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Assessing consumer perspectives on population need for substance use services Open Access


Other title
population need
substance use services
substance misuse
Type of item
Degree grantor
University of Alberta
Author or creator
Hyshka, Elaine E
Supervisor and department
Wild, T. Cameron (School of Public Health)
Examining committee member and department
Bubela, Tania (School of Public Health)
Nykiforuk, Candace (School of Public Health)
Raine, Kim (School of Public Health)
Cairney, John (Family Medicine, McMaster University)
Newtown, Amanda (Pediatrics)
Wild, T. Cameron (School of Public Health)
School of Public Health
Health Promotion & Socio-Behavioural Sciences
Date accepted
Graduation date
Doctor of Philosophy
Degree level
Effective substance use services often fail to reach many people experiencing drug or alcohol problems in the community. Recognition of this large treatment gap has stimulated efforts to better align service systems with existing population need. A growing body of research assesses population need by estimating the prevalence of substance use disorders using objective, expert-defined measures. Subjective, consumer-derived need measures have the potential to enhance this work and improve its relevance for service planning, but it is unclear how frequently consumer perspectives are incorporated into the literature on population need for substance use services. Additionally, few studies have assessed consumer perceptions of need amongst socially marginalized, hidden populations, despite their increased likelihood of experiencing substance use disorders and related harm. In light of these knowledge gaps, this dissertation had two broad objectives: (1) systematically describe and map the literature on population need for substance use services; and (2) examine consumer perceptions of service need among a sample of street-involved people who use drugs. Two studies addressed these objectives: a systematic scoping review assessing 1930 articles on population need for substance use services, and a survey of 320 street-involved people who use drugs. The vast majority of research on population need for substance use services prioritizes objective, expert- determined need estimates, with only a small fraction of studies reporting data on subjective need. Those studies that do assess consumer perspectives have several methodological and measurement weaknesses, including a tendency to estimate need for one type of service only, which limit their utility for system planning. When consumer perceptions are assessed across several service categories, street-involved people who use drugs report high rates of perceived unmet need and self-assessed barriers to services. However, participants’ levels of unmet need and barriers vary considerably across services, and socioeconomic marginalization and problem severity increase the likelihood of reporting unmet need for some services, but not others. Taken together these findings imply that different factors both predict and underlie perceived unmet need across various kinds of substance use services, and that a large proportion of extant research may not be capturing this complexity. There are a number of ways to improve research on consumer perspectives and population need for substance use services. In particular, the concept of subjective, consumer-defined need should be further refined and standardized instruments capable of assessing consumer perspectives across a variety of substance use service categories should be developed. This work is necessary to enable a more nuanced investigation of factors underlying the substance use disorder treatment gap for both general and hidden populations, and to improve the ability of research in this area to inform substance use service planning. Robust research on consumer perspectives within the literature on population need for services is overdue. An emerging public health approach to substance use provides an opportunity to unify and advance multidisciplinary research on consumer perspectives, and leverage their full potential to reduce the population burden of substance use disorders.
This thesis is made available by the University of Alberta Libraries with permission of the copyright owner solely for the purpose of private, scholarly or scientific research. This thesis, or any portion thereof, may not otherwise be copied or reproduced without the written consent of the copyright owner, except to the extent permitted by Canadian copyright law.
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