Differential Quality Assessment of Harm Reduction Service in Drop-in Centers and Shelters: from expectations to perceptions

Document Type : Original Article

Authors

1 Professor of Sociology, Department of Sociology, Faculty of Social Sciences, University of Tehran, Tehran, Iran.

2 Master of Social Sciences Research, Department of Sociology, Faculty of Social Sciences, University of Tehran, Tehran, Iran

3 Ph.D of Social Health Studies, Department of Social Sciences, Faculty of Humanities, École normale supérieure, Paris, France

4 Ph.D of Social Work, Department of Social Sciences, Faculty of Humanities, École normale supérieure, Paris, France

5 Master of Epidemiology, Department of Epidemiology and Biostatics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran

Abstract

Background and objective: Harm reduction centers are founded in Iran to reduce health, economic and social side effects of drug abuse. Nevertheless, the quality of services in these centers are of the main issues which facing the concerned organizations. The objective of this study was to assess the quality and the difference of providing services to reduce harms in drop-in centers and shelters of state welfare organization.
Methods: This study is a descriptive and cross-sectional study. The study population is consisted of clients who were coming to harm reduction centers (drop-in centers and shelter). The sample size is 268 people.  The stratified random probability method was used for sampling. The data collection tools were adjusted questionnaire of measuring service quality (SERVQUAL) by Parasuraman et al. The data were analyzed by SPSS 22.0 software and paired t-test, Friedman and Kruskal–Wallis tests.
Results: The findings showed that there is a significant difference between the clients’ expectations of overall quality of harm reduction services and their perception (p≤0.01). Beside that there is a significant difference between clients’ expectations of the quality of each one of the aspects of harm reduction services and their perception of their corresponding dimensions (p≤0.01). Dimensions of Tangibles, reliability, responsiveness, empathy and assurance and harm reduction centers of Nejatzendegi, Qoqnoos, Aramesh, Asak and Hedayet respectively had the lowest and highest mean ranking.
Conclusion: The services which are given to clients of drop-in centers and shelters increase the possibility of reducing the social, economic, health consequences of drug abuse among them and in society. The clients of drop-in centers and shelters see the quality of harm reduction services as a supporting mechanism that need government support to increase the quality of programs and harm reduction services.
Paper Type: Research Article.

Keywords


1.    Cook C, Kanaef N. The Global State of Harm Reduction 2008: mapping the response to drug-related HIV and hepatitis C epidemics. London: Harm Reduction International; 2008.
2.    IHRA: The Global State of Harm Reduction 2010, key issues for broadening the response, London: International Harm Reduction Association, 2010.
3.    Razzaghi E, Rahimia Movaghar A, Craig T, Khoshnood K. Profiles of risk: a qualitative study of injecting drug users in Tehran, Iran, Harm Reduction Journal, 2006, 3:12.
4.    Beaumont B. Care of drug users in general practice: a hram reduction approach (2th ed), London: Royal College of General Practitioners, 2004.
5.    WHO. Orientation on harm reduction: three-hour training course participant manual, Western Pacific Region: World Health Organization, 2007.
6.    WHO. Social contexts of access to treatment and care for HIV, hepatitis C andtuberculosis among people who inject drugs in European cities, Western Pacific Region: World Health Organization, 2012.
7.    Khajehkazemi R, Osooli M, Sajadi L, Karamouzian M, Sedaghat A, Fahimfar N, Safaie A, Mostafavi E, Haghdoost A-A: HIV prevalence and risk behaviours among people who inject drugs in Iran: the 2010 national surveillance survey. Sexually Transmitted Infections 2013:1–4.
8.    National AIDS Committee Secretariat. Islamic Republic of Iran AIDS Progress Report: On Monitoring of the United Nations General Assembly Special Session on HIV and AIDS; National AIDS Committee Secretariat, 2012.
9.    Shojaeizadeh D, Taheri GE, Tehrani H. The Effect of Education on Knowledge and Attitude of High School Students about AIDS in Faruj, Iran. Journal of Health and Development. 2012;1(1):67-73.
10.    Marlatt GA, Larimer ME, Witkiewitz K. Harm reduction: pragmatic strategies for managing high-risk behaviors (2th ed), New York: Guilford Press, 2012.
11.    Normand J, Li J, Thomson N, Jarlais DD. Harm reduction, Journal of Food and Drug Administration 2013; 21: S10-S12.
12.    Allen S, Ruiz M, O’Rourke A. How far will they go?: assessing the travel distance of current and former drug users to access harm reduction services, Harm Reduction Journal 2015; 12: 3.
13.    Baggett TP, O’Connell JJ, Singer DE, Rogotti NA. The unmet health care needs of homeless adults: a national study, Am J Public Health 2010; 100: 1326–33.
14.    Moore G, Manias E, Gerdtz MF. Complex health service needs for people who are homeless, Aust Health Rev 2011; 35(4): 480–5.
15.    Robbins JL, Wenger L, Lorvick J, Shiboski C, Kral AH. Health and oral health care needs and health care-seeking behavior among homeless injection drug users in San Francisco, J Urban Health 2010; 87(6): 920–30.
16.    Kuehn BM. Supportive housing cuts costs of caring for the chronically homeless JAMA 2012; 308(1): 17–29.
17.    Solhi M, Jormand H, Gohari MH. The Impact of Media Literacy Intervention on the Female Students' Attitudes about Self-Medication of Slimming Supplements. Journal of Health Literacy. Spring 2016;1(1):[13-24].
18.    Dorabjee J. The view from the trenches, Harm Reduction Journal 2015; 12: 44.
19.    Malekinejad M, Vazirian M: Transition to injection amongst opioid users in Iran: Implications for harm reduction. International Journal of Drug Policy 2012, 23:333–337.
20.    Abu-Raddad L, Akala FA, Semini I, Riedner G, Wilson D, Tawil O: Characterizing the HIV/AIDS epidemic in the Middle East and North Africa: time for strategic action. Washington: The World Bank; 2010
21.    Sadeghi H, Habibi Z, Haghrangbar F, Madanipour K. The Effectiveness of Harm Reduction Programs on Reduce Crimes of Addicts Referred the Drop in Centers (DIC), Procedia - Social and Behavioral Sciences 2012; 84: 496-500.
22.    Ghobadian A, Speller S. Service quality: concept and models. Int J of Quality Management 1994; 11: 43-66.
23.    Stafford MR. Deteminants of service quality in the banking industry, Journal of Service Marketing 1998; 10(4): 6-22.
24.    Change T, Chen S. Market orientiation, service quality and business profitability: a conceptual model and empirical evidence, Journal of Service Marketing 1998; 12(4): 246-264.
25.    Mahdavi P. Passionate uprisings: Iran's sexual revolution, Stanford: Stanford University Press, 2009.
26.    Aldlaigan A, Buttle F. SYSTRA-SQ: A new measure of Bank Service Quality, International Journal of Service Industry Management 2002; 13(4): 362-381.
27.    Bruggmann P, Grebely J. Prevention, treatment and care of hepatitis C virus infection among people who inject drugs International Journal of DrugPolicy 2015; 26: S22–S26.
28.    Stone K.  Reviewing harm reduction for people who inject drugs in Asia: the necessity for growth, Harm Reduction Journal 2015; 12: 32.
29.    Khoshemehry G, Tehrani H, Fatin S. A survey of the knowledge and attitude of student of Elmi-Karbordi higher education center at Tehran Jahad-e-Daneshgahi about Ecstasy. journal of Jahrom University of Medical Science. 2010;8(3):29-33.
30.    Bridge J, Hunter B, Albers E, Cook C, Guarinieri M, Lazarus J, et al. The Global Fund to Fight AIDS, Tuberculosis and Malaria’s investments in harm reduction through the rounds-based funding model (2002–2014), International Journal of Drug Policy 2015; In Press.
31.    Hekmatpou D, Sorani M, Farazi A A, Fallahi Z, Lashgarara B. A survey on the quality of medical services in teaching hospitals of Arak University of Medical Sciences with SERVQUL model in Arak, 2010. Arak University of Medical Sciences Journal 2012; 15(7): 1-9.
32.    Heimer R. Syringe exchange programs: Lowering the transmission of syringe borne diseases and beyond, Public Health Reports 1998; 113 (1): 67–74.
33.    Kidorf M, King VL. Expanding the public health benefits of syringe exchange programs, Canadian Journal of Psychiatry 2008; 53(8): 487-95.
34.    Toushmal G, Hakak M, Heidary H. A survey of quality gap of Khoramabad medical emergency services using SERVQUAL model, Yafteh 2015; 17(1): 78-86.
35.    Johnson RL, Tsiros M, Lancioni RA. Measuring service quality: a systems approach, Journal of Services Marketing 1995; 9(5): 6 – 19.
36.    Parasuraman A, Zeithaml VA, Berry LL. SERVQUAL: A Multiple-Item Scale for Measuring Consumer Perceptions of Service Quality, Journal of Retailing 1988; 86(1): 12-40.
37.    Lovelock C, Wright L. Principles of Service Marketing and Management (2th ed), New Jersey: Prentice Hall, 2001.
38.    Rosenbluth H, Peters DM. The customer comes second: put your people first and watch 'em Kick Butt, New York: HarperBusiness, 2002.
39.    Zeithaml VA, Rust RT, Lemon KN. The customer pyramid: creating and serving profitable customers, California Management Review 2001; 43(4):118-142.
40.    Fletcher M. The effects of internal communication, leadership and team performance on successful service quality implementation: A South African perspective, Team Performance Management: An International Journal 1999; 5: 150–163.