| Objectives:Methadone maintenance treatment(MMT)is the main method for opioid users to improve the problems of using drugs and reduce HIV and other infectious diseases infection.The motivation of treatment/detoxification will directly affect the compliance of MMT and the final effect of treatment.Currently,the research subjects of most researches on the motivation of treatment/detoxification are the compulsory detoxificatione personnel,but few of them are from methadone clinics or communities.TCU treatment motivation scale has been widely used in the United States for the measurement of motivation in the MMT population and other drug abuse fields for many years,with good reliability and validity.Therefore,this study,based on the TCU treatment motivation scale,translated,reformed and modified into the MMT motivation scale.By investigating the basic informations and motivation of the MMT patients in Yuxi city,Yunnan province,the applicability of the scale in the local area and the relevant influencing factors affecting the motivation of MMT were explored.Methods:From August 2019 to November 2019,according to the principle of convenience sampling method,172 subjects from 5 methadone maintenance treatment clinics in Yuxi city Yunnan province were selected for on-site questionnaire survey,personal interviews,experts consultation,quantitative analysis and qualitative analysis.After translating the TCU treatment motivation scale,through three rounds of experts consultation method.According to the Chinese culture,social condition,reading habits and other aspects to improve the scale.After the pre-survey(translation draft of the scale)and the second survey(revision draft of the scale),the reliability and validity of the improved scale were analyzed,and the items with unsatisfactory obvervational indexs were eliminated or modified,and the final scale(methadone maintenance therapy motivation scale)was formed after adjustment.SPSS 22 and Mplus 7.0 were used for statistical analysis.SPSS completed the item analysis,reliability analysis,exploratory factor analysis,and the relationship between methadone maintenance treatment and treatment motivation,and Mplus completed the confirmatory factor analysis of methadone maintenance treatment motivation scale.Results:(1)In this study,172 questionnaires were distributed and 172 were recovered,with a recovery rate of 100%.The translation draft of TCU treatment motivation scale was investigated in 71 cases.31 cases were investigated on the revised draft scale.The formal questionaire was investigated 70 cases,most of them were men;The average age was 41.56±8.233 years.(2)in the preliminary survey,the Cronbach a coefficient of the translation draft scale and each dimension were 0.760,0.523,0.256 and 0.487,and DH was not suitalife for factor analysis in the four dimensions.The factor load of a large number of questions in PR,TR and EP was less than 0.6,and the total variation explains was less than 40%.The electronic questionnaire took less time(9.8min)than the paper questionnaire(15.27min)(P<0.001),and the electronic questionnaire(66.7%)was more acceptable.(3)The revised draft includes a total of 46 items,including 29 items in the original scale(after modification)and 17 new items.After consulting the experts,two questions that are not meet China's national conditions have been deleted,41 questions were retained and 2 questions(EP)were added.There were 43 items in total.After item analysis,reliability and validity analysis and consulting the experts,the revised version of the scale retained three dimensions:PR,DH and EP,18 questions.(4)Evaluation of methadone maintenance treatment motivation scale:the reliability analysis showed that the component reliability and spilt-half reliability were 0.906 and 0.802,and the component reliability of each dimension was 0.833,0.861 and 0.768,respectively.The spilt-half reliability of each dimension was 0.754,0.851 and 0.758,respectively.Exploratory factor analysis showed that the factor loading of all items in the scale was more than 0.6,and the total variation explained after extraction in the three dimensions was more than 50%.After confirmatory factor analysis,the model fitting indexes of the three dimensions of the scale all reached the evaluation standard.The parameter significance estimation showed that the standardized factor load of all items in the scale was greater than 0.5,the P value was less than 0.05,and the convergent validity of all three dimensions of the scale was greater than 0.4.(5)MMT motivation and its influencing factors:the score of MMT motivation scale was 4.34±0.64 on the total scale,the score of PR was 4.62±0.59,the score of DH was 4.600±0.65,and the score of EP was 3.81 ±0.97.According to the factor analysis suggested that,MMT motivation scale:MMT patients with no relapse behavior,voluntary detoxification,and not living alone had strong motivation.PR dimension:MMT patients who have no relapse behavior and voluntary detoxification have strong motivation in this dimension.DH dimension:patients with no relapse behavior,voluntary withdrawal from drugs,and high education have strong motivation in this dimension,while the higher the dose of methadone,the weaker the motivation to change the dimension.EP dimension:the patients treated without relapse,non-voluntary detoxification and without living alone have strong motivation in this dimension.Conclusion:The reliability and validity of the TCU treatment motivation scale's translation draft are not perfect.After improvement,the reliability and validity of the methadone maintenance treatment motivation scale are ideal.All tems could be accepted,the fit of the model was good,the feasibility and acceptability was higher than before,also suitable for the Chinese MMT people,could be applied for the treatment of Chinese MMT population's motive measurement.The moti-vation of methadone maintenance treatment was different depending on the patient's education levels,occupation,residential status and self-rated physical health.It is suggested that methadone clinics should strengthen the management of patients with low educational level,living alone,engaged in agriculture and living in rural areas,and popularize the knowledge of methadone maintenance reatment.Patients' drug withdrawal intention,whether out of the group,whether there is relapse,whether there is a positive urine test record,the time since the first drinking of methadone,methadone dose,and take-home methadone service will cause differences in PR,DH,EP and total scale score,leading to different levels of MMT motivation.It was suggested that the management and health education should be strengthened for the patients with the problems of out of the group,relapse and positive urine test.Some targeted intervention measures can be taken to improve the treatment motivation and compliance of this group of people. |
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