Using Participant Feedback to Iteratively Improve Training for Positive Recovery Jouranling, an Intervention for Substance Use Disorders

Abstract

Background: Recovering from substance use disorders is challenging given the biopsychosocial stressors encountered in recovery. Positive Recovery Journaling (PRJ), developed by the second author, is a daily therapeutic practice rooted in concepts of positive psychology and values affirmation, with pilot data suggesting a positive impact during early recovery. The purpose of the present study was to develop and iteratively improve procedures for teaching PRJ to 5 cohorts (N = 37) of counselors for implementation in their practice settings. Methods: In this mixed-methods study, we assessed feasibility, appropriateness, and acceptability of PRJ after the training using Weiner et al. (2017)’s scales. The percent who chose to implement PRJ after the 4.5h training provided additional evidence of these constructs. Based on survey feedback from Cohort 1, we made improvements to subsequent training sessions. We compared Cohort 1 to subsequent cohorts to determine whether training improvements enhanced ratings of PRJ feasibility, appropriateness, and acceptability and decision to use PRJ after the training. Findings: Qualitative feedback from Cohort 1 indicated that participants found the 4.5h training too long, the language in PRJ group session slides too advanced, and the training insufficient for some components of PRJ. As a result, in subsequent trainings, we split the training from one to two sessions, made the language more accessible, and thoroughly covered all components. Comparing the first cohort with all subsequent cohorts combined, 90% (n = 10) versus 96% (n = 27) chose to implement PRJ (Fisher’s exact test p = .473). Based on a 5-point scale, PRJ was rated by Cohort 1 versus subsequent cohorts after the training as acceptable (mean=4.4, sd=.6 versus 4.8, SD=.3, t(11)= -2.0, p = .078), appropriate (mean=4.2, SD=.6 versus 4.8 sd=.4, t(12)= -2.5, p = .028), and feasible (mean=4.3, sd=.7 versus 4.8, SD=.4, t(11)= -2.4, p = .037). Implications for D&I Research: Participant feedback is crucial for adapting interventions to fit real-world settings. This study highlights how an iterative process can be used to adapt an existing training to support improved perception of an intervention and rates of implementation.