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

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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

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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 and Anthony Shakeshaft

International Journal of Environmental Research and Public Health, Vol.20(5), pp.1-15

2023

DOI: https://doi.org/10.3390/ijerph20054223

PMID: 36901233

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Abstract

Aboriginal and Torres Strait Islander

alcohol and other drugs

audit

co-design

cultural responsiveness

implementation

service delivery

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.

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Title: 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
Authors: Sara Farnbach (Corresponding Author) - UNSW Sydney
Alexandra Henderson - UNSW Sydney
Julaine Allan - Charles Sturt University
Raechel Wallace - Alcohol and Drug Foundation
Anthony Shakeshaft - The University of Queensland
Publication details: International Journal of Environmental Research and Public Health, Vol.20(5), pp.1-15
Publisher: MDPI AG
Date published: 2023
DOI: 10.3390/ijerph20054223
ISSN: 1660-4601
PMID: 36901233
Copyright note: Copyright: © 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/)
Data Availability: The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. The data are not publicly available due to potential for re-identification of participating services.
Grant note: National Drug and Alcohol Research Centre (http://data.elsevier.com/vocabulary/SciValFunders/501100007281)
Organisation Unit: School of Health - Psychology
Language: English
Record Identifier: 991241467702621
Output Type: Journal article

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