Barriers for Implementing the Hub and Spoke Model to Expand Medication for Opioid Use Disorder: A Case Study of Montana

Purpose: Access to medication for opioid use disorder (MOUD) varies across the rural-urban continuum. The Hub & Spoke Model (H&S) emerged to address these gaps in service whereby hubs with staff expertise in MOUD support delivery of specialized care to a network of spoke locations, often located in rural communities with workforce shortages. This paper presents a case study of efforts to implement the hub and spoke model in a frontier and rural (FAR) state: Montana. Methods: The primary data are structured interviews with 65 MOUD program staff in hub and spoke locations within Montana. Both inductive and deductive coding were used to analyze the transcripts. Findings: Using the H&S structure to expand access to MOUD in Montana led to mixed results. There were consistent themes identified in the interviews about the reasons why hubs struggled to successfully recruit spokes, including (1) geographic barriers, (2) a lack of interest among medical providers, (3) fears about excessive demand, (4) concerns about the financial viability of the model, and (5) a preference for informal technical assistance rather than a formal H&S relationship. In addition to these 5 themes, efforts to implement H&S across different medical systems were unsuccessful, whereas the H&S model worked more effectively when H&S locations were within the same organization. Conclusion: This case study identified limits to the H&S model utility in supporting states’ abilities to expand access to MOUD treatment and offers suggestions for adapting it to accommodate variation across divergent rural contexts. We conclude with recommendations for strategies that may assist in expansion of MOUD in rural communities that are like those found in Montana.

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Taste and chemical composition as drives for utilitarian redundancy and equivalence: a case study in local medical systems in Northeastern Brazil

10.21203/rs.3.rs-900485/v1 ◽

2021 ◽

Author(s):

RAFAEL CORRÊA PROTA DOS SANTOS REINALDO ◽

Flávia Rosa Santoro ◽

ULYSSES PAULINO ALBUQUERQUE ◽

PATRÍCIA MUNIZ MEDEIROS

Keyword(s):

Chemical Composition ◽

Rural Communities ◽

Northeastern Brazil ◽

Medical Systems ◽

Structured Interviews ◽

Organoleptic Characteristics ◽

Therapeutic Function ◽

Equivalence Model ◽

Selection Of

Abstract Background We aimed to verify whether the taste and chemical composition influence the selection of plants in each medicinal category, whether within a socio-ecological system or between different socio-ecological systems. To this end, we use the theoretical bases of the Utilitarian Redundancy Model and the Utilitarian Equivalence Model. We studied the local medical systems of four rural communities in northeastern Brazil, used as models to test our assumptions. Methods The data on medicinal plants and local therapeutic function were obtained from semi-structured interviews associated with the free-listing method, allowing to generate indexes of similarity of therapeutic use between the plants cited in each region. During the interviews, each informer was also asked to report the tastes of the plants cited. Subsequently, we classified each plant in each region according to the most cited taste. The data about the chemical composition of each plant were obtained from a systematic review, using Web of Knowledge and Scopus databases. Results Pairs of plants with similar tastes are 1.46 times more likely to have the same therapeutic function within a local medical system (redundancy), but not between medical systems (equivalence). We also find that chemical compounds are not primarily responsible for utilitarian redundancy and equivalence. However, there was a tendency for alkaloids to be doubly present with greater expressiveness in pairs of equivalent plants. Conclusions The results indicate that each social group can create its means of using the organoleptic characteristics as clues to select new species as medicinal. Furthermore, this study corroborates the main prediction of the Utilitarian Equivalence Model, that people in different environments choose plants with traits in common for the same functions.

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Syringe service program-based telemedicine linkage to opioid use disorder treatment: protocol for the STAMINA randomized control trial

BMC Public Health ◽

10.1186/s12889-021-10669-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Dennis P. Watson ◽

James A. Swartz ◽

Lisa Robison-Taylor ◽

Mary Ellen Mackesy-Amiti ◽

Kim Erwin ◽

...

Keyword(s):

Study Protocol ◽

Randomized Control Trial ◽

Treatment Protocol ◽

Opioid Use Disorder ◽

Additional Treatment ◽

Initial Assessment ◽

Opioid Use ◽

Structured Interviews ◽

Randomized Control ◽

Opioid Users

Abstract Background A key strategy for mitigating the current opioid epidemic is expanded access to medications for treating opioid use disorder (MOUD). However, interventions developed to expand MOUD access have limited ability to engage opioid users at higher levels of overdose risk, such as those who inject opioids. This paper describes the study protocol for testing STAMINA (Syringe Service Telemedicine Access for Medication-assisted Intervention through NAvigation), an intervention that engages high-risk opioid users at community-based syringe service programs (SSP) and quickly links them to MOUD using a telemedicine platform. Methods This randomized control trial will be conducted at three SSP sites in Chicago. All participants will complete an initial assessment with a provider from a Federally Qualified Health Center who can prescribe or refer MOUD services as appropriate. The control arm will receive standard referral to treatment and the intervention arm will receive immediate telemedicine linkage to the provider and (depending on the type of MOUD prescribed) provided transportation to pick up their induction prescription (for buprenorphine or naltrexone) or attend their intake appointment (for methadone). We aim to recruit a total of 273 participants over two years to provide enough power to detect a difference in our primary outcome of MOUD treatment linkage. Secondary outcomes include treatment engagement, treatment retention, and non-MOUD opioid use. Data will be collected using structured interviews and saliva drug tests delivered at baseline, three months, and six months. Fixed and mixed effects generalized linear regression analyses and survival analysis will be conducted to compare the probabilities of a successful treatment linkage between the two arms, days retained in treatment, and post-baseline opioid and other drug use. Discussion If successful, STAMINA’s telemedicine approach will significantly reduce the amount of time between SSP clients’ initial indication of interest in the medication and treatment initiation. Facilitating this process will likely lead to stronger additional treatment- and recovery-oriented outcomes. This study is also timely given the need for more rigorous testing of telemedicine interventions in light of temporary regulatory changes that have occurred during the COVID-19 pandemic. Trial registration ClinicalTrials.gov (Clinical Trials ID: NCT04575324 and Protocol Number: 1138–0420). Registered 29 September 2020. The study protocol is also registered on the Open Science Framework (DOI 10.17605/OSF.IO/4853 M).

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Framing the role of higher education in sustainable development: a case study analysis

International Journal of Sustainability in Higher Education ◽

10.1108/ijshe-05-2020-0164 ◽

2021 ◽

Vol ahead-of-print (ahead-of-print) ◽

Author(s):

Suzanna Elmassah ◽

Marwa Biltagy ◽

Doaa Gamal

Keyword(s):

Higher Education ◽

Sustainable Development ◽

Educational Leaders ◽

Primary Data ◽

Study Analysis ◽

Structured Interviews ◽

Content Type ◽

Case Study Analysis

Purpose Higher education institutions (HEIs) should play a fundamental role in achieving the international 2030 sustainable development (SD) agenda. Quality education is the fourth of the sustainable development goals (SDGs), and one of the targets related to this is to ensure that by 2030 all learners acquire the knowledge and skills needed to promote SD. Therefore, the SDGs provide a motive for HEIs to integrate SD concepts into their day-to-day practices. This study aims to introduce a framework for HEIs’ sustainable development assessment. Such a framework guides HEIs and educational leaders to support their countries’ commitments to achieving the SDGs. Design/methodology/approach This paper presents the results of a case study analysis of the role and successful techniques of HEIs in achieving SD in three countries, namely, Germany, Japan and Egypt. Primary data was collected by semi-structured interviews with three Cairo University officials, while secondary data was collected by reviewing the universities' official websites, reports, publications and related papers. This study introduces a novel framework for HEIs' SD analysis and assessment, which guides HEIs and educational leaders to support SD to fulfill their countries' commitments to achieving the SDGs. This framework is based on the following five categories: strategic direction and institutional working practices, supporting students, supporting university staff competencies, supporting society's stakeholders and networking and sustainable campus. Consideration is given to the potential role of HEIs to support SD in each of these areas. Findings Cairo University could learn from the novel and pioneer practices of the Leuphana University of Lüneburg, and the University of Tokyo to fill in the gaps it has in different roles. It can also put more effort into adopting the suggested higher education programs of Egypt's Vision 2030. Research limitations/implications This paper is limited to a case analysis comparing three countries, Germany, Japan and Egypt. Second, this study has not considered school education, which is equally essential in countries' SD. Practical implications HEIs can use the framework and the findings in this paper to evaluate their current roles in supporting SD, identify the gaps and take actions accordingly to address their weaknesses. Originality/value The paper compares three universities, one in each of the case study countries. It draws conclusions that identify ways in which the paper's framework and findings can guide SD practice in HEIs internationally, especially those in the developing world.

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Ketahanmalangan Pengelola PKBM Dalam Mengembangkan Inovasi Pendidikan Nonformal

Aksara: Jurnal Ilmu Pendidikan Nonformal ◽

10.37905/aksara.7.3.987-998.2021 ◽

2021 ◽

Vol 7 (3) ◽

pp. 987

Author(s):

Devi Merina Tuz Sa’diyah ◽

Ahmad Ahmad ◽

Nilna Sa’adayah

Keyword(s):

Teaching And Learning ◽

Formal Education ◽

Secondary Data ◽

Learning Activities ◽

Primary Data ◽

Learning Activity ◽

Structured Interviews ◽

Matrix Methods ◽

Main Partner

The focus of this research is to describe the strategy of adversity quotient for the management of the Community Learning Activity Center (PKBM) to develop innovations in turning barriers into opportunities for non-formal education programs. Qualitative research with this type of case study was carried out at PKBM Mentari, using structured interviews as the primary data collection method, in order to obtain primary data and document matrix methods to obtain secondary data. the data were analyzed using interactive techniques belonging to Miles and Huberman with the stages of data reduction, data presentation and conclusion drawing. The results of this study are the adversity quotient strategy that generally implemented by PKBM is very good, this can be seen from the indicators including: 1) Organizing learning activities flexibly in terms of time, so that it does not interfere with the daily activities of the community; 2) Provide learning at affordable costs so as not to burden the community in participating in learning; 3) Making the community the main partner in the continuation of teaching and learning activities at PKBM and 4) Building synergies with local village officials. The relatively short research time is the main limitation in compiling this study, so that it only maximizes the statements of the main informants.

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Millennial and gen Z perspective towards eco-office campaign implementation in public sector

IOP Conference Series Earth and Environmental Science ◽

10.1088/1755-1315/905/1/012122 ◽

2021 ◽

Vol 905 (1) ◽

pp. 012122

Author(s):

H P Pramana ◽

S Hastjarjo ◽

Sudarmo

Keyword(s):

Change Agents ◽

Secondary Data ◽

Primary Data ◽

Structured Interviews ◽

Fully Integrated ◽

Study Results ◽

Self Actualization ◽

New Policies ◽

Electronic Media Use

Abstract This study explains millennial and Gen-Z attitudes, perspectives, and behaviors in implementing the eco-office concept. As a qualitative method study, the study uses primary data through semi-structured interviews and secondary data collected from reports, public/private publications, and census results, using the Yin case study model as data analysis. The study results reveal that the biggest challenge in implementing new policies is self-thinking. Leaders, as change agents, play an essential role in penetrating messages that make them act pro-environment. The reward system will be very effective, especially providing satisfaction for self-actualization. The findings of this study have implications for policymakers as input. For example, the results show that social media plays a crucial role in increasing environmental awareness. In addition, simple shifts such as electronic media use at work will cut the file chain, making it more effective and favored by young people. They understand the consequences of their actions on the environment and have the education, motivation, and social awareness to participate in the green movement. However, beliefs and actions are not fully integrated, and investigating and understanding their behavior and unique needs in the workplace will lead employees to integrate and succeed together to support the environment.

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An Examination of Rural Homestay Operations through the Lens of the Sustainable Livelihood Framework: A Case Study of Phou Khao Khouay National Park Community-Based Tourism (PKK NP CBT), Lao PDR

10.26686/wgtn.17136143.v1 ◽

2021 ◽

Author(s):

◽

Khamsavay Pasanchay

Keyword(s):

Qualitative Methodology ◽

Local Community ◽

Culture Shock ◽

Primary Data ◽

Sustainable Livelihood ◽

Structured Interviews ◽

Community Based ◽

Sustainable Livelihood Framework ◽

The Government

In many developing countries, Community-Based Tourism (CBT) is regarded as a sustainable tourism development tool as well as a catalyst for rural community development through the involvement of local people and the improvement of the standard of living. To extend the involvement of the local community in CBT, homestay tourism is a form of operation unit and its concept aims to facilitate individual household social-cultural and economic benefit from CBT directly. Although homestays are widely regarded as providing better livelihoods directly to the homestay operators, it is not clear to what extent homestay operations actually contribute to the sustainable livelihood of homestay operators when considering the wider livelihood implications. This research seeks to explore this gap by analysing homestay operators through the lens of Sustainable Livelihood theory (Scoones, 1998). This research adopts a post-positivist paradigm with qualitative methodology. Taking a case study approach, semi-structured interviews and observations were employed to collect primary data from community leaders, heads and deputy heads of the tourist guides, and homestay operators themselves. Results of the study found that although homestay tourism was initially established by the government. The study also found the main characteristics of the homestay operation are in a small size with a limitation of bedrooms, and a few family members involved in hosting tourists, which are husband, wife, and an adult child. All of these people are unpaid labour but receive benefits from the sharing of food and shelter. The study also uncovered that cash-based income, gender empowerment enhancement, and environmental enhancement were the positive impacts of homestay tourism on the livelihoods of the homestay operators, and these positive livelihood outcomes were in line with the original sustainable livelihood framework. In addition, cultural revitalisation was found as an emerged indicator of the sustainable livelihood outcomes, which was used to extend the revised framework. However, the study discovered that opportunity costs, culture shock, and conflict with villagers were negative implications affecting sustainable livelihood outcomes of the homestay operators. The revised Sustainable Livelihood Framework (SLF) suggests that if these negative implications are mitigated, the overall livelihood outcomes will be even greater. The results of this study are expected to provide a deeper understanding of how the impacts of homestay tourism on the sustainable livelihood of the homestay operators.

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Egyptian Electronic Government

Managing Customer Trust, Satisfaction, and Loyalty through Information Communication Technologies ◽

10.4018/978-1-4666-3631-6.ch019 ◽

2013 ◽

pp. 328-341

Author(s):

H. S. Hassan ◽

A. A. M. Abdelkader

Keyword(s):

Organisational Culture ◽

Electronic Government ◽

Primary Data ◽

Service Development ◽

Structured Interviews ◽

Government Program ◽

Main Driver ◽

Administrative Development ◽

Service Projects

Many developing countries’ governments have invested heavily in increasing the number of e-government projects. However, there is a lack of clear case material, which describes the potentialities and consequence experienced by governments trying to manage with this change. The Ministry of State for Administrative Development (MSAD) is the organization responsible for the e-Government program in Egypt since early 2004. This paper presents the findings of the CRM case study, one of the e-service projects led by MSAD. Semi-structured interviews have been used as primary data collection techniques. The findings of the study reveal that the main driver to the success of the project is changing the organisational culture and thinking. It is noticed there is an influence of the project on citizens’ encouragement for public participation as it was able to increase their satisfaction levels. Also, the findings emphasised the problems that face the overall e-government program in Egypt. They also explain the relationships among those identified problems of governmental e-service development.

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Sustainable Entrepreneurship, Family Farms and the Dairy Industry

10.4018/978-1-6684-3550-2.ch041 ◽

2022 ◽

pp. 898-916

Author(s):

Vanessa Ratten ◽

Leo-Paul Dana

Keyword(s):

Rural Communities ◽

Rural Areas ◽

Family Farms ◽

Structured Interviews ◽

Regional Competitiveness ◽

Agricultural Industry ◽

Study Approach ◽

International Standing ◽

Entrepreneurial Strategies

There has been increasing recognition that for regional competitiveness in rural areas there needs to be a focus on sustainable farming initiatives especially for family farms that are competing with global conglomerates. Family farms, whilst declining in number, are the purpose of this paper studying the rural entrepreneurship in family farms as they are at the heart of rural communities and the overall agricultural industry and comprise a high percentage of total farms. This paper takes a case study approach using in-depth semi structured interviews to delve into the types of entrepreneurial strategies that are distinctive of family farms in terms of their sustainability approach to farming. Dairy farms in the West Victorian area of Australia are studied and the findings suggest that family farms can increase their regional competitiveness and international standing by focusing on their collaborative, social and sustainable entrepreneurial strategies.

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