All ETDs from UAB

Advisory Committee Chair

Peter S Hendricks

Advisory Committee Members

Burel Goodin

Kevin Fontaine

Andrea Cherrington

Heith Copes

Document Type


Date of Award


Degree Name by School

Doctor of Philosophy (PhD) School of Public Health


The objective of this study was to understand and assess barriers and facilitators to the uptake of appropriate care for co-occurring chronic noncancer pain (CNCP) and opioid use disorder. Rates of CNCP and opioid overdose have doubled in the past decade. When a patient transitions from appropriate use to misuse, significant changes must be made to their treatment plan. Considering most CNCP is treated with opioids in the primary care setting, primary care providers (PCPs) are potential change agents to remediate the epidemic of opioid abuse. Although studies have explored opioid stewardship, we still lack an understanding of the factors influencing the treatment of CNCP and opioid use disorder together, when opioids are no longer appropriate. Guided by the Consolidated Framework for Implementation Research (CFIR), a semi-structured interview guide was developed and tested. A refined guide was used to explore multi-level factors influencing PCP’s uptake of best practices. Eleven PCPs participated in the interviews, which were audio-recorded and transcribed. Open-ended text from an online questionnaire were also abstracted for analyses. The CFIR codebook was applied to all text, and then reviewed and amended. The qualitative text, literature review, and guidance of an expert panel were then used to create a 44-item draft survey questionnaire. The questionnaire was administered to a national sample on 509 PCPs and analyzed for dimensionality, inter-item reliability Thematic analysis of interviews (N=11) and open-ended responses from the online questionnaire (N=9) revealed frequent barriers were available resources (staff, time, and alternative therapies), knowledge and training (addiction and/or pain management, attitudes towards opioids), and internal and external policies. While the most commonly cited facilitators were communication (ability to communicate/refer to specialists), knowledge of and access to alternative treatments, and the needs of the patients being served. Principal component analysis resulted in a 22-item questionnaire. Twelve more items were removed because of their influence on coefficient alphas, resulting in a 10-item questionnaire with 4 domains: Desire to Treat, Assessing Risk, Trust in Evidence, and Patient Access. The final questionnaire and scales demonstrated adequate validity and good inter-item reliability. Future steps include testing the questionnaire’s predictive validity.

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