Development of a Community-Based Treatment (CBTx) System to Reduce Drug-Related Harms among Substance Use Disorder Patients in Phra Yuen District, Khon Kaen Province.

Abstract

      This participatory action research aimed to study the context and situation, develop and implement a model, examine the effects of the model, and identify the success factors in developing a harm reduction care system through community-based treatment and rehabilitation (CBTx) for people with substance use problems in Phra Yuen District, Khon Kaen Province. The study followed the PAOR cycle of Kemmis and McTaggart together with the Appreciation-Influence-Control (AIC) process, and applied the PCT2H Model (Participation, CBTx, Telemedicine, Health Rider, and Harm Reduction). Data were collected from March to October 2026, a total of 8 months. The target group comprised 468 participants: 122 network partners, including the District Chief Officer or representative, the Superintendent of Phra Yuen Police Station or representative, the Director of Phra Yuen Hospital or representative, local administrative organizations, community leaders, hospital and sub-district health promoting hospital staff, and village health volunteers; 173 patients with substance use problems; and 173 patients' relatives or family members. Participants were selected by purposive sampling. The research instruments were questionnaires for patients and relatives (general information, the SMI-V Scan, the Mind7 observation form, the Overt Aggression Scale (OAS), a patient follow-up form, and a relatives' satisfaction questionnaire), a questionnaire for network partners (knowledge, skills, attitudes, and community participation), and focus group discussion guidelines. Qualitative data were analyzed using content analysis. Quantitative data were analyzed using frequency, percentage, mean, standard deviation, and paired t-test.

      The results showed that most patients with substance use problems were male (91.33%), and most were aged 30–39 years (41.62%) (Mean±SD = 34.82±8.46, Min = 18, Max = 62). The model development comprised 4 approaches: 1) community-based case finding and screening with participation of network partners, and classification of patients into green, yellow, orange, and red groups; 2) continuous follow-up of red-group patients and patients at risk of violence using Telemedicine and Health Rider; 3) establishing a working committee and signing memoranda of understanding (MOUs) with district-level network partners; and 4) social rehabilitation and patient referral among village, sub-district, and district levels. After implementation of the model, network partners' participation, knowledge, skills, and attitudes, and relatives' satisfaction increased, while the incidence of violence among patients with substance use problems who had psychiatric symptoms and were at risk of violence decreased, with statistical significance (p < .05; t = 12.45, 10.87, 9.63, 8.21, respectively).