Feasibility and acceptability of incorporating social network visualizations into a culturally centered motivational network intervention to prevent substance use among urban Native American emerging adults: a qualitative study

David P Kennedy, Elizabeth J D'Amico, Ryan A Brown, Alina I Palimaru, Daniel L Dickerson, Carrie L Johnson, Anthony Lopez, David P Kennedy, Elizabeth J D'Amico, Ryan A Brown, Alina I Palimaru, Daniel L Dickerson, Carrie L Johnson, Anthony Lopez

Abstract

Background: Coupling social network visualizations with Motivational Interviewing in substance use interventions has been shown to be acceptable and feasible in several pilot tests, and has been associated with changes in participants' substance use and social networks. The objective of this study was to assess acceptability and feasibility of an adaptation of this behavior change approach into a culturally centered behavior change intervention for American Indian/Alaska Native (AI/AN) emerging adults living in urban areas. AI/AN populations experience high rates of health disparities and substance use. Although 70% of AI/AN people live outside of tribal lands, there are few culturally tailored health interventions for these AI/AN populations. Social networks can both increase and discourage substance use. Leveraging healthy social networks and increasing protective factors among urban AI/AN emerging adults may help increase resilience.

Methods: We conducted thirteen focus groups with 91 male and female participants (32 urban AI/AN emerging adults ages 18-25, 26 parents, and 33 providers) and one pilot test of the three workshop sessions with 15 AI/AN emerging adults. Focus group participants provided feedback on a proposed workshop-based intervention curriculum that combined group Motivational Interviewing (MI) and social network visualizations. Pilot workshop participants viewed their own social networks during group MI sessions focused on substance use and traditional practices and discussed their reactions to viewing and discussing their networks during these sessions. We used a combination of open coding of focus group and workshop session transcripts to identify themes across the group sessions and content analysis of comments entered into an online social network interview platform to assess the extent that participants had an intuitive understanding of the information conveyed through network diagrams.

Results: Focus group and pilot test participants reacted positively to the intervention content and approach and provided constructive feedback on components that should be changed. Themes that emerged included feasibility, acceptability, relevance, understandability, and usefulness of viewing personal network visualizations and discussing social networks during group MI workshops. Workshop participants demonstrated an intuitive understanding of network concepts (network composition and structure) when viewing their diagrams for the first time.

Conclusions: Social network visualizations are a promising tool for increasing awareness of social challenges and sources of resilience for urban AI/AN emerging adults. Coupled with Motivational Interviewing in a group context, social network visualizations may enhance discussions of network influences on substance use and engagement in traditional practices.

Trial registration: ClinicalTrials.gov Identifier: NCT04617938. Registered October 26, 2020.

Keywords: Alcohol and other drug use; EgoWeb 2.0; Emerging Adults; Motivational Interviewing; Native Americans; Personal network visualizations; Qualitative; Social networks; Substance use.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Hypothetical network visualizations provided to focus group participants. Network visualizations were generated with hypothetical data entered into EgoWeb 2.0. Example network members are represented by circles (nodes), labeled with example names, and lines between nodes represent members who interacted with each other in the past two weeks. Placement of nodes in two dimensions for each graph was generated using the “Fruchterman-Reingold” layout algorithm in the R package “igraph”. The “Your Network” graph on the left shows the names of people the participant reported interacting with in the past two weeks and highlights the centrality of nodes by calibrating node size and color with number of connections for a particular node (degree centrality), and line thickness with the participant’s rating of how frequently the two nodes interacted. The middle graph labeled “Substance use” shows larger red nodes for people who the respondent rates as likely to use AOD in the next two weeks and smaller blue nodes for those who are unlikely. The right-hand graph labeled “Traditional Practice Support” shows larger green nodes for people who engage in traditional practices, and smaller blue nodes for people who do not
Fig. 2
Fig. 2
Network visualizations of 3 pilot workshop participants and text comments entered by participants into EgoWeb 2.0. Network visualizations were generated from pilot participant network data using the same layout, node size, node color visualization processing steps as Fig. 1. Participants viewed these visualizations directly in EgoWeb 2.0 after entering responses to questions about their networks. Node labels displayed in the EgoWeb 2.0 diagrams viewed by the pilot test visualizations have been removed. Text associated with each visualization is a verbatim response entered into a text box by each participant when viewing the diagram. Participants were prompted to enter text with the following text: (Your Network) “Take a look at the picture and think about what makes sense to you about the picture. Also, what is something you did not realize about your social network before looking at the picture?”; (Substance Use) “What do you notice about your picture?”; (Traditional Practice Support): “What do you think about how these different types of people are connected with each other?”

References

    1. Duran E, Duran B. Native American post-colonial psychology. New York: Suny Press; 1995.
    1. Jernigan VBB, Peercy M, Branam D, Saunkeah B, Wharton D, Winkleby M, et al. Beyond health equity: achieving wellness within American Indian and Alaska Native communities. Am J Public Health. 2015;105(Suppl 3):S376–S379. doi: 10.2105/AJPH.2014.302447.
    1. Jernigan VBB, Wetherill MS, Hearod J, Jacob T, Salvatore AL, Cannady T, et al. Food insecurity and chronic diseases among American Indians in rural Oklahoma: the THRIVE study. Am J Public Health. 2017;107(3):441–446. doi: 10.2105/AJPH.2016.303605.
    1. Ivanich JD, Weckstein J, Nestadt PS, Cwik MF, Walls M, Haroz EE, et al. Suicide and the opioid overdose crisis among American Indian and Alaska Natives: a storm on two fronts demanding swift action. Am J Drug Alcohol Abuse. 2021;47(5):527–534. doi: 10.1080/00952990.2021.1955895.
    1. Mitton JA, Jackson S, Ho JJ, Tobey M. Opioid and amphetamine treatment trends among American Indians in the Great Plains. J Addict Med. 2020;14(4):e100–e102. doi: 10.1097/ADM.0000000000000594.
    1. Schick MR, Goldstein SC, Nalven T, Spillane NS. Alcohol- and drug-related consequences across latent classes of substance use among American Indian adolescents. Addict Behav. 2021;113:106682. doi: 10.1016/j.addbeh.2020.106682.
    1. Coughlin LN, Lin L, Jannausch M, Ilgen MA, Bonar EE. Methamphetamine use among American Indians and Alaska Natives in the United States. Drug Alcohol Depend. 2021;227:108921. doi: 10.1016/j.drugalcdep.2021.108921.
    1. Dickerson DL, Fisher DG, Reynolds GL, Baig S, Napper LE, Anglin MD. Substance use patterns among high-risk American Indians/Alaska Natives in Los Angeles County. Am J Addict. 2012;21(5):445–452. doi: 10.1111/j.1521-0391.2012.00258.x.
    1. Whitbeck BL, Chen X, Hoyt DR, Adams GW. Discrimination, historical loss and enculturation: culturally specific risk and resiliency factors for alcohol abuse among American Indians. J Stud Alcohol Drugs. 2004;65(4):409–418. doi: 10.15288/jsa.2004.65.409.
    1. DeNavas-Walt C, Proctor BD. US Census Bureau, current population reports: income, poverty, and health insurance coverage in the United States: 2013. Washington DC: US Government Printing Office; 2014.
    1. Dickerson DL, Johnson CL, Castro C, Naswood E, Leon J. Community voices: integrating traditional healing services for urban American Indians/Alaska Natives in Los Angeles County. Los Angeles: Los Angeles County Department of Mental Health; 2012.
    1. Jones ML, Galliher RV. Daily racial microaggressions and ethnic identification among Native American young adults. Cultur Divers Ethnic Minor Psychol. 2015;21(1):1–9. doi: 10.1037/a0037537.
    1. Norris T, Vines PL, Hoeffel EM. The American Indian and Alaska Native population: 2010. US Census Bureau. Contract No.: C2010BR-10. 2012
    1. U.S. Census Bureau. Census 2010 American Indian and Alaska Native Summary. 2010.
    1. Dickerson DL, Baldwin JA, Belcourt A, Belone L, Gittelsohn J, Kaholokula K, et al. Encompassing cultural contexts within scientific research methodologies in the development of health promotion interventions. Prev Sci. 2020;21(Suppl 1):33–42. doi: 10.1007/s11121-018-0926-1.
    1. Indian Health Service. IHS implements groundbreaking new policy regarding opioid prescribing. 2016.
    1. Venner KL, Donovan DM, Campbell ANC, Wendt DC, Rieckmann T, Radin SM, et al. Future directions for medication assisted treatment for opioid use disorder with American Indian/Alaska Natives. Addict Behav. 2018;86:111–117. doi: 10.1016/j.addbeh.2018.05.017.
    1. Tipps RT, Buzzard GT, McDougall JA. The opioid epidemic in Indian Country. J Law Med Ethics. 2018;46(2):422–436. doi: 10.1177/1073110518782950.
    1. Schulenberg JE, Patrick ME, Johnston LD, O'Malley PM, Bachman JG, Miech RA. Monitoring the future national survey results on drug use, 1975–2020. Vol II, College students and adults ages 19–60. Institute for social research. 2021.
    1. Hasin DS, Saha TD, Kerridge BT, Goldstein RB, Chou SP, Zhang H, et al. Prevalence of marijuana use disorders in the United States Between 2001–2002 and 2012–2013. JAMA Psychiat. 2015;72(12):1235–1242. doi: 10.1001/jamapsychiatry.2015.1858.
    1. Hanson KL, Lisdahl Medina K, Padula CB, Tapert SF, Brown SA. Impact of adolescent alcohol and drug use on neuropsychological functioning in young adulthood:10-year outcomes. J Child Adolesc Subst Abuse. 2011;20(2):135–154. doi: 10.1080/1067828X.2011.555272.
    1. United Nations Office on Drugs and Crime. World drug report: Vienna, Austria: United Nations. 2014.
    1. Substance Abuse and Mental Health Services Administration (SAMHSA). 2019 National Survey on Drug Use and Health: American Indians and Alaska Natives (AI/ANs). 2020.
    1. Valente TW. Social networks and health. Models, methods, and applications. New York: Oxford University Press; 2010.
    1. Kahler CW, Read JP, Wood MD, Palfai TP. Social environmental selection as a mediator of gender, ethnic, and personality effects on college student drinking. Psychol Addict Behav. 2003;17(3):226–234. doi: 10.1037/0893-164X.17.3.226.
    1. Kelly JF, Hoeppner B, Stout RL, Pagano M. Determining the relative importance of the mechanisms of behavior change within Alcoholics Anonymous: a multiple mediator analysis. Addiction. 2012;107(2):289–299. doi: 10.1111/j.1360-0443.2011.03593.x.
    1. Kaskutas LA, Bond J, Humphreys K. Social networks as mediators of the effect of Alcoholics Anonymous. Addiction. 2002;97(7):891–900. doi: 10.1046/j.1360-0443.2002.00118.x.
    1. Bond J, Kaskutas LA, Weisner C. The persistent influence of social networks and alcoholics anonymous on abstinence. J Stud Alcohol. 2003;64(4):579–588. doi: 10.15288/jsa.2003.64.579.
    1. Owen PL, Slaymaker V, Tonigan JS, McCrady BS, Epstein EE, Kaskutas LA, et al. Participation in alcoholics anonymous: Intended and unintended change mechanisms. Alcoholism-Clin Exp Res. 2003;27(3):524–532. doi: 10.1097/01.ALC.0000057941.57330.39.
    1. Tucker JA, Cheong J, Chandler SD, Crawford SM, Simpson CA. Social networks and substance use among at-risk emerging adults living in disadvantaged urban areas in the southern United States: a cross-sectional naturalistic study. Addiction. 2015;110(9):1524–1532. doi: 10.1111/add.13010.
    1. Arnett JJ. The developmental context of substance use in emerging adulthood. J Drug Issues. 2005;35(2):235–254. doi: 10.1177/002204260503500202.
    1. Kulis S, Wagaman MA, Tso C, Brown EF. Exploring indigenous identities of urban American Indian youth of the Southwest. J Adolesc Res. 2013;28(3):271–298. doi: 10.1177/0743558413477195.
    1. Rees C, Freng A, Winfree LT. The Native American adolescent: social network structure and perceptions of alcohol induced social problems. J Youth Adolesc. 2014;43(3):405–425. doi: 10.1007/s10964-013-0018-2.
    1. Tingey L, Cwik M, Chambers R, Goklish N, Larzelere-Hinton F, Suttle R, et al. Motivators and influences on American Indian adolescent alcohol use and binge behavior: a qualitative exploration. J Child Adolesc Subst Abuse. 2017;26(1):75–85. doi: 10.1080/1067828X.2016.1210552.
    1. Martinez MJ, Ayers SL, Kulis S, Brown E. The relationship between peer, parent, and grandparent norms and intentions to use substances for Urban American Indian youths. J Child Adolesc Subst Abuse. 2015;24(4):220–227. doi: 10.1080/1067828X.2013.812529.
    1. Shelton RC, Lee M, Brotzman LE, Crookes DM, Jandorf L, Erwin D, et al. Use of social network analysis in the development, dissemination, implementation, and sustainability of health behavior interventions for adults: a systematic review. Soc Sci Med. 2018;220:81–101. doi: 10.1016/j.socscimed.2018.10.013.
    1. Christakis NA, Fowler JH. The collective dynamics of smoking in a large social network. N Engl J Med. 2008;358(21):2249–2258. doi: 10.1056/NEJMsa0706154.
    1. Knecht AB, Burk WJ, Weesie J, Steglich C. Friendship and alcohol use in early adolescence: a multilevel social network approach. J Res Adolesc. 2010;21(2):475–487. doi: 10.1111/j.1532-7795.2010.00685.x.
    1. de la Haye K, Green HD, Kennedy DP, Pollard MS, Tucker JS. Selection and influence mechanisms associated with marijuana initiation and use in adolescent friendship networks. J Res Adolesc. 2013;23(3):474–486. doi: 10.1111/jora.12018.
    1. Tucker JS, de la Haye K, Kennedy DP, Green HD, Jr, Pollard MS. Peer influence on marijuana use in different types of friendships. J Adolesc Health. 2014;54(1):67–73. doi: 10.1016/j.jadohealth.2013.07.025.
    1. Rosenquist JN, Murabito J, Fowler JH, Christakis NA. The spread of alcohol consumption behavior in a large social network. Ann Intern Med. 2010;152(7):426–433. doi: 10.7326/0003-4819-152-7-201004060-00007.
    1. Philip J, Ford T, Henry D, Rasmus S, Allen J. Relationship of social network to protective factors in suicide and alcohol use disorder intervention for rural Yup’ik Alaska Native youth. Psychosoc Interv. 2016;25(1):45–54. doi: 10.1016/j.psi.2015.08.002.
    1. D’Amico EJ, Dickerson DL, Brown RA, Johnson CL, Agniel D, Klein DJ. Motivational interviewing and culture for Urban Native American youth (MICUNAY): a randomized controlled trial. J Subst Abuse Treat. 2020;111:86–99. doi: 10.1016/j.jsat.2019.12.011.
    1. Venner KL, Feldstein SW. Native American Motivational Interviewing. 2006.
    1. Tomlin K, Walker R, Grover J, Arquette W, Stewart P. Trainer’s guide to motivational interviewing: Enhancing motivation for change—A learner’s manual for the American Indian/Alaska Native counselor. Portland: One Sky Center; 2014.
    1. Miller WR, Rollnick S. Motivational interviewing: helping people change. 3. New York: Guilford press; 2013.
    1. Dickerson DL, Moore LA, Rieckmann T, Croy C, Venner KL, Moghaddam J, et al. Correlates of motivational interviewing use among substance use treatment programs serving American Indians/Alaska Natives. J Behav Health Serv Res. 2018;45(1):31–45. doi: 10.1007/s11414-016-9549-0.
    1. Kennedy DP, Hunter SB, Osilla KC, Maksabedian E, Golinelli D, Tucker JS. A computer-assisted motivational social network intervention to reduce alcohol, drug and HIV risk behaviors among Housing First residents. Addict Sci Clin Pract. 2016;11(1):1–13. doi: 10.1186/s13722-016-0052-y.
    1. Osilla KC, Kennedy DP, Hunter SB, Maksabedian E. Feasibility of a computer-assisted social network motivational interviewing intervention for substance use and HIV risk behaviors for housing first residents. Addict Sci Clin Pract. 2016;11(14):1–11.
    1. Kennedy DP, Osilla KC, Hunter SB, Golinelli D, Maksabedian Hernandez E, Tucker JS. Restructuring personal networks with a motivational interviewing social network intervention to assist the transition out of homelessness. PLoS ONE. 2022;12(1):e0262210. doi: 10.1371/journal.pone.0262210.
    1. Tucker JS, Kennedy DP, Osilla KC, Golinelli D. Motivational network intervention to reduce substance use and increase supportive connections among formerly homeless emerging adults transitioning to housing: study protocol for a pilot randomized controlled trial. Addict Sci Clin Pract. 2021;16(1):18. doi: 10.1186/s13722-021-00227-9.
    1. Kennedy DP, Osilla KC, Hunter SB, Golinelli D, Maksabedian Hernandez E, Tucker JS. A pilot test of a Motivational Interviewing social network intervention to reduce substance use among housing first residents. J Subst Abuse Treat. 2018;86:36–44. doi: 10.1016/j.jsat.2017.12.005.
    1. Kennedy DP, Osilla KC, Tucker JS. Feasibility of a computer-assisted social network motivational interviewing intervention to reduce substance use and increase supportive connections among emerging adults transitioning from homelessness to housing. Addict Sci Clin Pract. 2022;17(1):26. doi: 10.1186/s13722-022-00307-4.
    1. D’Amico EJ, Dickerson DL, Rodriguez A, Brown RA, Kennedy DP, Palimaru AI, et al. Integrating traditional practices and social network visualization to prevent substance use: study protocol for a randomized controlled trial among urban Native American emerging adults. Addict Sci Clin Pract. 2021;16(1):56. doi: 10.1186/s13722-021-00265-3.
    1. Dickerson DL, D'Amico EJ, Palimaru A, Brown R, Kennedy D, Johnson CL, et al. Traditions and connections for Urban Native Americans (TACUNA): utilizing community-based input to develop an opioid prevention intervention for urban American Indian/Alaska Native emerging adults. J Subst Abuse Treat. 2022;139:108764. doi: 10.1016/j.jsat.2022.108764.
    1. Vindrola-Padros C, Johnson GA. Rapid techniques in qualitative research: a critical review of the literature. Qual Health Res. 2020;30(10):1596–1604. doi: 10.1177/1049732320921835.
    1. Perry BL, Pescosolido BA, Borgatti SP. Egocentric network analysis: foundations, methods, and models. Cambridge: Cambridge University Press; 2018.
    1. McCarty C, Lubbers MJ, Vacca R, Molina JL. Conducting personal network research: a practical guide. New York: Guilford Press; 2019.
    1. Guest G, MacQueen KM, editors. Handbook for team based qualitative research. Lanham, MD: AltaMira Press; 2007.
    1. Guest G, MacQueen KM, Namey EE. Applied thematic analysis. Thousand Oaks: Sage Publications, Incorporated; 2011.
    1. D'Amico EJ, Barnes D, Gilbert ML, Ryan G, Wenzel SL. Developing a tripartite prevention program for impoverished young women transitioning to young adulthood: addressing substance use, HIV risk, and victimization by intimate partners. J Prev Interv Community. 2009;37:112–128. doi: 10.1080/10852350902735726.
    1. Strauss AC, Corbin J. Basics of qualitative research: techniques and procedures for developing grounded theory. Thousand Oaks: Sage Publications, Inc.; 1998.
    1. Glaser BG, Strauss AL. The discovery of grounded theory: strategies for qualitative research. New York: Aldine De Gruyter; 1999.
    1. Weber RP. Basic content analysis. Newbury Park, CA: Sage Publications, Inc.; 1990.
    1. Ryan GW, Bernard HR. Techniques to identify themes. Field Methods. 2003;15(1):85–109. doi: 10.1177/1525822X02239569.
    1. Krippendorf K. Content analysis: an introduction to its methodology. Beverly Hills: Sage Publications; 1980.
    1. Bernard HR, Ryan GW. Text analysis: qualitative and quantitative methods. In: Bernard HR, editor. Handbook of methods in cultural anthropology. Walnut Creek: AltaMira Press; 1998. pp. 595–646.
    1. Norton IM, Manson SM. Research in American Indian and Alaska Native communities: navigating the cultural universe of values and process. J Consult Clin Psychol. 1996;64(5):856–860. doi: 10.1037/0022-006X.64.5.856.
    1. Tucker JS, D'Amico EJ, Ewing BA, Miles JNV, Pedersen ER. A group-based motivational interviewing brief intervention to reduce substance use and sexual risk behavior among homeless young adults. J Subst Abuse Treat. 2017;76:20–27. doi: 10.1016/j.jsat.2017.02.008.
    1. D'Amico EJ, Houck JM, Hunter SB, Miles JNV, Osilla KC, Ewing BA. Group motivational interviewing for adolescents: change talk and alcohol and marijuana outcomes. J Consult Clin Psychol. 2015;83(1):68–80. doi: 10.1037/a0038155.
    1. Gone JP, Blumstein KP, Dominic D, Fox N, Jacobs J, Lynn RS, et al. Teaching tradition: diverse perspectives on the pilot urban American Indian traditional spirituality program. Am J Community Psychol. 2017;59(3–4):382–389. doi: 10.1002/ajcp.12144.
    1. Johnson C, Begay C, Dickerson D. Final development of the Native American Drum, Dance, and Regalia Program (NADDAR), a behavioral intervention utilizing traditional practices for urban Native American families: a focus group study. Behav Ther. 2021;44(4):198–203.
    1. Rempel GR, Neufeld A, Kushner KE. Interactive use of genograms and ecomaps in family caregiving research. J Fam Nurs. 2007;13(4):403–419. doi: 10.1177/1074840707307917.
    1. Guest G, Namey E, McKenna K. How many focus groups are enough? Building an evidence base for nonprobability sample sizes. Field Methods. 2016;29(1):3–22. doi: 10.1177/1525822X16639015.

Source: PubMed

Sponsors et collaborateurs

Les conditions médicales

Interventions en matière de drogue

3
S'abonner