The UH HOI Evaluation Team is led by Principal Investigator Dr. Victoria Fan (Center on Aging) and Co-Principal Investigator Dr. Seunghye Hong (Department of Social Work) with Katherine Burke as lead evaluator and junior epidemiologist, Dr. Andrew Abe as junior epidemiologist, and a group of undergraduate and graduate students.
Like the 2019 Evaluation Report, the 2020 Evaluation Report has four key domains: (1) Epidemiologic Landscape, (2) Document Review, (3) Data Collection, and (4) Synthesis.
The Epidemiologic Landscape is aggregated as an interactive data dashboard based on the National Survey on Drug Use and Health (NSDUH) to enhance our data-driven understanding of statewide opioid use. The Evaluation Team also obtained epidemiologic analyses from the Emergency Medical Services and Injury Prevention System Branch (EMSIPSB) epidemiologist Dr. Daniel Galanis as part of its assessment, contextualized with the social determinants of health.
The Document Review is based on the consistent service of participant observation provided by the UH HOI Evaluation Team. Coordination activities for the HOI included preparing meeting agendas, meeting minutes, and other logistics convening stakeholders spanning various sectors, disciplines, expertise, and backgrounds of the seven Work Groups, and the Operational Work Group. Remarkably, the activities and meetings of the HOI are not required by statute but rather are organized voluntarily through pertinent agencies. As part of the documentation review for this evaluation report, the UH HOI Evaluation Team requested additional documentation from ADAD on its activities and contracts as part of the HOI.
The 2020 Evaluation Report has an expanded Data Collection methodology including: (1) the Pharmacist Survey on Naloxone, (2) an HOI Work Group Member Survey, and (3) Key Informant Interviews.
The Pharmacist Naloxone Survey intended to assess the impact of Act 154 “Relating to Pharmacists Prescribing and Dispensing of Opioid Antagonist,” one of three opioids-related bills passed during the 2019 legislative session, that focused on naloxone distribution. With the support of Work Group 5, this survey was disseminated by the Hawaiʻi Pharmacists Association to assess the knowledge, awareness, and training needs associated with Act 154 as well as to assess successes, challenges and opportunities to ensure equitable naloxone access statewide. The performative scope of this evaluation strategy is to gather information from key stakeholders (pharmacists), while raising awareness of naloxone distribution (see Annex 2 for the Pharmacist Naloxone Survey). This online survey was conducted from June 8 to July 6, 2020, canvassed all 1113 active and non-active Hawaiʻi Pharmacists Association members, of which 58 are active pharmacists. In total, 18 respondents completed the survey.
The HOI Work Group Member Survey was distributed to invite all 186 Work Group members to provide feedback on HOI 2.0 Objectives progress, successes, challenges and recommendations (see Annex 2 for the questionnaire). The survey was distributed twice via email to all members during the month of June.
Key Informant Interviews were conducted with ADAD-contracted providers and staff as well as the Native Hawaiian Health Care System (NHHCS) on each of the neighbor islands (Hawaiʻi, Maui, Molokaʻi, Kauaʻi, Lanaʻi) and Oʻahu. ADAD providers were recruited from monthly meetings, and NHHCS providers were recruited by the executive director of Papa Ola Lōkahi. The UH HOI Evaluation Team began meeting with providers in July 2020. An interview guide was prepared and a team of five trained undergraduate students were trained by the lead evaluator to complete interviews in pairs via Zoom. The interview guide inquires about awareness of the HOI, the relevance of the 2019 epidemiologic data with their current patient population, the recruitment to and participation in the HOI, and finally, recommendations. See Annex 3 for the interview guide and background information sheet. A total of 14 providers have been interviewed. Interviews will be transcribed, coded for themes, and summarized.
All methods of data collection included two additional focus areas. Questions were included regarding (1) the COVID-19 pandemic that began during data collection in March 2020 in order to maximize the opportunity to learn from providers about impacts and challenges in ensuring continuity of care; and (2) inputs on the Senate Concurrent Resolution 103 (2019) “Urging the Inclusion of Native Hawaiian Cultural Intervention Treatment Programs, Wellness Plans, and Holistic Living Systems of Care in the State of Hawaiʻi’s Response to the Rise of Misuse and Abuse of Opioids or Illicit Substances in Hawaiʻi” to assess training needs, perceptions, and readiness.