Access to substance abuse treatment in the Cape Town metropole ...

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2.1. POPULATION CHARACTERISTICS INFLUENCING HEALTHSERVICES UTILIZATIONThe BHSU suggests that health service utilization is partly a function of theseparate and combined influence of three categories of populationcharacteristics: predisposing factors, factors which enable/restrict health serviceuse, and need for care variables (Andersen, 1995; Andersen & Davidson, 1997).2.1.1. Predisposing characteristicsThis model defines predisposing characteristics as variables that exist within theindividual prior to the onset of a particular health need and that predispose theindividual to take a particular course of action (Andersen, 1995; Andersen &Newman, 1973). These variables reflect the propensity of an individual to useservices and seem to be associated with help-seeking in the presence of needvia their influence on enabling factors (Andersen, 1995). The following areincluded in the predisposing variable domain: demographic, social structure, andattitudinal-belief variables. This study also includes social-cognitive variables.2.1.1.1. Demographic and social structural factorsDemographic variables (such as age and gender) represent biologicalcharacteristics that may be associated with the probability of a person usinghealth services (Andersen, 1968; Andersen, 1995). Although demographicvariables are generally immutable and not easily influenced by policy changes,these variables can reflect opportunities for intervention (Booth et al., 2001).Social structural characteristics reflect the location (status) of the individual insociety, as measured by ethnicity/race; socio-economic status; education; andsocial environment, including neighbourhood disadvantage, state of physicalenvironment and community resources (Andersen, 1968; Andersen & Newman,1973; Thind & Andersen, 2003). These weakly mutable characteristics mayimpact on ability to access treatment via their influence on (i) status within acommunity and (ii) enabling/restricting factors such as ability to cope with15
presenting problems and ability to gather resources to address problems(Andersen, 1995; Andersen & Davidson, 1996; Thind & Andersen, 2003).2.1.1.2. Attitudinal-belief variablesAttitudinal-belief variables refer to the attitudes and beliefs that people haveabout specific health problems and health services. Beliefs about the efficacy ofhealth care and attitudes towards service providers may influence (i) perceptionsof need and (ii) whether individuals seek care (Andersen, 1995; Booth et al.,2001; Thind & Andersen, 2003, Wallace et al., 2004). Attitudinal-belief variablesmay help account for how social structural factors influence enabling factors anduse of services (Andersen, 1995). The present study includes measures ofhealth beliefs that are specific to the substance abuse treatment context, namelybeliefs about treatment and community views about access to treatment.2.1.1.3. Psychological predisposing variablesStudies using the BHSU as an organizing framework have generally excludedpsychological characteristics from their understandings of predisposing factors(Andersen, 1995; Bradley et al., 2002) – despite the fact that other theories ofhelp-seeking have shown that psychosocial factors play an important role indecision-making processes (Bradley et al., 2002). To address this limitation, thepresent study expanded the set of predisposing factors to include social-cognitivefactors; specifically self-efficacy to change substance use which is associatedwith help-seeking in the substance abuse treatment literature (Broyles, Narine, &Robertson, 2004).2.1.2. The enabling variable domainThe BHSU defines enabling factors as resources that facilitate (or restrict) theindividual’s use of substance abuse treatment services when services arerequired (Andersen, 1995). These factors represent the actual ability of anindividual to obtain health services (Andersen, 1995; Booth et al., 2001; Wallaceet al., 2004) and are mutable by interventions (Andersen, 1995). The modelassumes that as enabling resources increase, the likelihood of accessing care16
Page 1 and 2: Access to substance abuse treatment
Page 3 and 4: CONTENTSINTRODUCTION ..............
Page 5 and 6: 5.4. SUMMARY.......................
Page 7 and 8: al., 2004; Reddy et al., 2003; Shis
Page 9 and 10: 1.3. IS ACCESS TO SUBSTANCE ABUSE T
Page 11 and 12: 1.4.2. Racial disparities in the ne
Page 13 and 14: illegally and are unregulated by th
Page 15: CONCEPTUAL MODELThis study’s conc
Page 19 and 20: need for services is the most immed
Page 21 and 22: This study focuses specifically on
Page 23 and 24: METHOD3.1. STUDY AIMS & OBJECTIVESA
Page 25 and 26: the researcher to explore possible
Page 27 and 28: esidential areas from each of the s
Page 29 and 30: 3.3.2.4. Data collection: controlsF
Page 31 and 32: o Problem recognition, Desire for h
Page 33 and 34: Table 1.Domains and measures compri
Page 35 and 36: The 19-item MOS-SSS measures functi
Page 37 and 38: information on the accessibility of
Page 39 and 40: RESULTS: PHASE ONE4.1. VARIABLES AS
Page 41 and 42: efficacy to stop using drugs for mo
Page 43 and 44: (Table 6). Effect sizes were large
Page 45 and 46: were 2.4 times more likely to not a
Page 47 and 48: esteem scales (Table 9). Stigma als
Page 49 and 50: Table 10.Logistic regression coeffi
Page 51 and 52: 4.2.2. Model 2: Predisposing variab
Page 53 and 54: poverty scale, and the variable “
Page 55 and 56: of the model increased significantl
Page 57 and 58: controls had greater self-efficacy
Page 59 and 60: and R1000 per month than their fema
Page 61 and 62: subjects earning less than R500 per
Page 63 and 64: and race (Table 16). This indicates
Page 65 and 66: were 3 times more likely to earn le
Page 67 and 68:
(which are higher for Black/African
Page 69 and 70:
substance use or remain abstinent d
Page 71 and 72:
monetary needs rise, subjects repor
Page 73 and 74:
with improved awareness of services
Page 75 and 76:
4.4.4.4. Predictors of “community
Page 77 and 78:
• In historically disadvantaged c
Page 79 and 80:
RESULTS: PHASE TWODuring qualitativ
Page 81 and 82:
5.1.1.3. Government’s responses t
Page 83 and 84:
“Part of the government's agenda
Page 85 and 86:
putting extra strain and pressure o
Page 87 and 88:
The impact of availability and affo
Page 89 and 90:
availability of affordable services
Page 91 and 92:
completed a hospital-based detoxifi
Page 93 and 94:
“I have thirty beds that are unus
Page 95 and 96:
“I don't see it amongst the bona
Page 97 and 98:
going to be a good day. So, yes it
Page 99 and 100:
in the fourth week they relapse, it
Page 101 and 102:
esponses to treatment, in part, are
Page 103 and 104:
• Awareness of appropriate treatm
Page 105 and 106:
This perception is prevalent in Col
Page 107 and 108:
substance abuse problem - without a
Page 109 and 110:
o These community influences are lo
Page 111 and 112:
6.2.1. Awareness of substance abuse
Page 113 and 114:
informational support can improve a
Page 115 and 116:
salient for low-income groups who h
Page 117 and 118:
diminishing self-efficacy and motiv
Page 119 and 120:
self-efficacy and negative percepti
Page 121 and 122:
6.3. TREATMENT SYSTEM FACTORS ASSOC
Page 123 and 124:
This study found that limited resou
Page 125 and 126:
6.4. RECOMMENDATIONSBased on study
Page 127 and 128:
• As findings suggest that female
Page 129 and 130:
• While the affordability of trea
Page 131 and 132:
To address these barriers, we argue
Page 133 and 134:
o To ensure objectivity, this needs
Page 135 and 136:
egistration process should gather i
Page 137 and 138:
REFERENCESAday, L.A., & Awe, W.C. (
Page 139 and 140:
First, MB; Spitzer, RL; Gibbon, M;
Page 141 and 142:
Myers, B., & Parry, C.D.H. (2005).
Page 143 and 144:
Ross, M.W., Williams, M.L., Timpson
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