PAC 799B Module 5 Chapter 4: Results Example

Chapter 4: Results of the Pine Hollow Naloxone Evaluation

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Psychology and Addiction Studies Program, Aspen University

PAC 799B: Addiction Studies Capstone

Instructor Name

Month Day, Year

Chapter 4: Results of the Pine Hollow Naloxone Evaluation

Introduction

This chapter reports what the evaluation of the kit offer at Pine Hollow, the capstone's imaginary Georgia jail, found. Findings follow the sequence of the four questions. Interpretation is reserved for Chapter 5.

Data Analyzed

After cleaning, the quantitative analysis included 619 eligible releases: 412 during the twelve opt-in months and 207 during the six opt-out months. The qualitative analysis included fourteen transcripts: ten from people released within the previous three months, six under opt-in and four under opt-out, and four from the two jail nurses, each interviewed before and after the switch. Of the six people interviewed who were released under opt-in, four had declined a kit; of the four released under opt-out, one had removed it at the desk.

RQ1: Uptake Under the Opt-In Offer

Across the opt-in year, 157 of 412 eligible people released left with a kit, or 38.1 percent (95% CI 33.4 to 42.9).

The largest differences were by time and type of release. Uptake at night was 23 percentage points lower than by day. Uptake among people released from court was 18 points lower than among people completing a sentence.

RQ2: Reasons for Accepting or Declining

Ten released people and both nurses were interviewed; the nurses were interviewed twice. Analysis along the lines laid out by Braun and Clarke (2006) produced four themes, each supported by at least five participants.

Not in front of them, from eight participants. People described the release desk as a public place where taking a kit felt like owning up to drug use with officers watching. One said, "You take that thing, they look at you like, I knew it." Some feared a record: "I didn't want it written down anywhere that I took it." Two who removed the kit under opt-out said they worried about being stopped by police with it.

Out the door, from seven participants. Releases at night and from court were described as rushed, with the offer barely registering. A nurse said, "At three in the morning it's me, one officer and someone who wants to be gone." A released person said, "I don't even remember her saying anything. I just wanted my stuff."

For my family, from six participants. People who took kits often described them as protection for family members rather than themselves. "My brother uses. I took it for him." The framing made accepting easier: "It's not about me, it's for whoever."

It was already there, from six participants, all four released under opt-out and both nurses. People described not having to decide. "It was just in the bag. I didn't think about it." A nurse said, "Now I'm not selling anything. I'm just telling them it's there."

Themes by Group

The themes were not spread evenly. "Not in front of them" came mostly from people who had declined a kit and from the two who removed it under opt-out. "Out the door" came from people released at night or from court and from both nurses. "For my family" came almost entirely from people who took a kit. "It was already there" came only from people released under opt-out and from the nurses after the switch.

RQ3: Uptake After the Switch to Opt-Out

During the six opt-out months, 168 of 207 eligible people left with a kit, or 81.2 percent (95% CI 75.3 to 86.0). Monthly uptake ranged from 80.0 to 82.5 percent. Under opt-out, uptake was 78.6 percent at night (66 of 84) and 82.9 percent by day (102 of 123), a gap of about four points.

A segmented regression of the type described by Lopez Bernal et al. (2017) was fitted to the eighteen monthly values.

Restricted to releases whose kit was packed, the estimated change in level was +45.1 points (39.6 to 50.6). Excluding the two baseline records coded as declined made no material difference.

RQ4: Integration

Fetters et al. (2013) describe joint displays as a way to set results from both strands side by side. The display below links each quantitative pattern to the interview material that bears on it.

What Happened to the Kits

Although the project did not set out to measure kit use, five interviewees had left with a kit and described what happened to it. One had used it to revive a friend who stopped breathing two weeks after release; the friend survived. Two had given their kits to family members who use opioids. One had lost the kit, and one still carried it. These accounts are reported for completeness and are not a measure of how often kits are used.

Monthly Uptake Under Opt-Out

Summary

Under the opt-in offer, fewer than two in five eligible people left with a kit, with the lowest uptake at night and among court releases. Four themes came out of the interviews. After the switch to opt-out, uptake rose to about four in five, an estimated jump of about 43 points that persisted across six months, and the night gap largely closed. About one in five still declined, for reasons the interviews describe. Chapter 5 interprets these results.

References

Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77-101. https://doi.org/10.1191/1478088706qp063oa

Fetters, M. D., Curry, L. A., & Creswell, J. W. (2013). Achieving integration in mixed methods designs: Principles and practices. Health Services Research, 48(6, Pt. 2), 2134-2156. https://doi.org/10.1111/1475-6773.12117

Lopez Bernal, J., Cummins, S., & Gasparrini, A. (2017). Interrupted time series regression for the evaluation of public health interventions: A tutorial. International Journal of Epidemiology, 46(1), 348-355. https://doi.org/10.1093/ije/dyw098