Identifying barriers and enablers to opt-out hepatitis C virus screening in provincial prisons in Quebec, Canada: A multilevel, multi-theory informed qualitative study with correctional and healthcare professional stakeholders

Ana Saavedra Ruiz; Guillaume Fontaine; Andrea M Patey; Jeremy M Grimshaw; Justin Presseau; Joseph Cox; Camille Dussault; Nadine Kronfli

doi:10.1016/j.drugpo.2022.103837

Identifying barriers and enablers to opt-out hepatitis C virus screening in provincial prisons in Quebec, Canada: A multilevel, multi-theory informed qualitative study with correctional and healthcare professional stakeholders

Int J Drug Policy. 2022 Nov:109:103837. doi: 10.1016/j.drugpo.2022.103837. Epub 2022 Aug 26.

Authors

Ana Saavedra Ruiz¹, Guillaume Fontaine², Andrea M Patey³, Jeremy M Grimshaw⁴, Justin Presseau⁵, Joseph Cox⁶, Camille Dussault¹, Nadine Kronfli⁷

Affiliations

¹ Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, 2155 Guy Street, Suite 500, Montreal, QC, H3H 2R9, Canada.
² Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, L1255, Box 711, Ottawa, ON, K1H 8L6, Canada; Faculty of Medicine, University of Ottawa, 451 Smyth Road #2044, Ottawa, ON, K1H 8M5, Canada.
³ Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, L1255, Box 711, Ottawa, ON, K1H 8L6, Canada; School of Rehabilitation Therapy, Queen's University, Louise D Acton Building, 31 George St, Kingston, ON, K7L 3N6, Canada; School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Room 101, Ottawa, ON, K1G 5Z3, Canada.
⁴ Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, L1255, Box 711, Ottawa, ON, K1H 8L6, Canada; Faculty of Medicine, University of Ottawa, 451 Smyth Road #2044, Ottawa, ON, K1H 8M5, Canada; School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Room 101, Ottawa, ON, K1G 5Z3, Canada.
⁵ Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, L1255, Box 711, Ottawa, ON, K1H 8L6, Canada; School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Room 101, Ottawa, ON, K1G 5Z3, Canada; School of Psychology, University of Ottawa, 136 Jean-Jacques Lussier, Vanier Hall, Ottawa, ON, K1N 6N5, Canada.
⁶ Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, 2155 Guy Street, Suite 500, Montreal, QC, H3H 2R9, Canada; Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University Health Centre, 1001 Decarie boulevard-D02.4110, Montreal, QC, H4A 3J1, Canada; Department of Epidemiology and Biostatistics, School of Population and Global Health, Faculty of Medicine and Health Sciences, McGill University, 2001 McGill College Avenue, Suite 1200, Montréal, QC, H3A 1G1, Canada.
⁷ Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, 2155 Guy Street, Suite 500, Montreal, QC, H3H 2R9, Canada; Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University Health Centre, 1001 Decarie boulevard-D02.4110, Montreal, QC, H4A 3J1, Canada. Electronic address: [email protected].

PMID: 36030569
DOI: 10.1016/j.drugpo.2022.103837

Abstract

Background: Diffuse implementation of hepatitis C virus (HCV) treatment is dependent on universal screening for HCV, but screening strategies are heterogenous across prisons in the province of Quebec (Canada). We sought to identify barriers and enablers to universal opt-out HCV screening and to describe the multisectoral decision-making processes related to HCV screening in Quebec provincial prisons.

Methods: A multilevel, multi-theory informed qualitative descriptive approach was used to conduct semi-structured interviews. Interview guides and analyses with correctional stakeholders were informed by the Consolidated Framework for Implementation Research (CFIR) and those with healthcare professionals (HCPs) were based on the Theoretical Domains Framework (TDF). Directed content analysis was used to identify domains within CFIR and TDF reflecting barriers and enablers to opt-out HCV screening.

Results: Sixteen interviews (correctional stakeholders: n = 8; HCPs: n = 8) were conducted in April-May 2021. Twelve CFIR constructs were identified as barriers, seven as enablers, and two as neutral factors for the implementation of opt-out HCV screening. Correctional stakeholders underscored the need for political will (construct: external policy and incentives), highlighted limited resources (construct: available resources), and expressed concerns for the lack of consideration of implementation issues (constructs: trialability, planning). Six TDF domains were identified among HCPs as relevant to the implementation of opt-out HCV screening: beliefs about consequences (mixed = enablers and barriers), environmental context and resources (barrier), social influences (barrier), optimism (mixed), emotions (mixed), and behavioural regulation (barrier). The decision-making processes vis-à-vis HCV care in Quebec correctional settings were found to be hierarchical and complex.

Conclusions: The use of CFIR and TDF was helpful in identifying barriers and enablers to HCV screening at multiple levels for people incarcerated in Quebec provincial prisons. Going forward, several political, structural, and organizational factors should be addressed through the engagement of stakeholders and people with lived experience of incarceration.

Keywords: Barrier; Enabler; Hepatitis C virus; Implementation science; Prison; Screening.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Delivery of Health Care
Hepacivirus
Hepatitis C* / diagnosis
Hepatitis C* / epidemiology
Humans
Prisons*
Qualitative Research
Quebec