Inequitable access to substance abuse treatment services in Cape Town, South Africa

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dc.contributor.authorMyers, Bronwyn Jen_ZA
dc.contributor.authorLouw, Johannen_ZA
dc.contributor.authorPasche, Sonjaen_ZA
dc.date.accessioned2015-10-30T09:35:53Z
dc.date.available2015-10-30T09:35:53Z
dc.date.issued2010en_ZA
dc.description.abstractBACKGROUND:Despite high levels of substance use disorders in Cape Town, substance abuse treatment utilization is low among people from disadvantaged communities in Cape Town, South Africa. To improve substance abuse treatment utilization, it is important to identify any potential barriers to treatment initiation so that interventions to reduce these barriers can be implemented. To date, substance abuse research has not examined the factors associated with substance abuse treatment utilization within developing countries. Using the Behavioural Model of Health Services Utilization as an analytic framework, this study aimed to redress this gap by examining whether access to substance abuse treatment is equitable and the profile of variables associated with treatment utilization for people from poor communities in Cape Town, South Africa. METHODS: This study used a case-control design to compare 434 individuals with substance use disorders from disadvantaged communities who had accessed treatment with 555 controls who had not accessed treatment on a range of predisposing, treatment need and enabling/restricting variables thought to be associated with treatment utilization. A hierarchical logistic regression was conducted to assess the unique contribution that the need for treatment, predisposing and enabling/restricting variable blocks made on substance abuse treatment utilization. RESULTS: Findings revealed that non-need enabling/restricting variables accounted for almost equal proportions of the variance in service utilization as the need for treatment variables. These enabling/restricting variables also attenuated the influence of the treatment need and predisposing variables domains on chances of treatment utilization. Several enabling/restricting variables emerged as powerful partial predictors of utilization including competing financial priorities, geographic access barriers and awareness of treatment services. Perceived severity of drug use, a need for treatment variable) was also a partial predictor of utilization. CONCLUSIONS: Findings point to inequitable access to substance abuse treatment services among people from poor South African communities, with non-need factors being significant determinants of treatment utilization. In these communities, treatment utilization can be enhanced by (i) expanding the existing repertoire of services to include low threshold services that target individuals with less severe problems; (ii) providing food and transport vouchers as part of contingency management efforts, thereby reducing some of the financial and geographic access barriers; (iii) introducing community-based mobile outpatient treatment services that are geographically accessible; and (iv) employing community-based outreach workers that focus on improving awareness of where, when and how to access existing treatment services.en_ZA
dc.identifier.apacitationMyers, B. J., Louw, J., & Pasche, S. (2010). Inequitable access to substance abuse treatment services in Cape Town, South Africa. <i>Substance Abuse Treatment, Prevention, and Policy</i>, http://hdl.handle.net/11427/14540en_ZA
dc.identifier.chicagocitationMyers, Bronwyn J, Johann Louw, and Sonja Pasche "Inequitable access to substance abuse treatment services in Cape Town, South Africa." <i>Substance Abuse Treatment, Prevention, and Policy</i> (2010) http://hdl.handle.net/11427/14540en_ZA
dc.identifier.citationMyers, B., Louw, J., & Pasche, S. (2010). Inequitable access to substance abuse treatment services in Cape Town, South Africa. Subst Abuse Treat Prev Policy, 5(28), 597X-5.en_ZA
dc.identifier.ris TY - Journal Article AU - Myers, Bronwyn J AU - Louw, Johann AU - Pasche, Sonja AB - BACKGROUND:Despite high levels of substance use disorders in Cape Town, substance abuse treatment utilization is low among people from disadvantaged communities in Cape Town, South Africa. To improve substance abuse treatment utilization, it is important to identify any potential barriers to treatment initiation so that interventions to reduce these barriers can be implemented. To date, substance abuse research has not examined the factors associated with substance abuse treatment utilization within developing countries. Using the Behavioural Model of Health Services Utilization as an analytic framework, this study aimed to redress this gap by examining whether access to substance abuse treatment is equitable and the profile of variables associated with treatment utilization for people from poor communities in Cape Town, South Africa. METHODS: This study used a case-control design to compare 434 individuals with substance use disorders from disadvantaged communities who had accessed treatment with 555 controls who had not accessed treatment on a range of predisposing, treatment need and enabling/restricting variables thought to be associated with treatment utilization. A hierarchical logistic regression was conducted to assess the unique contribution that the need for treatment, predisposing and enabling/restricting variable blocks made on substance abuse treatment utilization. RESULTS: Findings revealed that non-need enabling/restricting variables accounted for almost equal proportions of the variance in service utilization as the need for treatment variables. These enabling/restricting variables also attenuated the influence of the treatment need and predisposing variables domains on chances of treatment utilization. Several enabling/restricting variables emerged as powerful partial predictors of utilization including competing financial priorities, geographic access barriers and awareness of treatment services. Perceived severity of drug use, a need for treatment variable) was also a partial predictor of utilization. CONCLUSIONS: Findings point to inequitable access to substance abuse treatment services among people from poor South African communities, with non-need factors being significant determinants of treatment utilization. In these communities, treatment utilization can be enhanced by (i) expanding the existing repertoire of services to include low threshold services that target individuals with less severe problems; (ii) providing food and transport vouchers as part of contingency management efforts, thereby reducing some of the financial and geographic access barriers; (iii) introducing community-based mobile outpatient treatment services that are geographically accessible; and (iv) employing community-based outreach workers that focus on improving awareness of where, when and how to access existing treatment services. DA - 2010 DB - OpenUCT DO - 10.1186/1747-597X-5-28 DP - University of Cape Town J1 - Substance Abuse Treatment, Prevention, and Policy LK - https://open.uct.ac.za PB - University of Cape Town PY - 2010 T1 - Inequitable access to substance abuse treatment services in Cape Town, South Africa TI - Inequitable access to substance abuse treatment services in Cape Town, South Africa UR - http://hdl.handle.net/11427/14540 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/14540
dc.identifier.urihttp://dx.doi.org/10.1186/1747-597X-5-28
dc.identifier.vancouvercitationMyers BJ, Louw J, Pasche S. Inequitable access to substance abuse treatment services in Cape Town, South Africa. Substance Abuse Treatment, Prevention, and Policy. 2010; http://hdl.handle.net/11427/14540.en_ZA
dc.language.isoengen_ZA
dc.publisherBioMed Central Ltden_ZA
dc.publisher.departmentDepartment of Psychiatry and Mental Healthen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis is an Open Access article distributed under the terms of the Creative Commons Attribution Licenseen_ZA
dc.rights.holder2010 Myers et al; licensee BioMed Central Ltd.en_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/2.0en_ZA
dc.sourceSubstance Abuse Treatment, Prevention, and Policyen_ZA
dc.source.urihttp://substanceabusepolicy.biomedcentral.com/en_ZA
dc.subject.otherSubstance Abuseen_ZA
dc.subject.otherTreatment servicesen_ZA
dc.titleInequitable access to substance abuse treatment services in Cape Town, South Africaen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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