A Cluster-Randomised Stepped-Wedge Impact Evaluation of a Pragmatic Implementation Process for Improving the Cultural Responsiveness of Non-Aboriginal Alcohol and Other Drug Treatment Services: A Pilot Study

Sara Farnbach; Alexandra Henderson; Julaine Allan; Raechel Wallace; Anthony Shakeshaft

doi:10.3390/ijerph20054223

A Cluster-Randomised Stepped-Wedge Impact Evaluation of a Pragmatic Implementation Process for Improving the Cultural Responsiveness of Non-Aboriginal Alcohol and Other Drug Treatment Services: A Pilot Study

Int J Environ Res Public Health. 2023 Feb 27;20(5):4223. doi: 10.3390/ijerph20054223.

Authors

Sara Farnbach¹, Alexandra Henderson¹, Julaine Allan², Raechel Wallace^{1

3}, Anthony Shakeshaft^{1

4}

Affiliations

¹ National Drug and Alcohol Research Centre (NDARC), UNSW Sydney, Sydney, NSW 2052, Australia.
² Rural Health Research Institute, Charles Sturt University, Orange, NSW 2800, Australia.
³ Network of Alcohol and Drug Agencies, Woolloomooloo, NSW 2011, Australia.
⁴ Poche Centre for Urban Indigenous Health, University of Queensland, Brisbane, QLD 4072, Australia.

Abstract

There is limited evidence regarding implementing organisational improvements in the cultural responsiveness of non-Aboriginal services. Using a pragmatic implementation process to promote organisational change around cultural responsiveness, we aimed to (i) identify its impact on the cultural responsiveness of participating services; (ii) identify areas with the most improvement; and (iii) present a program logic to guide cultural responsiveness. A best-evidence guideline for culturally responsive service delivery in non-Aboriginal Alcohol and other Drug (AoD) treatment services was co-designed. Services were grouped geographically and randomised to start dates using a stepped wedge design, then baseline audits were completed (operationalization of the guideline). After receiving feedback, the services attended guideline implementation workshops and selected three key action areas; they then completed follow-up audits. A two-sample Wilcoxon rank-sum (Mann-Whitney) test was used to analyse differences between baseline and follow-up audits on three key action areas and all other action areas. Improvements occurred across guideline themes, with significant increases between median baseline and follow-up audit scores on three key action areas (median increase = 2.0; Interquartile Range (IQR) = 1.0-3.0) and all other action areas (median increase = 7.5; IQR = 5.0-11.0). All services completing the implementation process had increased audit scores, reflecting improved cultural responsiveness. The implementation process appeared to be feasible for improving culturally responsive practice in AoD services and may be applicable elsewhere.

Keywords: Aboriginal and Torres Strait Islander; alcohol and other drugs; audit; co-design; cultural responsiveness; implementation; service delivery.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Alcoholism* / therapy
Australia
Cultural Competency*
Health Services, Indigenous
Humans
Pilot Projects
Substance-Related Disorders* / therapy

Grants and funding

The Alcohol and Other Drugs Treatment Guidelines for Working with Aboriginal and Torres Strait Islander people in a non-Aboriginal setting project was initiated and funded by a coalition of six PHNs in NSW, Australia. The project arose from the intention by the six PHNs to enhance and standardise culturally responsive practices at non-government AoD Treatment Services. The PHNs identified and contacted potential services within their jurisdictions regarding participation and provided contact details of the services to the project team. Funding was provided to National Drug and Alcohol Research Centre (NDARC) to conduct the project evaluation. The PHNs had no role in the evaluation design, implementation, data collection, analysis, interpretation of the data, or in the writing of this manuscript.