Doctor of Philosophy, The Ohio State University, 2023, Social Work
Background: Approximately 50% of individuals seeking treatment for substance use and mental health conditions in behavioral healthcare settings have a lifetime history of TBI affecting their ability to engage in behavioral health treatment. Identifying lifetime history of TBI using validated screening methods can optimize interventions for these individuals, however, TBI screening adoption has failed in these settings. Drawing on the Theory of Planned Behavior and Diffusion of Innovations Theory, this explanatory sequential mixed methods study aimed to improve our understanding about how provider characteristics (attitudes, subjective norms, perceived behavioral control (PBC), intentions), innovation-level factors (acceptability, feasibility, appropriateness), and contextual determinants affect TBI screening adoption in behavioral healthcare settings.
Methods: In Phase I, 215 behavioral health providers in the United States completed a training introducing the OSU TBI-ID, followed by a web-based survey assessing attitudes, PBC, subjective norms, and intentions to screen for TBI (Time 1). After one-month, providers completed a second survey assessing the number of TBI screens conducted, and the acceptability, feasibility, and appropriateness of TBI screening (Time 2). Data were analyzed using structural equation modelling with logistic regressions (SEM) and logistic regression with moderation effects. Results informed development of a qualitative interview guide. In Phase II, 20 providers from Phase I participated in interviews to build upon the quantitative results. Data were analyzed thematically and integrated with the quantitative results. Barriers to adoption were also identified and linked to constructs from the Consolidated Framework for Implementation Research (CFIR).
Results: Approximately 25% of providers adopted TBI screening, which was driven by motivations to trial the innovation. SEM demonstrated that more favorable attitudes toward TBI screening were (open full item for complete abstract)
Committee: Alicia Bunger (Advisor); Alan Davis (Committee Member); Jennifer Bogner (Committee Member)
Subjects: Behavioral Sciences; Health Care; Public Health; Social Research; Social Work