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“There are things I want to say but you do not ask”: a comparison between standardised and individualised evaluations in substance use treatment

Publication . Alves, Paula Cristina Gomes; Sales, Célia Maria Dias; Ashworth, Mark; Faisca, Luis

There has been an increasing call for service users to be more actively involved with the evaluation of treatment outcomes. One strategy to impove such involvement is to ask service users to contribute with their own criteria for evaluation by sharing their personal story and perspective about their clinical situation. In this cross-sectional study, we contrasted the contents elicited by service users completing two individualised measures against the contents of three widely used standardised measures. We also compared two methods to generate individualised data using self-report and interview-based instruments (PSYCHLOPS and PQ). Following a thematic comparison approach, we found that one quarter of the problems reported by patients in individualised measures were not covered by any of our standardised comparators. Also, half of our sample generated at least one problem whose theme was not covered by any of the three standardised measures. We also found that patients in this population have many other concerns beyond drug use. These included psychological (e.g. interpersonal relationships) and socio-economic (e.g. money) problems, which were frequently reported. Our study suggests that listening to service users’ stories allows us to capture issues of importance to service users in substance use treatment, which may be underestimated by standardised measures.

2018Journal article

Open Access

Personalising outcome measurement in substance misuse treatment: the feasibility and psychometrics of two individualised outcome measures

Publication . Alves, Paula; Faisca, Luis; Sales, Célia M. D.; Ashworth, Mark

Individualised information in substance misuse treatment complements standardised outcome measures. However, few studies investigate the use of individualised measures and their robustness in terms of quantifying outcomes. In this study, we analysed the psychometrics and feasibility of two individualised outcome measures (PQ and PSYCHLOPS). We followed a cross-sectional methodology, administering the individualised measures and three additional standardised measures (TOP, a measure of psychological health within addiction services; PHQ-9; CORE-OM) to a sample of 93 patients entering substance misuse treatment in four clinical services. The results showed high levels of patient acceptability of the two individualised measures (response rates > 95%). The internal reliability was good for both PQ and PSYCHLOPS (Cronbach’s alpha, .79 and .72, respectively). Convergent validity of PQ with standardised measures was weak: Pearson’s r values for TOP (psychological health), PHQ-9 and CORE-OM were .21, .22 and .27, respectively. In contrast, convergent validity of PSYCHLOPS was moderate: r = .40, .39 and .50, respectively. Convergence between PQ and PSYCHLOPS was weak (r = .28). Experience of previous treatment episodes was associated with higher PQ and PSYCHLOPS scores; PSYCHLOPS but not PQ scores were higher among those opting to complete the questionnaires in written rather than verbal format. Our findings demonstrated that PQ and PSYCHLOPS are reliable and feasible individualised outcome measures for use in substance misuse treatment units, although the lack of strong convergent validity indicates that they may be measuring different underlying constructs. Optimal outcome measurement may involve combining individualised and standardised measures.

2020Journal article

Open Access