Dissemination and Implementation of the Swedish National Guidelines for Treatment of Substance use : A five year evaluation

Sammanfattning: This thesis contains four empirical studies. The data derives from an evaluation project named Knowledge to Practice (KtP) that aimed to disseminate and implement the Swedish National Guidelines for Alcohol and Substance Abuse in Substance Use Disorder-treatment from 2010–2014. The aim of this thesis was to identify key determinants affecting implementation.The data collection consisted of:- Web surveys that were distributed annually from 2010–2014 to a panel of 3,852 respondents working in substance abuse treatment in social services and health care- Web surveys distributed to approximately 10,000 participants in the national core curriculum course. Surveys were distributed before the start of the course and immediately after the course ended. A follow-up web survey was distributed one year later- Semi-structured surveys for all regions’ user organizations to answer in focus groups- Interviews with process managers in every regionThe aim of Study I was to describe KtP's efforts and the situation in 2012. Web surveys were distributed to a panel of 3,852 respondents and 10,000 participants from core curriculum courses. Process managers from all 21 regions were interviewed. Study II used an instrument named Organizational Readiness for Change (ORC).The aim was to: (a) identify clusters of employees with different ORC profiles and (b) investigate whether belonging to a specific profile predicted the use of therapy methods, assessment instruments and cross-sectional collaboration. The ORC instrument was part of an annual web survey to a panel of 3,852 respondents.The aim of Study III was to evaluate, via a four-year follow-up study, whether user organizations continued existing after national support concluded and if their influence within social services and health care was implemented over time. The aim of Study III was to evaluate, via a four-year follow-up study, whether user organizations continued existing after national support concluded and if their influence within social services and health care was implemented over time. The aim of Study IV was to evaluate the extent of the dissemination and implementation work organised by KtP and whether there was increased use of treatment methods, assessment instruments and changes in cross-sectional collaboration between authorities. Factors associated with success were studied on three organizational levels: regional, municipal and individual. Results show that setting and person-related determinants, as measured by the ORC instrument, predicted implementation of assessment instruments and treatment methods. Profiles with high scores on institutional resources, staff attributes and organizational climate and low scores on motivational readiness were associated with more successful implementation. Respondent-level specialist competence and the ORC factors of staff attributes and institutional resources were related to the use of treatment methods. The ORC factor of organizational climate was related to the increase of cross-sectionalcollaboration at a respondent level. Years of employment working with substance users predicted increased use of assessment instruments and in contrast, the ORC factor institutional resources available were negatively related to instrument use. No predictors were found at the region/municipality level. The majority of respondents were positive to the national guidelines and found them useful in their daily work. They also reported positive attitudes to the KtP project. In 2011, two-thirds of the process managers from Sweden's 21 counties assessed that KtP's most important results were access to education and method support. The one-year follow-up web survey distributed to the participants in core curriculum courses showed that memory retention of the course content was fair. Eighty per cent of the respondents gave the correct answer to seven out of nine questions. User organizations still existed in most regions and they reported increased influence in the field of substance use treatment, both in social services and within health care services.