) and (ii) a political process of care (in which a consumer takes care of others treated with the medication by administering it 'gently'). We conclude by exploring the political affordances of a politics of care approach for the uptake of take-home naloxone.
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Affiliation(s)
- Adrian Farrugia
- Social Studies of Addiction Concepts Research Program, Faculty of Health Sciences, National Drug Research Institute, Curtin University, Melbourne, Vic, Australia
| | - Suzanne Fraser
- Social Studies of Addiction Concepts Research Program, Faculty of Health Sciences, National Drug Research Institute, Curtin University, Melbourne, Vic, Australia
- Centre for Social Research in Health, Faculty of Arts and Social Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Robyn Dwyer
- Social Studies of Addiction Concepts Research Program, Faculty of Health Sciences, National Drug Research Institute, Curtin University, Melbourne, Vic, Australia
- Centre for Alcohol Policy Research, School of Psychology and Public Health, La Trobe University, Melbourne, Vic, Australia
| | - Renae Fomiatti
- Social Studies of Addiction Concepts Research Program, Faculty of Health Sciences, National Drug Research Institute, Curtin University, Melbourne, Vic, Australia
| | - Joanne Neale
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Paul Dietze
- Behaviours and Health Risks Programs, Burnet Institute, Melbourne, Vic, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia
| | - John Strang
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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