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J Alcohol Drug Educ. Author manuscript; available in PMC 2016 December 01. Published in final edited form as: J Alcohol Drug Educ. 2015 December ; 59(3): 67–90.
Development of a Community Readiness Survey for Coalitions to Address Prescription Opioid Misuse Kimberlee J. Trudeau, Ph.D. Inflexxion, Inc.
Abstract Author Manuscript
A community readiness survey for coalitions to address the growing epidemic of prescription opioid misuse was developed in this four-part study. A total of 70 coalition members participated. 1) We conducted 30-minute phone interviews with coalition members (n=30) and a literature review to develop an item list. 2) Coalition members rated these 60 items for three criteria: importance, confidence in own answer, confidence in others’ answer. 3) Highly rated items were included in a revised survey that was tested with coalition members (n=10) using in-person cognitive interviewing to assess how coalition members were interpreting the questions. 4) Lastly, pre-testing and satisfaction testing with additional coalition members (n=30). Most (83%) of the respondents reported positive overall impressions of the survey.
Keywords
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coalition; drug; readiness; survey; prescription; opioid; misuse There is a prescription drug overdose epidemic in the United States (CDC 2012; ONDCP, 2014). Prescription opioids, widely available and easily obtained by young people, offer an inexpensive means of altering one’s mental and physical state. For these reasons, prescription opioids have become an increasingly popular drug option in younger age groups. Meanwhile, the dangers of prescription drug misuse are not well-understood: As Dr. Volkow stated in testimony to the U.S. Congress last year, “Because prescription drugs are safe and effective when used properly and are broadly marketed to the public, the notion that they are also harmful and addictive when abused can be a difficult one to convey” (Department of Health and Human Services, 2014).
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Early efforts to reduce prescription opioid misuse/abuse within communities utilized a general approach, including predominantly non-targeted educational interventions. There have been both local (Georgia’s http://genrx.us/; Utah’s http://www.useonlyasdirected.org/ campaign) and national (e.g., http://www.awarerx.org/; http://www.upandaway.org/) public awareness campaigns (SAMHSA, 2015a). The Governor’s Opioid Working group in Massachusetts is currently launching a Stop Addiction in its Tracks media campaign to educate parents about how to prevent opioid misuse (http://www.mass.gov/eohhs/gov/
CONTACT INFORMATION: Kimberlee J. Trudeau, Ph.D., Inflexxion, Inc., 320 Needham St., Newton, MA 02464, [email protected].
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departments/dph/stop-addiction/stop-addiction-campaigns.html). In addition, many organizations, including the Office of National Drug Control Policy (ONDCP) have responded to this emerging public health problem by developing research reports (e.g., “Prescription for Danger;” 2008) as a means of drawing public awareness to the problem. For example, a report on Prescription Drug Abuse (NIDA, 2014) is included within the NIDA Research Report series which “simplifies the science of research findings for the educated lay public, legislators, educational groups, and practitioners.” There are also resources available on the Web; for example, the nonprofit organization Partnership for Drug-Free Kids (2015), formerly known as Partnership for a Drug-Free America, has comprehensive resources on their website pertaining to prescription drug abuse. These information-based resources are useful, but require significant publicity to reach their target audience; they may not be specific enough to change public attitudes and behaviors, because the public may not be ready to hear these messages.
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It is necessary to address educational and prevention messages in such a way that local communities can come to a consensus to set goals and respond effectively to prescription opioid misuse andabuse. Community anti-drug coalitions offer a potential avenue for such intervention due to their understanding of local needs, links to the community, and knowledge of local abuse prevention resources. Community members working together within a coalition can maximize their resources, increase their reach across the community, have greater credibility, and provide more information-sharing opportunities (Cohen et al., 2002). In addition, coalitions can: a) affect more distal population-level outcomes; b) bring about community-wide behavior change; and c) bring about changes in the community (Roussos & Fawcett, 2000).
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Coalitions have been eligible for funding from the Congress-enacted Drug-Free Communities Support Program (DFC) since 1997. The goal of DFC funding is to reduce substance use and strengthen community collaborations. Use of the Strategic Prevention Framework (SPF) is now required by DFC grantees to build the infrastructure required for effective prevention planning; consequently, many government agencies and nonprofit organizations are using this framework. The first step of the SPF is to assess community needs and resources, including community readiness, to address the problem (SAMHSA, 2015b).
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The Community Readiness Model is a theory-based method to increase collaboration and cohesion with a coalition through awareness of members’ readiness for change. The Community Readiness Model (Edwards et al., 2000; Oetting et al., 1995; Oetting et al., 2001) suggests that communities are at one of nine stages of readiness to address local problems. The stages are: No awareness; Denial/Resistance; Vague Awareness; Preplanning; Preparation; Initiation; Stabilization; Expansion/Confirmation; and Community Ownership (Tri-Ethnic Center for Prevention Research, 2014). To develop Community Readiness Model, researchers at the Tri-Ethnic Center at Colorado State University (Edwards et al., 2000; Oetting et al., 1995; Oetting et al., 2001) drew on several theories of community development, including Rogers’ (1995) Diffusion of Innovations model, Beal’s (1964) Social Action Process, as well as a stage-based theory of
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behavior change among individuals, Prochaska’s Stages of Change Model (Prochaska et al., 1994). Although Prochaska’s stage-based model for behavior change among individuals has come under criticism in recent years (Callaghan et al., 2007; Riemsma et al., 2003; West, 2005), the Community Readiness Model has gained a wide degree of acceptance and usage among community researchers and practitioners in diverse communities.
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Since the model was developed in the mid-1990s, more than 150 rural and ethnic communities have used it to develop drug prevention strategies; the model has also been applied to impact diverse problems such as domestic violence, child abuse, head injuries, HIV/AIDS, suicide prevention (Plested et al., 2006), and, more recently, healthy eating and drinking (Kesten et al., 2013). A study focusing on traumatic brain injury found that the Community Readiness Model identifies counties more likely to engage in prevention, and that readiness changes where programs are initiated (Stallones et al., 2008); these results suggest that readiness can be considered a proxy for community change.
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Community readiness has been measured through structured in-person key informant interviews using the Community Readiness Scale (CRS; Oetting et al., 1995); the CRS includes questions on five dimensions: Community Knowledge of the Issue; Community Knowledge of Efforts; Community Climate; Leadership; and Resources. This model has been applied in a broad range of racial/ethnic communities. Ultimately, this assessment provides targeted interventions for each readiness stage; however, in-person interviews are costly in resources (time, money, and people) for organizations that are not well-funded. A few readiness surveys exist as well (Raffle, 2011). For example, the Community Key Leader Survey (Goodman & Wandersman, 1996) is a 40-item survey with various Likert-scale response options regarding personal and organizational awareness of and involvement in alcohol and other drug prevention efforts. Unfortunately, existing community readiness surveys are not targeted toward the unique issues of prescription opioid misuse and abuse. The goal of this project was to develop items for a community readiness survey to help coalitions collect data that could be used to inform their efforts to address prescription opioid misuse and abuse in their communities.
Methods & Results
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Funded by NIH, this project was conducted in four steps in 2010. Each step is described below. A total of 70 coalition members from 59 different coalitions participated in the various parts of this study. The inclusion criteria were: (1) currently a member of an antidrug community coalition; (2) experience with the coalition (i.e., worked with the coalition for at least one year, for a minimum of one hour per month); (3) at least 18 years old; (4) willing to give informed consent; and (5) English speaking. Recruitment Nationwide participants were recruited through: (1) email outreach to anti-drug coalitions across the four U.S. census geographical areas (Northeast, Midwest, West, South) via 2008/2009 Community Anti-Drug Coalitions of America (CADCA) attendee lists; (2) our extensive contacts with substance abuse treatment centers and health agencies; and (3)
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recruiting coalition members at professional conferences. Participants from local coalitions (for the in-person cognitive interviews) were recruited by identifying local coalitions through web searching and by contacting local town halls and mayor’s offices. All participants were invited to share the recruitment information with their colleagues (e.g., via coalition listservs, personal email, meetings, etc.). Study procedures were approved by the New England Institutional Review Board. Participants
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A total of 70 coalition members participated in this four-part study. The group of 70 individuals consisted of 51 women (73%) and 19 men (27%), with 51 (73%) respondents identifying themselves as Caucasian, 10 (14%) as African American, 3 (4%) as American Indian or Alaskan Native, 3 (4%) as Hispanic, 1 (1%) Pacific Islander, and 2 (3%) as “Other”. The mean age of all 70 participants was 45.26 years (range from 22 to 74, SD=12.55). Coalitions The coalitions represented by the 70 participants throughout the four parts of the study included 23% located in the South, 17% in the West, 23% in the Northeast, and 37% in the Midwest (per the U.S. Census map region categories); 32 coalitions (35%) served urban areas, 31 coalitions (34%) served suburban areas, and 29 coalitions (32%) served rural areas [note: some served more than one area type]. Participants reported a mean of 48.25 active members in their coalitions (range from 8 to 200, SD=42.14). See demographic data by study task in Table 1. Step 1. Initial Interviews
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Procedures: We conducted 30-minute phone interviews with coalition members (n=30) about how coalitions function. All 30 participants were asked about challenges and concepts for survey items. The first 15 interviews were about coalition strategies to assess and address prescription drug abuse in their communities. The last 15 interviews were about how coalitions currently conduct surveys. A list of 60 different concepts for items for the readiness survey were generated during the interviews and a literature review. Each participant was paid $75 for participating in the interview.
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Results: Sixty percent of the 30 respondents reported that prescription drug abuse was listed among the “top 3 issues” that their coalitions are working on. The most common challenges that impeded coalitions’ (n=30) ability to address issues in their communities included lack of: funding (43%); coordination between schedules for meeting/planning (40%); and staff/ volunteers (30%). During the interviews about strategies (n=15), 87% said that community attitudes were a challenge in addressing prescription drug abuse in their communities: People think that prescription drugs are safe because they are legal, or people are in denial that there is a local problem. Seventy-three percent of the coalitions (n=15) stated that they conduct surveys. When asked during the interviews about their current experiences with carrying out surveys, the majority of the respondents (8 out of the 11) conduct them via paper, and 6 of the 11 have conducted them online. These findings suggested that there was a need and a desire by coalition members for the proposed program. In addition, data from J Alcohol Drug Educ. Author manuscript; available in PMC 2016 December 01.
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these interviews helped to develop categorical responses to questions in the readiness survey (e.g., How does a community know if there is a prescription drug problem in the community? Responses: through community needs assessment; focus groups; student survey; hospital or emergency room discharge data; police reports; medical examiner reports; etc.). In Figure 1, see the evolution of a sample item about safe storage of prescription drugs, starting with two quotations from the Step 1 interviews. Step 2. Item Rating
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Procedures: Sixty different concepts for items for the readiness survey were generated from the 30-minute interviews with 30 coalition members, a review of the literature, and consultant feedback. To maintain compatibility between this survey and community readiness theory, the following domains from the Tri-ethnic Center’s Community Readiness model (Edwards et al., 2000; Oetting et al., 1995; Oetting et al., 2001) were used to organize the items: Community Climate; Community Knowledge of Issue; Community Knowledge of Efforts; Leadership; and Resources. Twenty-seven out of thirty coalition members rated these 60 items for importance, confidence in their ability to answer accurately, and confidence in others’ ability to answer accurately on a scale of 1=Not at all to 5 = Extremely. Participants were paid $75 for completing the online ratings. Results: Forty-three items for which at least 2/3 variables received a 3, 4, or 5 from at least 70% or more of the 27 participants were revised based on discussion with consultants and further review of the theory and interview data. Version 1 of the survey included a total of 49 readiness items (plus 6 demographic items). Step 3. Cognitive Interviews
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Procedures: Version 1 of the survey was tested with new participants (n=10) using inperson cognitive interviewing, a method in which the respondent’s interpretation of each item is discussed (Willis, 1999). The questions and interview protocol were revised multiple times during the cognitive interview process, as we gained insight about how coalition members were interpreting the questions.
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Results: First, we learned that the screen out question “Are you a member of [INSERT COALITION NAME]” was too limiting. Community members who were interested in the topic (and therefore on the email list) may not self-identify as coalition members and then automatically screen out. It was important to collect data from both active (e.g., go to meetings) and passive members (e.g., receive emails, newsletters, or other updates.”) to ensure that we captured insights about community readiness from as many stakeholders as possible. Therefore, the screen out question was revised to: “What is your role in [INSERT COALITION NAME]” with various options provided indicating levels of involvement. The survey included a question regarding safe storage and disposal of prescription drugs. During cognitive testing, these began as knowledge questions (e.g., How can people safely store their prescription drugs?) followed by behavior questions (e.g., Safe storage of prescription drugs includes both keeping track of medicine – where they are and how much you have left – as well as keeping them away from others. How often do you safely store
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your prescription drugs?). These questions seemed to pull for positive responses. Upon review, it was decided that to get at community readiness it was necessary to ask about attitudes not knowledge: “Do you think that people in [CITY/TOWN] know that how well they keep prescription drugs away from others and how they get rid of prescription drugs when they do not need them anymore can influence the local rate of prescription drug abuse?” See Figure 1.
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A systematic change implemented throughout the survey draft was the following: several preliminary yes/no questions that were followed by category-based questions were replaced by including a “no” category (e.g., I am not a part of any of these community groups”). These changes both reduced the total number of items and increased the clarity of the types of responses that were associated with a “yes” response. The specific response categories were clarified and augmented based on participant feedback as well. For example, additional consequences of prescription drug abuse that were suggested were; more suicides, more poverty, and more unwanted pregnancies. Version 2 of the survey for use in pretesting included a total of 36 readiness items plus 7 demographic items. See Figure 2. Step 4. Pretesting and Satisfaction Testing Procedures: To test version 2 of this survey 30 new participants completed the survey independently at a predetermined time. Then they were called to answer survey pretesting questions about their experience taking the survey. After pre-testing, they were sent a link to a prototype of a survey administration program that included satisfaction testing questions. There were two phases of item iteration during pretesting; based on input from the first 10 participants, we revised some of the questions for testing with the last 20 participants.
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Results: All 30 respondents completed the survey in one sitting. The first version of the survey took 27 minutes (range from 12 to 50 minutes, SD=11.6). The revised survey took 23 minutes (range from 11 to 38 minutes, SD=8.3). [NOTE: The survey took longer for some participants because they were asked to take notes about questions they wanted to comment on during the pretesting interview; therefore it is not an accurate representation of how long it would take to do the survey alone].
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According to the pretesting results, 83% of the respondents reported positive overall impressions of the survey (e.g., “easy to use,” “well organized,” and “led to critical thinking about the issue”). Criticisms included: a few recurring issues regarding the wording of select items; online formatting; and one case of item-ordering that disrupted the survey flow; these suggestions were incorporated into the final survey (36 readiness items plus 7 demographic items). The final draft of the survey to assess community readiness to address prescription opioid misuse is included in Figure 2. Almost half of the respondents (41%) indicated that if these questions were asked by their coalition, they would want their responses to remain anonymous. Specific ways for how the results of the survey could be used to come up with program goals and activities were identified by 26/30 participants: define problem and select targets to approach (23%); provide evidence of their work (19%); determine coalition level of awareness (19%);
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identify gaps in policy/programs (15%); help adapt to issues/plan ahead (15%); and help apply for grants (8%).
Discussion
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Educational interventions are ineffective in communities that are disinterested in change (Wagenaar & Perry, 1994), so it is important to utilize interventions that are specific to the community’s level of readiness. The value of connecting resources to readiness has had policy implications: Grant recipients of the Congress-enacted Drug-Free Communities Support Program are mandated to use the Strategic Prevention Framework (SPF) (SAMHSA, 2015b) which includes a readiness assessment. The original Community Readiness Model assessment interview requires extensive resources because it requires conducting 20–60 minute interviews, transcription of those interviews, followed by the scoring of each interview by two independent raters (Tri-Ethnic Center for Prevention Research, 2014). These time and money-intensive requirements may be a barrier for a coalition to use the assessment and/or a barrier to participation by many valuable potential key respondents. In contrast, the new Community Readiness Survey for Prescription Drug Abuse is a 15minute self-report assessment that was developed with input from a total of 70 coalition members over a four-step process: item generation interviews, evaluation of each item for importance on a scale of 1=Not at all to 5 = Extremely, cognitive interviewing, and pretesting interviews. This new 42-item survey is: (1) short (takes less than 15 minutes to complete); and (2) theory-based (i.e., the Community Readiness Model); and (3) received positive reviews by coalition members.
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The results of this survey could help coalitions identify where and how to intervene on the issue of prescription opioid misuse given that coalitions may have limited resources (time, staff) and multiple key stakeholders who may have diverse agendas. In addition, Feinberg et al., (2004) found that internal coalition functioning mediated the significant relationship between readiness and perceived effectiveness of the coalition’s efforts, suggesting that a readiness tool can positively impact coalition effectiveness by improving coalition functioning. This survey is a data-gathering tool about factors specifically associated with community readiness to address prescription opioid misuse. With this information, coalition leaders may have direction to inform next steps to employ in their community. For example, if the descriptive data show that many participants responded “no” to “Do you think that people in [Town/City/County] realize that the way they store and dispose of prescription drugs can influence the local rate of prescription drug abuse?” then a next step might be to provide public education on the local rate of prescription drug abuse with information about safe storage of medications.
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Limitations This project has several limitations. Unlike the CRM assessment which can be customized to assess community readiness to address a specific community problem (Tri-Ethnic Center for Prevention Research, 2014), these items only apply to prescription drug misuse. The wording of the survey items were derived and tested with a convenience sample of coalition
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members. In addition, the survey has no scoring instructions and has not been validated. In comparison, the original Community Readiness Model developed by the Tri-Ethnic Center has scoring instructions to assess a linear, stage-based model (Plested et al., 2006) that advises matching intervention strategies by stage. Recent research on community coalitions in Wisconsin found that non-stage specific interventions for alcohol abuse prevention were effective in increasing community readiness (Paltzer et al., 2013), suggesting that a descriptive versus linear approach to improving community readiness has potential. Future Directions
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In summary, this study provides the opportunity to apply the original Community Readiness Model to a current community issue, prescription opioid misuse and abuse, with a new, selfreport community assessment. Coalitions are invited to use and collate descriptive results per item to help develop community-specific strategies to address prescription opioid misuse. These items could be added to an online survey platform for dissemination to community members. For example, the Community Key Leader Survey (Goodman & Wandersman, 1996) has been disseminated to communities in Indiana via Survey Monkey. Participation in Community Readiness evaluations raised awareness of the abuse of inhalants and other harmful legal products in the Alaskan communities in which they were conducted (Ogilvie et al., 2008); hopefully, at minimum, use of this new readiness survey to address prescription opioid misuse will contribute to coalitions’ success at that important objective for improving community prevention efforts in this area.
Acknowledgments Author Manuscript
This project was funded by NIDA/NIH grant # 1R43DA026224. First, I would like to acknowledge the coalition members who voluntarily participated in this study to help develop this readiness survey. I would also like to thank the research team -- Meredith Trant, M.S.W., Daniel Surette, B.A., Mollie Wood, M.P.H., & Emil Chiauzzi, Ph.D. – and our four consultants: Ray Bullman, M.A.M., Mark Feinberg, Ph.D. Ronda Zakocs, Ph.D., M.P.H., and Patricia Gallagher, Ph.D. Lastly, I appreciate the constructive feedback from two anonymous reviewers.
References
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Feinberg ME, Greenberg MT, Osgood DW. Readiness, functioning, and perceived effectiveness in community prevention coalitions: A study of Communities That Care. American Journal of Community Psychology. 2004; 33:163–176. [PubMed: 15212176] Goodman, R.; Wandersman, A. Community Key Leader Survey. 1996. Retrieved May 26, 2015, from http://www.drugs.indiana.edu/spf/page.php?category=Assessment#Readiness-tab Kesten JM, Cameron N, Griffiths PL. Assessing community readiness for overweight and obesity prevention in pre-adolescent girls: A case study. BMC Public Health. 2013; 13:1205. [PubMed: 24359213] NIDA. Research Report Series: Prescription drug abuse. 2014. Retrieved May 26, 2015, from http:// www.drugabuse.gov/publications/research-reports/prescription-drugs/what-prescription-drugabuse Oetting ER, Donnermeyer JF, Plested BA, Edwards RW, Kelly K, Beauvais F. Assessing community readiness for prevention. The International Journal of the Addictions. 1995; 30:659–683. [PubMed: 7657396] Oetting ER, Jumper-Thurman P, Plested B, Edwards RW. Community readiness and health services. Substance Use and Misuse. 2001; 36:825–843. [PubMed: 11697613] Office of National Drug Control Policy. Prescription for Danger A Report on the Troubling Trend of Prescription and Over-the-Counter Drug Abuse Among the Nation’s Teens. 2008. Retrieved June 4, 2015, from http://www.decp.org/documents/pdfs/WhatNew/prescription_report.pdf Office of National Drug Control Policy. Epidemic: Responding to America’s Prescription Drug Abuse Crisis. 2011. Retrieved May 26, 2015, from https://www.whitehouse.gov/sites/default/files/ondcp/ policy-and-research/rx_abuse_plan.pdf Office of National Drug Control Policy. Fact Sheet: Opioid Abuse in the United States. 2014. Retrieved May 26, 2015, from https://www.whitehouse.gov/sites/default/files/ondcp/Fact_Sheets/ opioids_fact_sheet.pdf Ogilvie KA, Moore RS, Ogilvie DC, Johnson KW, Collins DA, Shamblen SR. Changing community readiness to prevent the abuse of inhalants and other harmful legal products in Alaska. Journal of Community Health. 2008; 33:248–258. [PubMed: 18392927] Paltzer J, Black P, Moberg DP. Evaluating community readiness to implement environmental and policy-based alcohol abuse prevention strategies in Wisconsin. Journal of Alcohol and Drug Education. 2013; 57(3):27–50. [PubMed: 25346555] Partnership at Drugfree.org and MetLife Foundation. 2012 Partnership Attitude Tracking Survey (PATS). Teens and parents report. 2013. Retrieved June 4, 2015, from http://www.drugfree.org/wpcontent/uploads/2013/04/PATS-2012-FULL-REPORT2.pdf Partnership for a Drug-Free Kids. Guides and resources. 2015. Retrieved June 4, 2015, from http:// www.drugfree.org/resources/ Plested, BA.; Edwards, RW.; Jumper-Thurman, P. Community Readiness: A handbook for successful change. Fort Collins, CO: Tri-Ethnic Center for Prevention Research; 2006 Apr. Prochaska, JO.; Norcross, JC.; DiClemente, CC. Changing for good. New York: Morrow; 1994. Raffle, H. Choosing a community readiness tool. Ohio Promoting Wellness and Recovery (OPEC); 2011. Retrieved May 15, 2015 from http://mha.ohio.gov/Portals/2/assets/SPF%20Phases/ Assessment/5_Community_Readiness_Tools.pdf Riemsma RP, Pattenden J, Bridle C, Sowden AJ, Mather L, Watt IS, Walker. Systematic review of the effectiveness of stage based interventions to promote smoking cessation. British Medical Journal. 2003; 326:1175–1177. [PubMed: 12775617] Rogers, EM. Diffusion of Innovations. 4th. New York: Free Press; 1995. SAMHSA. Results from the 2006 National Survey on Drug Use and Health: National findings. Office of Applied Studies, NSDUH Series H-32. Rockville, MD: 2007. SAMHSA. Substance Abuse Prevention Media Campaigns. 2015a. Retrieved June 4, 2015, from https://captus.samhsa.gov/access-resources/substance-abuse-prevention-media-campaigns SAMHSA. About the Strategic Prevention Framework (SPF). 2015b. Retrieved June 4, 2015, from https://captus.samhsa.gov/access-resources/about-strategic-prevention-framework-spf#Step1 Stallones L, Gibbs-Long J, Gabella B, Kakefuda I. Community readiness and prevention of traumatic brain injury. Brain Injury. 2008; 22:555–564. [PubMed: 18568708] J Alcohol Drug Educ. Author manuscript; available in PMC 2016 December 01.
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Tri-Ethnic Center for Prevention Research. Community Readiness for Community Change, Tri-Ethnic Center Community Readiness Handbook. 2nd. Fort Collins, CO: Tri-Ethnic Center for Prevention Research; 2014. Available at: http://triethniccenter.colostate.edu/communityReadiness_home.htm West R. Time for a change: putting the Transtheoretical (Stages of Change) model to rest. Addiction. 2005; 100:1036–1039. [PubMed: 16042624] Willis, GB. Cognitive interviewing: A “how to” guide. Research Triangle Institute; 1999. Retrieved June 4, 2015, from http://www.hkr.se/pagefiles/35002/gordonwillis.pdf
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Figure 1.
Survey item development process using the item about safe storage as an example
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FIGURE 2.
Community Readiness Survey for Prescription Drug Abuse©
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J Alcohol Drug Educ. Author manuscript; available in PMC 2016 December 01. M = 187
*M = 48
Average coalition size
1 M = 92,472 SD = 169,186
2
No
9
0
4
6
0
10
0
0
M = 154,311 SD = 257,847
28
Yes
14
Rural
Urban 11
2 10
Midwest
Suburban
6
7
West North East
15
M = 42.2 SD = 12.59
M = 48.07 SD = 13.27 South
1
1
0
Other
1
0
0
3
American Indian or Alaskan Native
0
Native Hawaiian or Pacific Islander
0
Asian
0
2
4
African American
8
7
3
Hispanic
20
22
8
White
Female
Male
Average size of communities served
Has the coalition been working on prescription drug misuse in the community?
**Types of communities served by coalition
Coalition Region
Age
Race
Gender
Preliminary Interviews n = 30
Cognitive Interviews n = 10
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Characteristics
M = 91
M = 272,788 SD = 509,659
8
22
15
16
16
24
0
5
1
M = 45.29 SD = 10.64
0
1
0
0
0
6
23
22
8
Acceptance/ Pretesting n = 30
M = 87.85
M = 173,190 SD = 373,740
11
59
29
31
32
26
16
12
16
M = 45.18 SD = 12.17
2
1
3
3
0
10
51
51
19
Total Sample n = 70
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Participant Characteristics (N = 70)
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Table 1 Trudeau Page 25
M = 9.7 SD = 5.54
M = 7.4 SD = 6.01
M = 31 SD = 39.87
SD = 126.38
Acceptance/ Pretesting n = 30
M = 8.20 SD = 5.54
M = 25.66 SD = 4.53
SD = 123.15
Total Sample n = 70
Note 3: 59 Coalitions were represented among the 70 participants (16% overlap). No more than 3 members represented any one coalition.
Note 2: Participants could indicate multiple response options. All data are based off a total of 92.
Note 1: These data are based on reports from 28 members; two outliers were dropped (5,000 and 1 million)
**
*
M = 8.9 SD = 5.06
Average coalition age (in years)
M = 22 SD = 14.19
SD = 205.98
*SD = 42.13 M = 24 SD = 28.72
Author Manuscript Average number of organizations represented
Cognitive Interviews n = 10
Author Manuscript Preliminary Interviews n = 30
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Characteristics
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J Alcohol Drug Educ. Author manuscript; available in PMC 2016 December 01.
J Alcohol Drug Educ. Author manuscript; available in PMC 2016 December 01. Published in final edited form as: J Alcohol Drug Educ. 2015 December ; 59(3): 67–90.
Development of a Community Readiness Survey for Coalitions to Address Prescription Opioid Misuse Kimberlee J. Trudeau, Ph.D. Inflexxion, Inc.
Abstract Author Manuscript
A community readiness survey for coalitions to address the growing epidemic of prescription opioid misuse was developed in this four-part study. A total of 70 coalition members participated. 1) We conducted 30-minute phone interviews with coalition members (n=30) and a literature review to develop an item list. 2) Coalition members rated these 60 items for three criteria: importance, confidence in own answer, confidence in others’ answer. 3) Highly rated items were included in a revised survey that was tested with coalition members (n=10) using in-person cognitive interviewing to assess how coalition members were interpreting the questions. 4) Lastly, pre-testing and satisfaction testing with additional coalition members (n=30). Most (83%) of the respondents reported positive overall impressions of the survey.
Keywords
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coalition; drug; readiness; survey; prescription; opioid; misuse There is a prescription drug overdose epidemic in the United States (CDC 2012; ONDCP, 2014). Prescription opioids, widely available and easily obtained by young people, offer an inexpensive means of altering one’s mental and physical state. For these reasons, prescription opioids have become an increasingly popular drug option in younger age groups. Meanwhile, the dangers of prescription drug misuse are not well-understood: As Dr. Volkow stated in testimony to the U.S. Congress last year, “Because prescription drugs are safe and effective when used properly and are broadly marketed to the public, the notion that they are also harmful and addictive when abused can be a difficult one to convey” (Department of Health and Human Services, 2014).
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Early efforts to reduce prescription opioid misuse/abuse within communities utilized a general approach, including predominantly non-targeted educational interventions. There have been both local (Georgia’s http://genrx.us/; Utah’s http://www.useonlyasdirected.org/ campaign) and national (e.g., http://www.awarerx.org/; http://www.upandaway.org/) public awareness campaigns (SAMHSA, 2015a). The Governor’s Opioid Working group in Massachusetts is currently launching a Stop Addiction in its Tracks media campaign to educate parents about how to prevent opioid misuse (http://www.mass.gov/eohhs/gov/
CONTACT INFORMATION: Kimberlee J. Trudeau, Ph.D., Inflexxion, Inc., 320 Needham St., Newton, MA 02464, [email protected].
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departments/dph/stop-addiction/stop-addiction-campaigns.html). In addition, many organizations, including the Office of National Drug Control Policy (ONDCP) have responded to this emerging public health problem by developing research reports (e.g., “Prescription for Danger;” 2008) as a means of drawing public awareness to the problem. For example, a report on Prescription Drug Abuse (NIDA, 2014) is included within the NIDA Research Report series which “simplifies the science of research findings for the educated lay public, legislators, educational groups, and practitioners.” There are also resources available on the Web; for example, the nonprofit organization Partnership for Drug-Free Kids (2015), formerly known as Partnership for a Drug-Free America, has comprehensive resources on their website pertaining to prescription drug abuse. These information-based resources are useful, but require significant publicity to reach their target audience; they may not be specific enough to change public attitudes and behaviors, because the public may not be ready to hear these messages.
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It is necessary to address educational and prevention messages in such a way that local communities can come to a consensus to set goals and respond effectively to prescription opioid misuse andabuse. Community anti-drug coalitions offer a potential avenue for such intervention due to their understanding of local needs, links to the community, and knowledge of local abuse prevention resources. Community members working together within a coalition can maximize their resources, increase their reach across the community, have greater credibility, and provide more information-sharing opportunities (Cohen et al., 2002). In addition, coalitions can: a) affect more distal population-level outcomes; b) bring about community-wide behavior change; and c) bring about changes in the community (Roussos & Fawcett, 2000).
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Coalitions have been eligible for funding from the Congress-enacted Drug-Free Communities Support Program (DFC) since 1997. The goal of DFC funding is to reduce substance use and strengthen community collaborations. Use of the Strategic Prevention Framework (SPF) is now required by DFC grantees to build the infrastructure required for effective prevention planning; consequently, many government agencies and nonprofit organizations are using this framework. The first step of the SPF is to assess community needs and resources, including community readiness, to address the problem (SAMHSA, 2015b).
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The Community Readiness Model is a theory-based method to increase collaboration and cohesion with a coalition through awareness of members’ readiness for change. The Community Readiness Model (Edwards et al., 2000; Oetting et al., 1995; Oetting et al., 2001) suggests that communities are at one of nine stages of readiness to address local problems. The stages are: No awareness; Denial/Resistance; Vague Awareness; Preplanning; Preparation; Initiation; Stabilization; Expansion/Confirmation; and Community Ownership (Tri-Ethnic Center for Prevention Research, 2014). To develop Community Readiness Model, researchers at the Tri-Ethnic Center at Colorado State University (Edwards et al., 2000; Oetting et al., 1995; Oetting et al., 2001) drew on several theories of community development, including Rogers’ (1995) Diffusion of Innovations model, Beal’s (1964) Social Action Process, as well as a stage-based theory of
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behavior change among individuals, Prochaska’s Stages of Change Model (Prochaska et al., 1994). Although Prochaska’s stage-based model for behavior change among individuals has come under criticism in recent years (Callaghan et al., 2007; Riemsma et al., 2003; West, 2005), the Community Readiness Model has gained a wide degree of acceptance and usage among community researchers and practitioners in diverse communities.
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Since the model was developed in the mid-1990s, more than 150 rural and ethnic communities have used it to develop drug prevention strategies; the model has also been applied to impact diverse problems such as domestic violence, child abuse, head injuries, HIV/AIDS, suicide prevention (Plested et al., 2006), and, more recently, healthy eating and drinking (Kesten et al., 2013). A study focusing on traumatic brain injury found that the Community Readiness Model identifies counties more likely to engage in prevention, and that readiness changes where programs are initiated (Stallones et al., 2008); these results suggest that readiness can be considered a proxy for community change.
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Community readiness has been measured through structured in-person key informant interviews using the Community Readiness Scale (CRS; Oetting et al., 1995); the CRS includes questions on five dimensions: Community Knowledge of the Issue; Community Knowledge of Efforts; Community Climate; Leadership; and Resources. This model has been applied in a broad range of racial/ethnic communities. Ultimately, this assessment provides targeted interventions for each readiness stage; however, in-person interviews are costly in resources (time, money, and people) for organizations that are not well-funded. A few readiness surveys exist as well (Raffle, 2011). For example, the Community Key Leader Survey (Goodman & Wandersman, 1996) is a 40-item survey with various Likert-scale response options regarding personal and organizational awareness of and involvement in alcohol and other drug prevention efforts. Unfortunately, existing community readiness surveys are not targeted toward the unique issues of prescription opioid misuse and abuse. The goal of this project was to develop items for a community readiness survey to help coalitions collect data that could be used to inform their efforts to address prescription opioid misuse and abuse in their communities.
Methods & Results
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Funded by NIH, this project was conducted in four steps in 2010. Each step is described below. A total of 70 coalition members from 59 different coalitions participated in the various parts of this study. The inclusion criteria were: (1) currently a member of an antidrug community coalition; (2) experience with the coalition (i.e., worked with the coalition for at least one year, for a minimum of one hour per month); (3) at least 18 years old; (4) willing to give informed consent; and (5) English speaking. Recruitment Nationwide participants were recruited through: (1) email outreach to anti-drug coalitions across the four U.S. census geographical areas (Northeast, Midwest, West, South) via 2008/2009 Community Anti-Drug Coalitions of America (CADCA) attendee lists; (2) our extensive contacts with substance abuse treatment centers and health agencies; and (3)
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recruiting coalition members at professional conferences. Participants from local coalitions (for the in-person cognitive interviews) were recruited by identifying local coalitions through web searching and by contacting local town halls and mayor’s offices. All participants were invited to share the recruitment information with their colleagues (e.g., via coalition listservs, personal email, meetings, etc.). Study procedures were approved by the New England Institutional Review Board. Participants
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A total of 70 coalition members participated in this four-part study. The group of 70 individuals consisted of 51 women (73%) and 19 men (27%), with 51 (73%) respondents identifying themselves as Caucasian, 10 (14%) as African American, 3 (4%) as American Indian or Alaskan Native, 3 (4%) as Hispanic, 1 (1%) Pacific Islander, and 2 (3%) as “Other”. The mean age of all 70 participants was 45.26 years (range from 22 to 74, SD=12.55). Coalitions The coalitions represented by the 70 participants throughout the four parts of the study included 23% located in the South, 17% in the West, 23% in the Northeast, and 37% in the Midwest (per the U.S. Census map region categories); 32 coalitions (35%) served urban areas, 31 coalitions (34%) served suburban areas, and 29 coalitions (32%) served rural areas [note: some served more than one area type]. Participants reported a mean of 48.25 active members in their coalitions (range from 8 to 200, SD=42.14). See demographic data by study task in Table 1. Step 1. Initial Interviews
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Procedures: We conducted 30-minute phone interviews with coalition members (n=30) about how coalitions function. All 30 participants were asked about challenges and concepts for survey items. The first 15 interviews were about coalition strategies to assess and address prescription drug abuse in their communities. The last 15 interviews were about how coalitions currently conduct surveys. A list of 60 different concepts for items for the readiness survey were generated during the interviews and a literature review. Each participant was paid $75 for participating in the interview.
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Results: Sixty percent of the 30 respondents reported that prescription drug abuse was listed among the “top 3 issues” that their coalitions are working on. The most common challenges that impeded coalitions’ (n=30) ability to address issues in their communities included lack of: funding (43%); coordination between schedules for meeting/planning (40%); and staff/ volunteers (30%). During the interviews about strategies (n=15), 87% said that community attitudes were a challenge in addressing prescription drug abuse in their communities: People think that prescription drugs are safe because they are legal, or people are in denial that there is a local problem. Seventy-three percent of the coalitions (n=15) stated that they conduct surveys. When asked during the interviews about their current experiences with carrying out surveys, the majority of the respondents (8 out of the 11) conduct them via paper, and 6 of the 11 have conducted them online. These findings suggested that there was a need and a desire by coalition members for the proposed program. In addition, data from J Alcohol Drug Educ. Author manuscript; available in PMC 2016 December 01.
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these interviews helped to develop categorical responses to questions in the readiness survey (e.g., How does a community know if there is a prescription drug problem in the community? Responses: through community needs assessment; focus groups; student survey; hospital or emergency room discharge data; police reports; medical examiner reports; etc.). In Figure 1, see the evolution of a sample item about safe storage of prescription drugs, starting with two quotations from the Step 1 interviews. Step 2. Item Rating
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Procedures: Sixty different concepts for items for the readiness survey were generated from the 30-minute interviews with 30 coalition members, a review of the literature, and consultant feedback. To maintain compatibility between this survey and community readiness theory, the following domains from the Tri-ethnic Center’s Community Readiness model (Edwards et al., 2000; Oetting et al., 1995; Oetting et al., 2001) were used to organize the items: Community Climate; Community Knowledge of Issue; Community Knowledge of Efforts; Leadership; and Resources. Twenty-seven out of thirty coalition members rated these 60 items for importance, confidence in their ability to answer accurately, and confidence in others’ ability to answer accurately on a scale of 1=Not at all to 5 = Extremely. Participants were paid $75 for completing the online ratings. Results: Forty-three items for which at least 2/3 variables received a 3, 4, or 5 from at least 70% or more of the 27 participants were revised based on discussion with consultants and further review of the theory and interview data. Version 1 of the survey included a total of 49 readiness items (plus 6 demographic items). Step 3. Cognitive Interviews
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Procedures: Version 1 of the survey was tested with new participants (n=10) using inperson cognitive interviewing, a method in which the respondent’s interpretation of each item is discussed (Willis, 1999). The questions and interview protocol were revised multiple times during the cognitive interview process, as we gained insight about how coalition members were interpreting the questions.
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Results: First, we learned that the screen out question “Are you a member of [INSERT COALITION NAME]” was too limiting. Community members who were interested in the topic (and therefore on the email list) may not self-identify as coalition members and then automatically screen out. It was important to collect data from both active (e.g., go to meetings) and passive members (e.g., receive emails, newsletters, or other updates.”) to ensure that we captured insights about community readiness from as many stakeholders as possible. Therefore, the screen out question was revised to: “What is your role in [INSERT COALITION NAME]” with various options provided indicating levels of involvement. The survey included a question regarding safe storage and disposal of prescription drugs. During cognitive testing, these began as knowledge questions (e.g., How can people safely store their prescription drugs?) followed by behavior questions (e.g., Safe storage of prescription drugs includes both keeping track of medicine – where they are and how much you have left – as well as keeping them away from others. How often do you safely store
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your prescription drugs?). These questions seemed to pull for positive responses. Upon review, it was decided that to get at community readiness it was necessary to ask about attitudes not knowledge: “Do you think that people in [CITY/TOWN] know that how well they keep prescription drugs away from others and how they get rid of prescription drugs when they do not need them anymore can influence the local rate of prescription drug abuse?” See Figure 1.
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A systematic change implemented throughout the survey draft was the following: several preliminary yes/no questions that were followed by category-based questions were replaced by including a “no” category (e.g., I am not a part of any of these community groups”). These changes both reduced the total number of items and increased the clarity of the types of responses that were associated with a “yes” response. The specific response categories were clarified and augmented based on participant feedback as well. For example, additional consequences of prescription drug abuse that were suggested were; more suicides, more poverty, and more unwanted pregnancies. Version 2 of the survey for use in pretesting included a total of 36 readiness items plus 7 demographic items. See Figure 2. Step 4. Pretesting and Satisfaction Testing Procedures: To test version 2 of this survey 30 new participants completed the survey independently at a predetermined time. Then they were called to answer survey pretesting questions about their experience taking the survey. After pre-testing, they were sent a link to a prototype of a survey administration program that included satisfaction testing questions. There were two phases of item iteration during pretesting; based on input from the first 10 participants, we revised some of the questions for testing with the last 20 participants.
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Results: All 30 respondents completed the survey in one sitting. The first version of the survey took 27 minutes (range from 12 to 50 minutes, SD=11.6). The revised survey took 23 minutes (range from 11 to 38 minutes, SD=8.3). [NOTE: The survey took longer for some participants because they were asked to take notes about questions they wanted to comment on during the pretesting interview; therefore it is not an accurate representation of how long it would take to do the survey alone].
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According to the pretesting results, 83% of the respondents reported positive overall impressions of the survey (e.g., “easy to use,” “well organized,” and “led to critical thinking about the issue”). Criticisms included: a few recurring issues regarding the wording of select items; online formatting; and one case of item-ordering that disrupted the survey flow; these suggestions were incorporated into the final survey (36 readiness items plus 7 demographic items). The final draft of the survey to assess community readiness to address prescription opioid misuse is included in Figure 2. Almost half of the respondents (41%) indicated that if these questions were asked by their coalition, they would want their responses to remain anonymous. Specific ways for how the results of the survey could be used to come up with program goals and activities were identified by 26/30 participants: define problem and select targets to approach (23%); provide evidence of their work (19%); determine coalition level of awareness (19%);
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identify gaps in policy/programs (15%); help adapt to issues/plan ahead (15%); and help apply for grants (8%).
Discussion
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Educational interventions are ineffective in communities that are disinterested in change (Wagenaar & Perry, 1994), so it is important to utilize interventions that are specific to the community’s level of readiness. The value of connecting resources to readiness has had policy implications: Grant recipients of the Congress-enacted Drug-Free Communities Support Program are mandated to use the Strategic Prevention Framework (SPF) (SAMHSA, 2015b) which includes a readiness assessment. The original Community Readiness Model assessment interview requires extensive resources because it requires conducting 20–60 minute interviews, transcription of those interviews, followed by the scoring of each interview by two independent raters (Tri-Ethnic Center for Prevention Research, 2014). These time and money-intensive requirements may be a barrier for a coalition to use the assessment and/or a barrier to participation by many valuable potential key respondents. In contrast, the new Community Readiness Survey for Prescription Drug Abuse is a 15minute self-report assessment that was developed with input from a total of 70 coalition members over a four-step process: item generation interviews, evaluation of each item for importance on a scale of 1=Not at all to 5 = Extremely, cognitive interviewing, and pretesting interviews. This new 42-item survey is: (1) short (takes less than 15 minutes to complete); and (2) theory-based (i.e., the Community Readiness Model); and (3) received positive reviews by coalition members.
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The results of this survey could help coalitions identify where and how to intervene on the issue of prescription opioid misuse given that coalitions may have limited resources (time, staff) and multiple key stakeholders who may have diverse agendas. In addition, Feinberg et al., (2004) found that internal coalition functioning mediated the significant relationship between readiness and perceived effectiveness of the coalition’s efforts, suggesting that a readiness tool can positively impact coalition effectiveness by improving coalition functioning. This survey is a data-gathering tool about factors specifically associated with community readiness to address prescription opioid misuse. With this information, coalition leaders may have direction to inform next steps to employ in their community. For example, if the descriptive data show that many participants responded “no” to “Do you think that people in [Town/City/County] realize that the way they store and dispose of prescription drugs can influence the local rate of prescription drug abuse?” then a next step might be to provide public education on the local rate of prescription drug abuse with information about safe storage of medications.
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Limitations This project has several limitations. Unlike the CRM assessment which can be customized to assess community readiness to address a specific community problem (Tri-Ethnic Center for Prevention Research, 2014), these items only apply to prescription drug misuse. The wording of the survey items were derived and tested with a convenience sample of coalition
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members. In addition, the survey has no scoring instructions and has not been validated. In comparison, the original Community Readiness Model developed by the Tri-Ethnic Center has scoring instructions to assess a linear, stage-based model (Plested et al., 2006) that advises matching intervention strategies by stage. Recent research on community coalitions in Wisconsin found that non-stage specific interventions for alcohol abuse prevention were effective in increasing community readiness (Paltzer et al., 2013), suggesting that a descriptive versus linear approach to improving community readiness has potential. Future Directions
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In summary, this study provides the opportunity to apply the original Community Readiness Model to a current community issue, prescription opioid misuse and abuse, with a new, selfreport community assessment. Coalitions are invited to use and collate descriptive results per item to help develop community-specific strategies to address prescription opioid misuse. These items could be added to an online survey platform for dissemination to community members. For example, the Community Key Leader Survey (Goodman & Wandersman, 1996) has been disseminated to communities in Indiana via Survey Monkey. Participation in Community Readiness evaluations raised awareness of the abuse of inhalants and other harmful legal products in the Alaskan communities in which they were conducted (Ogilvie et al., 2008); hopefully, at minimum, use of this new readiness survey to address prescription opioid misuse will contribute to coalitions’ success at that important objective for improving community prevention efforts in this area.
Acknowledgments Author Manuscript
This project was funded by NIDA/NIH grant # 1R43DA026224. First, I would like to acknowledge the coalition members who voluntarily participated in this study to help develop this readiness survey. I would also like to thank the research team -- Meredith Trant, M.S.W., Daniel Surette, B.A., Mollie Wood, M.P.H., & Emil Chiauzzi, Ph.D. – and our four consultants: Ray Bullman, M.A.M., Mark Feinberg, Ph.D. Ronda Zakocs, Ph.D., M.P.H., and Patricia Gallagher, Ph.D. Lastly, I appreciate the constructive feedback from two anonymous reviewers.
References
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Beal, GM. Social action: Instigated social change in large social systems. In: Copp, JH., editor. Our changing rural society: Perspectives and trends. Ames, Iowa: Iowa State University Press; 1964. p. 233-264. Callaghan RC, Taykor L, Cunningham JA. Does progressive stage transition mean getting better? A test of the Transtheoretical Model in alcoholism recovery. Addiction. 2007; 102:1588–1596. [PubMed: 17915357] Centers for Disease Control. CDC Grand Rounds: Prescription Drug Overdoses — a U.S. Epidemic. Morbidity and Mortality Weekly Report. 2012; 6:10–13. Retrieved May 26, 2015, from http:// www.cdc.gov/mmwr/preview/mmwrhtml/mm6101a3.htm. Cohen, L.; Baer, N.; Satterwhite, P. Developing effective coalitions: An eight step guide. In: Wurzback, ME., editor. Community Health Education & Promotion: A Guide to Program Design and Evaluation. 2nd. Gaithersburg, MD: Aspen Publishers Inc; 2002. p. 144-161. Department of Health and Human Services. National Institutes of Health. Testimony by Nora Volkow, MD. Director. National Institute on Drug Abuse; 2014. Prescription opioid and heroin abuse. Retrieved June 4, 2015, from http://www.drugabuse.gov/about-nida/legislative-activities/testimonyto-congress/2014/prescription-opioid-heroin-abuse#39 Edwards RW, Jumper-Thurman P, Plested BA, Oetting ER, Swanson L. Community readiness: Research to practice. Journal of Community Psychology. 2000; 28:291–307.
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Feinberg ME, Greenberg MT, Osgood DW. Readiness, functioning, and perceived effectiveness in community prevention coalitions: A study of Communities That Care. American Journal of Community Psychology. 2004; 33:163–176. [PubMed: 15212176] Goodman, R.; Wandersman, A. Community Key Leader Survey. 1996. Retrieved May 26, 2015, from http://www.drugs.indiana.edu/spf/page.php?category=Assessment#Readiness-tab Kesten JM, Cameron N, Griffiths PL. Assessing community readiness for overweight and obesity prevention in pre-adolescent girls: A case study. BMC Public Health. 2013; 13:1205. [PubMed: 24359213] NIDA. Research Report Series: Prescription drug abuse. 2014. Retrieved May 26, 2015, from http:// www.drugabuse.gov/publications/research-reports/prescription-drugs/what-prescription-drugabuse Oetting ER, Donnermeyer JF, Plested BA, Edwards RW, Kelly K, Beauvais F. Assessing community readiness for prevention. The International Journal of the Addictions. 1995; 30:659–683. [PubMed: 7657396] Oetting ER, Jumper-Thurman P, Plested B, Edwards RW. Community readiness and health services. Substance Use and Misuse. 2001; 36:825–843. [PubMed: 11697613] Office of National Drug Control Policy. Prescription for Danger A Report on the Troubling Trend of Prescription and Over-the-Counter Drug Abuse Among the Nation’s Teens. 2008. Retrieved June 4, 2015, from http://www.decp.org/documents/pdfs/WhatNew/prescription_report.pdf Office of National Drug Control Policy. Epidemic: Responding to America’s Prescription Drug Abuse Crisis. 2011. Retrieved May 26, 2015, from https://www.whitehouse.gov/sites/default/files/ondcp/ policy-and-research/rx_abuse_plan.pdf Office of National Drug Control Policy. Fact Sheet: Opioid Abuse in the United States. 2014. Retrieved May 26, 2015, from https://www.whitehouse.gov/sites/default/files/ondcp/Fact_Sheets/ opioids_fact_sheet.pdf Ogilvie KA, Moore RS, Ogilvie DC, Johnson KW, Collins DA, Shamblen SR. Changing community readiness to prevent the abuse of inhalants and other harmful legal products in Alaska. Journal of Community Health. 2008; 33:248–258. [PubMed: 18392927] Paltzer J, Black P, Moberg DP. Evaluating community readiness to implement environmental and policy-based alcohol abuse prevention strategies in Wisconsin. Journal of Alcohol and Drug Education. 2013; 57(3):27–50. [PubMed: 25346555] Partnership at Drugfree.org and MetLife Foundation. 2012 Partnership Attitude Tracking Survey (PATS). Teens and parents report. 2013. Retrieved June 4, 2015, from http://www.drugfree.org/wpcontent/uploads/2013/04/PATS-2012-FULL-REPORT2.pdf Partnership for a Drug-Free Kids. Guides and resources. 2015. Retrieved June 4, 2015, from http:// www.drugfree.org/resources/ Plested, BA.; Edwards, RW.; Jumper-Thurman, P. Community Readiness: A handbook for successful change. Fort Collins, CO: Tri-Ethnic Center for Prevention Research; 2006 Apr. Prochaska, JO.; Norcross, JC.; DiClemente, CC. Changing for good. New York: Morrow; 1994. Raffle, H. Choosing a community readiness tool. Ohio Promoting Wellness and Recovery (OPEC); 2011. Retrieved May 15, 2015 from http://mha.ohio.gov/Portals/2/assets/SPF%20Phases/ Assessment/5_Community_Readiness_Tools.pdf Riemsma RP, Pattenden J, Bridle C, Sowden AJ, Mather L, Watt IS, Walker. Systematic review of the effectiveness of stage based interventions to promote smoking cessation. British Medical Journal. 2003; 326:1175–1177. [PubMed: 12775617] Rogers, EM. Diffusion of Innovations. 4th. New York: Free Press; 1995. SAMHSA. Results from the 2006 National Survey on Drug Use and Health: National findings. Office of Applied Studies, NSDUH Series H-32. Rockville, MD: 2007. SAMHSA. Substance Abuse Prevention Media Campaigns. 2015a. Retrieved June 4, 2015, from https://captus.samhsa.gov/access-resources/substance-abuse-prevention-media-campaigns SAMHSA. About the Strategic Prevention Framework (SPF). 2015b. Retrieved June 4, 2015, from https://captus.samhsa.gov/access-resources/about-strategic-prevention-framework-spf#Step1 Stallones L, Gibbs-Long J, Gabella B, Kakefuda I. Community readiness and prevention of traumatic brain injury. Brain Injury. 2008; 22:555–564. [PubMed: 18568708] J Alcohol Drug Educ. Author manuscript; available in PMC 2016 December 01.
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Tri-Ethnic Center for Prevention Research. Community Readiness for Community Change, Tri-Ethnic Center Community Readiness Handbook. 2nd. Fort Collins, CO: Tri-Ethnic Center for Prevention Research; 2014. Available at: http://triethniccenter.colostate.edu/communityReadiness_home.htm West R. Time for a change: putting the Transtheoretical (Stages of Change) model to rest. Addiction. 2005; 100:1036–1039. [PubMed: 16042624] Willis, GB. Cognitive interviewing: A “how to” guide. Research Triangle Institute; 1999. Retrieved June 4, 2015, from http://www.hkr.se/pagefiles/35002/gordonwillis.pdf
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Figure 1.
Survey item development process using the item about safe storage as an example
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FIGURE 2.
Community Readiness Survey for Prescription Drug Abuse©
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J Alcohol Drug Educ. Author manuscript; available in PMC 2016 December 01. M = 187
*M = 48
Average coalition size
1 M = 92,472 SD = 169,186
2
No
9
0
4
6
0
10
0
0
M = 154,311 SD = 257,847
28
Yes
14
Rural
Urban 11
2 10
Midwest
Suburban
6
7
West North East
15
M = 42.2 SD = 12.59
M = 48.07 SD = 13.27 South
1
1
0
Other
1
0
0
3
American Indian or Alaskan Native
0
Native Hawaiian or Pacific Islander
0
Asian
0
2
4
African American
8
7
3
Hispanic
20
22
8
White
Female
Male
Average size of communities served
Has the coalition been working on prescription drug misuse in the community?
**Types of communities served by coalition
Coalition Region
Age
Race
Gender
Preliminary Interviews n = 30
Cognitive Interviews n = 10
Author Manuscript
Characteristics
M = 91
M = 272,788 SD = 509,659
8
22
15
16
16
24
0
5
1
M = 45.29 SD = 10.64
0
1
0
0
0
6
23
22
8
Acceptance/ Pretesting n = 30
M = 87.85
M = 173,190 SD = 373,740
11
59
29
31
32
26
16
12
16
M = 45.18 SD = 12.17
2
1
3
3
0
10
51
51
19
Total Sample n = 70
Author Manuscript
Participant Characteristics (N = 70)
Author Manuscript
Table 1 Trudeau Page 25
M = 9.7 SD = 5.54
M = 7.4 SD = 6.01
M = 31 SD = 39.87
SD = 126.38
Acceptance/ Pretesting n = 30
M = 8.20 SD = 5.54
M = 25.66 SD = 4.53
SD = 123.15
Total Sample n = 70
Note 3: 59 Coalitions were represented among the 70 participants (16% overlap). No more than 3 members represented any one coalition.
Note 2: Participants could indicate multiple response options. All data are based off a total of 92.
Note 1: These data are based on reports from 28 members; two outliers were dropped (5,000 and 1 million)
**
*
M = 8.9 SD = 5.06
Average coalition age (in years)
M = 22 SD = 14.19
SD = 205.98
*SD = 42.13 M = 24 SD = 28.72
Author Manuscript Average number of organizations represented
Cognitive Interviews n = 10
Author Manuscript Preliminary Interviews n = 30
Author Manuscript
Characteristics
Trudeau Page 26
Author Manuscript
J Alcohol Drug Educ. Author manuscript; available in PMC 2016 December 01.
