An implementation-focused process evaluation of an incentive intervention effectiveness trial in substance use disorders clinics at two Veterans Health Administration medical centers

Hildi J. Hagedorn, Cheryl B. Stetler, Ann Bangerter, Siamak Noorbaloochi, Maxine L. Stitzer, Daniel Kivlahan

Research output: Contribution to journalArticlepeer-review

16 Scopus citations


Background: One of the pressing concerns in health care today is the slow rate at which promising interventions, supported by research evidence, move into clinical practice. One potential way to speed this process is to conduct hybrid studies that simultaneously combine the collection of effectiveness and implementation relevant data. This paper presents implementation relevant data collected during a randomized effectiveness trial of an abstinence incentive intervention conducted in substance use disorders treatment clinics at two Veterans Health Administration (VHA) medical centers. Methods: Participants included patients entering substance use disorders treatment with diagnoses of alcohol dependence and/or stimulant dependence that enrolled in the randomized trial, were assigned to the intervention arm, and completed a post intervention survey (n = 147). All staff and leadership from the participating clinics were eligible to participate. A descriptive process evaluation was used, focused on participant perceptions and contextual/feasibility issues. Data collection was guided by the RE-AIM and PARIHS implementation frameworks. Data collection methods included chart review, intervention cost tracking, patient and staff surveys, and qualitative interviews with staff and administrators. Results: Results indicated that patients, staff and administrators held generally positive attitudes toward the incentive intervention. However, staff and administrators identified substantial barriers to routine implementation. Despite the documented low cost and modest staff time required for implementation of the intervention, securing funding for the incentives and freeing up any staff time for intervention administration were identified as primary barriers. Conclusions: Recommendations to facilitate implementation are presented. Recommendations include: 1) solicit explicit support from the highest levels of the organization through, for example, performance measures or clinical practice guideline recommendations; 2) adopt the intervention incrementally starting within a specific treatment track or clinic to reduce staff and funding burden until local evidence of effectiveness and feasibility is available to support spread; and 3) educate staff about the process, goals, and value/effectiveness of the intervention and engage them in implementation planning from the start to enhance investment in the intervention.

Original languageEnglish (US)
Article number12
JournalAddiction Science and Clinical Practice
Issue number1
StatePublished - Jan 27 2014

Bibliographical note

Funding Information:
This material is based on work supported by grant number IIR 03–120 from the Department of Veterans Affairs, Veterans Health Administration, Office of Research & Development, Health Services Research & Development. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government. The authors would like to express their gratitude to the following individuals for their contribution to this study: Nancy Rettmann, Lee Ann Heim, Tabitha Leighton, Eliza McManus, Evelina Marut, Alisha Baines Simon, Carl Isenhart, Brittney Hamilton, Tina Marie Schmidt, Michelle Ingalsbe, and Carl Rimmele.

Publisher Copyright:
© 2014 Hagedorn et al.; licensee BioMed Central Ltd.


  • Abstinence incentive intervention
  • Hybrid design
  • Implementation
  • Process evaluation
  • Substance use disorders treatment


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