Service users’ perception and attitude toward telemedicine-based treatment for substance use disorders: A qualitative study from India
Drug De-addiction and Treatment Centre, Department of Psychiatry, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh
How they used Delve
Addiction psychiatrists at PGIMER Chandigarh used Delve to have two coders independently apply a shared code dictionary to interviews with 15 patients with substance use disorders, reporting 78% inter-rater agreement across 25 themes about telemedicine-based addiction care.
“AG, APV, and TM read through the transcripts of five interviews and generated codes inductively. A code dictionary was created for further coding. APV and TM deductively coded the transcripts in Delve software separately. The inter-rater agreement was 78 percent. [...] The total number of common themes identified by both TM and APV was 18. Two unique themes were identified by APV and five by TM.”
- Field
- Addiction psychiatry and telemedicine; patient acceptability of telemedicine-based addiction care in India
- Data
- In-depth interviews, by video conference or in person as the patient preferred, with 15 adult patients with substance use disorders who had used both telemedicine and in-person care - mostly middle-aged men (mean 40.5 years, 86.7%), 86.7% dependent on two or more substances, with roughly 16 years of use and 11.5 years of dependence
- Approach
- Conventional content analysis with combined inductive and deductive coding: three researchers read five transcripts and generated codes inductively to build a code dictionary, two researchers then coded all transcripts deductively and separately in Delve, reaching 78% inter-rater agreement; of 25 themes, 18 were common to both coders, 2 unique to one and 5 to the other, and conflicts were resolved in discussion with the senior author before final coding and a thematic map
- Data types
- Interviews
Abstract
Aim: We aimed to assess the service user’s acceptability, feasibility, and attitude toward telemedicine practice and compare it with in-person consultation in substance use disorder (SUD). Materials and Methods: We recruited 15 adult patients with SUD who accessed both telemedicine and in-person care. We conducted in-depth interviews on awareness and access, facilitators and barriers, treatment satisfaction, and therapeutic relationship in the telemedicine context. We performed a conventional content analysis of the interview excerpts and used inductive and deductive coding. We assumed that social, personal, and logistic contexts influence patients’ perceptions and experiences with telemedicine-based addiction care (TAC). Results: Most participants were middle-aged men (40.5 years, 86.7%), dependent on two or more substances (86.7%), and had a history of chronic, heavy substance use (use ~16 years, dependence ~11.5 years). Patients’ perspectives on TAC could broadly be divided into three phases: pre-consultation, consultation, and post-consultation. Patients felt that TAC improved treatment access with adequate autonomy and control; however, there were technical challenges. Patients expressed privacy concerns and feared experiencing stigma during teleconsultation. They reported missing the elaborate inquiry, physical examination, and ritual of visiting their doctors in person. Additionally, personal comfort and technical difficulties determine the satisfaction level with TAC. Overall perception and suitability of TAC and the decision to continue it developed in the post-consultation phase. Conclusion: Our study provides an in-depth insight into the barriers and facilitators of telemedicine-based SUD treatment access, use, and retention; it also helps to understand better the choices and preferences for telehealth care vis-à-vis standard in-person care for SUDs.
Citation
Abhishek Ghosh, Tathagata Mahintamani, P. V. Aswathy, Debasish Basu, Surendra K. Mattoo, B. N. Subodh, Renjith R. Pillai, Manpreet Kaur (2023). Service users’ perception and attitude toward telemedicine-based treatment for substance use disorders: A qualitative study from India. Indian Journal of Psychiatry. https://doi.org/10.4103/indianjpsychiatry.indianjpsychiatry_167_23