Effectiveness of a Psycho-Social Intervention Aimed at Reducing Attrition at Methadone Maintenance Treatment Clinics: A Propensity Score Matching Analysis
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Participants
2.2. Procedure
2.3. Intervention
2.3.1. Intervention Group
2.3.2. Control Group
2.4. Measures
2.4.1. Drug Use and Detoxification Intention
2.4.2. MMT-Related Perceptions
2.4.3. Family and Social Support
2.4.4. Health Status
2.5. Sample Size Estimation
2.6. Statistical Analysis
3. Results
3.1. Baseline Characteristics
3.2. Primary Outcome
3.3. Secondary Outcomes
4. Discussion
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Before-matching Sample (n = 359) | After-matching Sample (n = 248) | |||||
---|---|---|---|---|---|---|
Control | Intervention | SDiff | Control | Intervention | SDiff | |
(%) | (%) | (%) | (%) | |||
Socio-demographic characteristics | ||||||
Sex (female) | 8.7 | 14.5 | 0.182 | 10.5 | 12.9 | 0.075 |
Age (>45 years) | 63.6 | 61.3 | 0.048 | 57.3 | 59.7 | 0.049 |
Education level | ||||||
Primary or below | 17.3 | 21.0 | 0.094 | 17.7 | 19.4 | 0.044 |
Junior high | 68.2 | 59.7 | 0.178 | 68.5 | 60.5 | 0.168 |
Senior high or above | 14.5 | 19.4 | 0.131 | 13.7 | 20.2 | 0.174 |
Current marriage status | ||||||
Single | 43.4 | 38.7 | 0.096 | 40.3 | 38.7 | 0.033 |
Married/cohabitating | 40.5 | 39.8 | 0.014 | 44.4 | 41.9 | 0.050 |
Divorced/other | 16.2 | 21.5 | 0.136 | 15.3 | 19.4 | 0.108 |
Current employment status (Employed) | 33.5 | 40.3 | 0.141 | 35.5 | 45.2 | 0.199 |
Monthly income (>1000 CNY) | 42.2 | 46.2 | 0.081 | 42.7 | 53.2 | 0.195 |
Being HIV positive (yes) | 1.7 | 11.3 | 0.397a | 2.4 | 4.0 | 0.091 |
Drug use-related characteristics | ||||||
Age of initial drug use (>25 years old) | 60.1 | 54.3 | 0.117 | 56.5 | 54.0 | 0.050 |
Duration of drug use (>20 years) | 58.4 | 61.6 | 0.065 | 56.5 | 59.3 | 0.057 |
Ever injected drugs (yes) | 59.0 | 73.1 | 0.301a | 65.3 | 64.5 | 0.017 |
Times of compulsory detoxification | ||||||
0 | 20.5 | 21.1 | 0.015 | 21.1 | 22.8 | 0.041 |
1-2 | 45.6 | 35.1 | 0.215 | 43.9 | 39.8 | 0.083 |
3~ | 33.9 | 43.8 | 0.204 | 35.0 | 37.4 | 0.050 |
Current drug use | ||||||
No use | 20.2 | 21.0 | 0.020 | 26.6 | 21.8 | 0.112 |
Less than once a day | 26.0 | 33.9 | 0.173 | 22.6 | 33.1 | 0.236 |
At least once a day | 53.8 | 45.2 | 0.173 | 50.8 | 45.2 | 0.112 |
detox intention score | ||||||
<8 | 23.7 | 25.3 | 0.037 | 20.0 | 29.0 | 0.210 |
8-9 | 42.2 | 34.4 | 0.161 | 40.3 | 35.5 | 0.099 |
10 | 34.1 | 40.3 | 0.129 | 39.5 | 35.5 | 0.083 |
MMT-related perceptions | ||||||
Having proper perception about MMT aim/time | 43.9 | 43.5 | 0.008 | 42.7 | 44.4 | 0.034 |
Having proper perception about MMT dosage | 42.2 | 40.9 | 0.026 | 38.7 | 46.0 | 0.148 |
Self-efficacy of MMT retention in the next six months | ||||||
Low | 24.3 | 26.9 | 0.060 | 25.0 | 25.0 | <0.001 |
Medium | 47.4 | 44.6 | 0.056 | 47.6 | 47.6 | <0.001 |
High | 28.3 | 28.5 | 0.004 | 27.4 | 27.4 | <0.001 |
Willing to accept psycho-social services (yes) | 72.3 | 87.6 | 0.389a | 84.7 | 84.7 | <0.001 |
Family and Social Support | ||||||
Score of Perceived Social Support Scale (Mean, SD) | 10.4, 2.0 | 10.1, 2.4 | 0.149 | 10.2, 2.2 | 10.5, 2.2 | 0.147 |
Family awareness of MMT | ||||||
Disagree/Extremely disagree | 21.4 | 29.6 | 0.189 | 21.8 | 21.0 | 0.020 |
Don’t know/hard to say | 40.5 | 28.5 | 0.254a | 36.3 | 33.1 | 0.067 |
Agree/Extremely agree | 38.2 | 41.9 | 0.076 | 41.9 | 46.0 | 0.083 |
Family support in MMT | ||||||
Disagree/Extremely disagree | 9.2 | 9.7 | 0.017 | 8.9 | 9.7 | 0.028 |
Don’t know/hard to say | 28.3 | 27.4 | 0.020 | 25.8 | 25.8 | <0.001 |
Agree/Extremely agree | 62.4 | 62.9 | 0.010 | 65.3 | 64.5 | 0.017 |
Good MMT communication with family members | ||||||
Disagree/Extremely disagree | 19.1 | 28.5 | 0.222 | 25.0 | 23.4 | 0.037 |
Don’t know/hard to say | 40.5 | 26.3 | 0.305a | 30.6 | 30.6 | <0.001 |
Agree/Extremely agree | 40.5 | 45.2 | 0.095 | 44.4 | 46.0 | 0.032 |
Overall health status (Mean, SD) | ||||||
Physical functioning | 50.8, 9.0 | 49.4, 9.5 | 0.153 | 50.6, 9.1 | 50.7, 8.5 | 0.016 |
Role-physical | 45.7, 16.5 | 44.9, 16.3 | 0.047 | 44.7, 17.0 | 46.9, 15.5 | 0.137 |
Role-emotional | 44.7, 18.8 | 37.8, 21.0 | 0.346 a | 43.3, 19.6 | 43.5, 19.2 | 0.009 |
Mental health | 45.9, 8.3 | 44.6, 10.3 | 0.147 | 46.3, 8.8 | 46.7, 9.2 | 0.049 |
General health | 44.3, 9.4 | 43.2, 11.3 | 0.109 | 44.3, 9.9 | 42.8, 11.3 | 0.138 |
Bodily pain | 49.8, 8.3 | 48.4, 9.0 | 0.160 | 50.1, 9.1 | 49.3, 8.3 | 0.095 |
Vitality | 49.0, 9.2 | 46.4, 9.8 | 0.267 a | 49.0, 9.8 | 47.6, 9.3 | 0.150 |
Social functioning | 43.3, 9.9 | 43.0, 10.5 | 0.033 | 42.6, 10.8 | 43.7, 9.7 | 0.114 |
Physical Component Summary | 49.3, 7.5 | 49.2, 8.5 | 0.005 | 49.1, 7.8 | 49.2, 7.3 | 0.004 |
Mental Component Summary | 44.1, 10.5 | 40.4, 13.0 | 0.320 a | 43.6, 11.0 | 43.7, 11.0 | 0.005 |
Attrition Rates (%) | Propensity-Matched Cohort | ||
---|---|---|---|
M1 | M6 | M12 | |
Control | 19.4 (24/124) | 52.4 (65/124) | 75.0 (93/124) |
Intervention | 10.5 (13/124) | 39.5 (49/124) | 58.9 (73/124) |
RR (95% CI) | 0.901 (0.811,1.001) | 0.787 (0.623,0.993) * | 0.608 (0.420,0.880) * |
Absolutely risk reduction (95% CI) | 0.089 [0.001,0.177] * | 0.129 (0.006,0.252) * | 0.161 (0.046,0.277) * |
Reciprocal of the absolute risk reduction | 12 | 8 | 6 |
M0 (n = 248) n (%) | M1 (n = 211) n (%) | M6 (n = 172) n (%) | P for Trend | |
---|---|---|---|---|
Socio-economic status | ||||
Current employment status (Employed) | ||||
Control | 44 (35.5) | 30 (30.3) | 29 (37.7) | 0.864 |
Intervention | 56 (45.2) | 47 (43.1) | 47 (50.0) | 0.516 |
RR (95% CI) | 1.18 (0.96,1.45) | 1.23 (0.99,1.51)+ | 1.25 (0.96,1.63) | |
Monthly income (>1000 CNY) | ||||
Control | 54 (43.5) | 38 (38.8) | 30 (39.0) | 0.481 |
Intervention | 66 (53.2) | 52 (47.7) | 52 (55.9) | 0.767 |
RR (95% CI) | 1.21 (0.95,1.54) | 1.17 (0.92,1.49) | 1.39 (1.04,1.85)* | |
Drug use-related characteristics | ||||
Current drug use | ||||
Control | 91 (73.4) | 26 (28.6) | 16 (21.6) | <0.001* |
Intervention | 97 (78.2) | 21 (19.6) | 12 (13.2) | <0.001* |
RR (95% CI) | 1.22 (0.78,1.90) | 0.889 (0.76,1.04) | 0.903 (0.78,1.04) | |
Detox intention score (=10) | ||||
Control | 49 (39.5) | 42 (42.4) | 25 (32.5) | 0.391 |
Intervention | 44 (35.5) | 54 (49.1) | 49 (51.6) | 0.014* |
RR (95% CI) | 0.94 (0.77,1.14) | 1.13 (0.88,1.45) | 1.40 (1.08,1.81)* | |
MMT-related perceptions | ||||
Proper perception about MMT aim/duration | ||||
Control | 53 (42.7) | 50 (50.0) | 34 (44.2) | 0.730 |
Intervention | 55 (44.4) | 53 (47.7) | 52 (54.7) | 0.133 |
RR (95% CI) | 1.03 (0.83,1.28) | 0.96 (0.73,1.25) | 1.23 (0.92,1.66) | |
Proper perception about MMT dosage | ||||
Control | 48 (38.7) | 39 (39.0) | 28 (36.4) | 0.763 |
Intervention | 57 (46.0) | 40 (36.0) | 28 (29.5) | 0.012* |
RR (95% CI) | 1.13 (0.92,1.41) | 0.95 (0.77,1.18) | 0.90 (0.73,1.12) | |
Social Support | ||||
Score of Perceived Social Support Scale (Mean, SD) | ||||
Control | 10.20,2.19 | 10.39,2.57 | 10.30,1.99 | 0.887 |
Intervention | 10.52,2.18 | 10.22,2.35 | 10.08,2.16 | 0.059+ |
Mean diff (95% CI) | 0.28 (−0.22,0.87) | −0.03 (−0.69,0.63) | −0.23 (−0.86,0.41) | |
Family awareness of MMT (agree/extremely agree) | ||||
Control | 52 (41.9) | 55 (55.6) | 31 (44.3) | 0.513 |
Intervention | 57 (46.0) | 63 (57.3) | 49 (54.4) | 0.180 |
RR (95% CI) | 1.08 (0.86,1.34) | 1.04 (0.76,1.42) | 1.22 (0.90,1.66) | |
Family support in MMT (Agree/Extremely agree) | ||||
Control | 81 (65.3) | 71 (71.7) | 43 (61.4) | 0.748 |
Intervention | 80 (64.5) | 78 (71.6) | 70 (77.8) | 0.034* |
RR (95% CI) | 0.98 (0.70,1.37) | 0.99 (0.65,1.53) | 1.74 (1.07,2.82) * | |
Good MMT communication with family members (Agree/Extremely agree) | ||||
Control | 55 (44.4) | 54 (54.5) | 28 (40.0) | 0.796 |
Intervention | 57 (46.0) | 60 (54.5) | 46 (51.1) | 0.401 |
RR (95% CI) | 1.03 (0.82,1.29) | 1.00 (0.74,1.35) | 1.23 (0.92,1.63) | |
Overall health status (Mean, SD) | ||||
Physical component summary | ||||
Control | 49.13,7.81 | 50.60,7.61 | 50.36,7.93 | 0.717 |
Intervention | 49.16,7.33 | 51.40,6.99 | 50.17,8.05 | 0.165 |
Mean difference (95% CI) | 0.03 (−1.86,1.93) | 0.80 (−1.18,2.79) | −0.20 (−2.62,2.23) | |
Mental component summary | ||||
Control | 43.64,11.01 | 45.07,11.13 | 43.70,11.10 | 0.396 |
Intervention | 43.70,10.98 | 42.93,11.68 | 46.46,12.47 | 0.058+ |
Mean difference (95% CI) | 0.06 (−2.69,2.81) | −2.14 (−5.25,0.97) | 2.77 (−0.80,6.33) |
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Fan, X.; Zhang, X.; Xu, H.; Yang, F.; Lau, J.T.F.; Hao, C.; Li, J.; Zhao, Y.; Hao, Y.; Gu, J. Effectiveness of a Psycho-Social Intervention Aimed at Reducing Attrition at Methadone Maintenance Treatment Clinics: A Propensity Score Matching Analysis. Int. J. Environ. Res. Public Health 2019, 16, 4337. https://doi.org/10.3390/ijerph16224337
Fan X, Zhang X, Xu H, Yang F, Lau JTF, Hao C, Li J, Zhao Y, Hao Y, Gu J. Effectiveness of a Psycho-Social Intervention Aimed at Reducing Attrition at Methadone Maintenance Treatment Clinics: A Propensity Score Matching Analysis. International Journal of Environmental Research and Public Health. 2019; 16(22):4337. https://doi.org/10.3390/ijerph16224337
Chicago/Turabian StyleFan, Xiaoyan, Xiao Zhang, Huifang Xu, Fan Yang, Joseph T.F. Lau, Chun Hao, Jinghua Li, Yuteng Zhao, Yuantao Hao, and Jing Gu. 2019. "Effectiveness of a Psycho-Social Intervention Aimed at Reducing Attrition at Methadone Maintenance Treatment Clinics: A Propensity Score Matching Analysis" International Journal of Environmental Research and Public Health 16, no. 22: 4337. https://doi.org/10.3390/ijerph16224337