Complexity of implementing Harm Reduction Services in community hospitals: A two-phase qualitative study

摘要: Objective Regardless of effective harm reduction services (HRS) in Thanyarak Hospital, difficulties exist while implementing them in community hospitals. This study aimed to investigate the complexities of HRS implementation in two community hospitals in Mae Hong Son. Methods Phase 1, in-depth interviews were conducted with 21 participants to investigate the complexity of HRS dissemination. An interview guide was developed from the seven domains of the Nonadoption, Abandonment, Scale-up, Spread, and Sustainability framework, and thematic analysis was used. Phase 2 involved two rounds of a Delphi technique with 17 experts to evaluate the HRS’s complexity level (complex, complicated, and simple). Results Although patients were highly satisfied with HRS, implementing it in community hospitals was complex. Complex issues included: complexity in opioid addiction caused by a variety of factors; understanding social contexts and cooperating of communities and agencies outside required health sectors; and emerging of unintended consequences. Complicated issues included resources and specialized knowledge required; concerns of staff’s competencies and readiness in re-arranging regular services for HRS. Conclusion The HRS operators should understand that they are working on complex issues. Engaging a broader system and preparing for unexpected events will boost the likelihood of success in the transfer of HRS to other settings.