Open Access Open Badges Research

An implementation-focused process evaluation of an incentive intervention effectiveness trial in substance use disorders clinics at two Veterans Health Administration medical centers

Hildi J Hagedorn123*, Cheryl B Stetler4, Ann Bangerter2, Siamak Noorbaloochi23, Maxine L Stitzer5 and Daniel Kivlahan67

Author Affiliations

1 Veterans Health Administration Substance Use Disorder Quality Enhancement Research Initiative, Minneapolis VA Healthcare System, One Veterans Drive, Minneapolis, MN 55417, USA

2 Veterans Health Administration Health Services Research and Development Center of Excellence, Minneapolis VA Healthcare System, Minneapolis, MN 55417, USA

3 University of Minnesota, Minneapolis, MN 55455, USA

4 Health Services Department, Boston University School of Public Health; and Independent Consultant, Amherst, MA 01002, USA

5 Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA

6 Center of Excellence in Substance Abuse Treatment and Education, VA Puget Sound Healthcare System, Seattle, WA 98108, USA

7 University of Washington School of Medicine, Seattle, WA 98185, USA

For all author emails, please log on.

Addiction Science & Clinical Practice 2014, 9:12  doi:10.1186/1940-0640-9-12

Published: 9 July 2014



One of the pressing concerns in health care today is the slow rate at which promising interventions, supported by research evidence, move into clinical practice. One potential way to speed this process is to conduct hybrid studies that simultaneously combine the collection of effectiveness and implementation relevant data. This paper presents implementation relevant data collected during a randomized effectiveness trial of an abstinence incentive intervention conducted in substance use disorders treatment clinics at two Veterans Health Administration (VHA) medical centers.


Participants included patients entering substance use disorders treatment with diagnoses of alcohol dependence and/or stimulant dependence that enrolled in the randomized trial, were assigned to the intervention arm, and completed a post intervention survey (nā€‰=ā€‰147). All staff and leadership from the participating clinics were eligible to participate. A descriptive process evaluation was used, focused on participant perceptions and contextual/feasibility issues. Data collection was guided by the RE-AIM and PARIHS implementation frameworks. Data collection methods included chart review, intervention cost tracking, patient and staff surveys, and qualitative interviews with staff and administrators.


Results indicated that patients, staff and administrators held generally positive attitudes toward the incentive intervention. However, staff and administrators identified substantial barriers to routine implementation. Despite the documented low cost and modest staff time required for implementation of the intervention, securing funding for the incentives and freeing up any staff time for intervention administration were identified as primary barriers.


Recommendations to facilitate implementation are presented. Recommendations include: 1) solicit explicit support from the highest levels of the organization through, for example, performance measures or clinical practice guideline recommendations; 2) adopt the intervention incrementally starting within a specific treatment track or clinic to reduce staff and funding burden until local evidence of effectiveness and feasibility is available to support spread; and 3) educate staff about the process, goals, and value/effectiveness of the intervention and engage them in implementation planning from the start to enhance investment in the intervention.

Substance use disorders treatment; Abstinence incentive intervention; Implementation; Process evaluation; Hybrid design