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

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3.3. PHASE 1: CASE-CONTROL STUDY3.3.1. Sample characteristics3.3.1.1. Eligibility criteriaSubjects had to meet the following eligibility criteria: they had to be at least 18years old; self-identify as either Black/African or Coloured; earn less than R1500per month from legal sources; have a lifetime substance dependence diagnosis(either treated or untreated); and provide written, informed consent to participate.3.3.1.2. Sampling methodAs the target population consisted of a hard-to-reach population for which limitedinformation was available, snowball sampling techniques were used to identifysubjects (Babbie & Mouton, 2001). During the data collection period, cases wereidentified at non-profit substance abuse treatment facilities in the Cape Townmetropole, with which the researcher had well-established relationships. Thesecentres were identified as starting points for sampling as compared to the forprofittreatment sector; they are more likely to serve clients from historicallydisadvantaged communities. In addition, community contacts were used toidentify controls in each of the 12 recruitment areas. These cases and controlsserved as starting points for snowball sampling by referring the researcher toother potential subjects. This chain referral process continued until the cases andcontrols adequately represented recruitment areas and the desired sample sizehad been obtained.As race and gender were identified as potential confounders of access totreatment, equal proportions of male and female as well as Black/African andColoured subjects were sampled and frequency matching was used to ensurethat the cases and controls were matched on these dimensions. Race andgender were also controlled for in statistical analyses.3.3.1.3. Recruitment areasTo ensure that controls represented the population of substance abusers fromhistorically disadvantaged communities (HDCs) in the Cape Town metropole, two25
esidential areas from each of the six sub-structures of the Cape Town metropolewere selected as key focus areas for sampling. To be selected, the area had toconsistently appear in SACENDU’s list of top ten residential areas for substanceuse or be identified by key informants as an area with high levels of substanceuse. Selected areas also had to be classified as “Black” or “Coloured” residentialareas under the apartheid regime; have high levels of health and socialproblems; have limited infrastructure to support service delivery; and be lowincomeareas.For this study, recruitment areas included: Atlantis and Dunoon in theBlaauwberg/ Northern sub-structure, Delft and Khayelitsha in the Tygerberg substructure,Eersterivier and Wallacedene in the Oostenberg/Eastern sub-structure,Macassar and Lowandle in the Helderberg sub-structure, Langa and Retreat inthe Southern Peninsula sub-structure, and Mitchell’s Plain and Gugulethu in theCentral sub-structure of the Cape Town metropole.3.3.1.4. Characteristics of the final sampleA non-random, snowball sample of 989 participants was drawn from the selectedrecruitment areas. The final sample consisted of 434 cases and 555 controls. Ofthese controls, approximately 46 were selected from each recruitment area. Chisquaretests of association reveal that cases and controls did not differ bygender, or race. Demographic data for this study are shown in Table 2.3.3.2. Procedures3.3.2.1. Pilot testingPrior to initiating phase 1, the Access to Treatment Survey Questionnaire (ATQ)was pilot-tested among 40 substance users from two historically disadvantagedcommunities in Cape Town. Feedback from the pilot-testing allowed researchersto refine the ATQ and change problematically worded items prior to the mainstudy. Pilot-testing also allowed the reliability of the scales that comprise the ATQto be established for a South African substance-using population. As feedbackfrom fieldworkers, key informants and participants revealed that most individuals26
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 and 16: CONCEPTUAL MODELThis study’s conc
Page 17 and 18: presenting problems and ability to
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: the researcher to explore possible
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
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This perception is prevalent in Col
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substance abuse problem - without a
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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
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self-efficacy and negative percepti
Page 121 and 122:
6.3. TREATMENT SYSTEM FACTORS ASSOC
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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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Access to substance abuse treatment in the Cape Town metropole ...

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