Exploring the question of financial incentives for training amongst non-adopters of MOUD in rural primary care.

BACKGROUND: Medication for opioid use disorder (MOUD) includes administering medications such as buprenorphine or methadone, often with mental health services. MOUD has been shown to significantly improve outcomes and success of recovery from opioid use disorder. In WV, only 18% of providers including physicians, physician assistants, and nurse practitioners are waivered, and 44% of non-waivered providers were not interested in free training even if compensated. This exploratory research seeks to understand intervention-related stigma in community-based primary care providers in rural West Virginia, determine whether financial incentives for training may be linked to levels of stigma, and what level of financial incentives would be required for non-adopters of MOUD services provision to obtain training. METHOD: Survey questions were included in the West Virginia Practice-Based Research Network (WVPBRN) annual Collective Outreach & Research Engagement (CORE) Survey and delivered electronically to each practice site in WV. General demographic, staff attitudes and views on compensation for immersion training for delivering MOUD therapy in primary care offices were returned. Statistical analysis included logistic and multinomial logistic regression and an independent samples t-test. RESULTS: Data were collected from 102 participants. Perceived stigma did significantly predict having a waiver with every 1-unit increase in stigma being associated with a 65% decreased odds of possessing a waiver for buprenorphine/MOUD (OR = 0.35; 95% CI 0.16-0.78, p = 0.01). Further, t-test analyses suggested there was a statistically significant mean difference in perceived stigma (t(100) = 2.78, p = 0.006) with those possessing a waiver (M = 1.56; SD = 0.51) having a significantly lower perceived stigma than those without a waiver (M = 1.92; SD = 0.57). There was no statistically significant association of stigma on whether someone with a waiver actually prescribed MOUD or not (OR = 0.28; 95% CI 0.04-2.27, p = 0.234). CONCLUSION: This survey of rural primary care providers demonstrates that stigmatizing beliefs related to MOUD impact the desired financial incentive to complete a one-day immersion, and that currently unwaivered providers endorse more stigmatizing beliefs about MOUD when compared to currently waivered providers. Furthermore, providers who endorse stigmatizing beliefs with respect to MOUD require higher levels of compensation to consider such training.

Using an Implementation Research Framework to Identify Facilitators and Barriers to Physical Activity and Weight Loss in Appalachia.

OBJECTIVES: West Virginia (WV) is the only state entirely located in Appalachia, a large, mostly rural area in the eastern United States. WV has the highest adult obesity rate in the United States, as well as one of the highest physical inactivity rates. Obesity has been found to be significantly higher in rural counties than in urban counties, and many rural communities do not have the resources to address this growing health concern. It is well documented that healthy eating and becoming more physically active can be successful in reducing weight and managing obesity-related illness. Despite this overwhelming evidence, obesity rates in WV continue to climb. The purpose of this study was to understand the factors associated with obesity in WV and identify what influences the behavior of people in regard to weight loss and exercise. METHODS: Four focus groups were conducted across the state of WV, transcribed, and thematically analyzed to examine the facilitators and barriers associated with healthy behaviors. The Consolidated Framework for Implementation Research (CFIR) was used as an approach to classify characteristics and plan implementation strategies integrating five domains. The CFIR has been used to identify potential barriers and facilitators to interventions and can be used before or during an intervention. In addition, the CFIR has been used as a framework to guide analysis and provide a means to organize intervention stakeholders' perceptions of barriers and facilitators to successful interventions. RESULTS: Participants identified barriers and facilitators across all 5 major domains of the CFIR-intervention characteristics, outer setting (eg, cultural norms, infrastructure), inner setting (eg, access to knowledge), characteristics of individuals, and the implementation process-and 16 subdomains. Participants discussed how socioeconomic, cultural, and environmental factors influenced diet and exercise. Cost, family culture, and limited access to resources (eg, healthy foods, community-based fitness programs, health care) were common themes expressed by participants. CONCLUSIONS: The results of this study identify how individuals living in rural Appalachian view lifestyle changes and what influences their ability to pursue physical activity and healthy eating. Future programs to encourage healthy lifestyles in Appalachia need to consider the characteristics of the given community to achieve the goal of a tailored lifestyle intervention program that is feasible and effective. In addition, the findings suggest that the CFIR can be used to implement and refine intervention strategies that can be used in the real world.