Background: In Sweden, the National Guidelines for Substance Abuse Treatment includes new recommendations concerning integrating a user perspective. From 2009 to 2014, the Swedish National Board of Health and Welfare supported and financed the development of organizations serving regional users. The programme was evaluated, and the results showed a development of user influence in substance use treatment services in 20 out of 21 regions by 2014. The implementation of user organizations’ influence was evaluated in 2018 for this follow-up study.

Aim: The aim of this four-year follow-up study was to evaluate whether user organizations continued existing once national support ended, and whether their influence in social services and health care, at both organizational and individual levels had been implemented.

Method: A questionnaire was dispatched to 20 regional user organizations. It included information and questions focused on their situation, and on participants’ experiences of the influence of user organizations in health care and social service.

Results: The results obtained from the questionnaire show that 14 out of 20 user organizations still existed and reported a developed influence in social services and health care at organizational and individual levels. National support was perceived as necessary for the ongoing development of user organizations and to continue increasing their influence.

Conclusions: Support at the national level initiated the development of user influence in Sweden, which has increased at both organizational and individual levels in the context of social services, as well as in health care for persons with substance use disorders.

In 2009, the Swedish government launched a nationwide dissemination and implementation project regarding substance abuse treatment, Knowledge to Practice (KTP), which was commissioned by the Swedish National Board of Health and Welfare (SoS). Aim: The study aimed to evaluate the effectiveness of a national project to disseminate and implement evidence-based assessment instruments and treatment methods, and to promote cross-sectional collaboration in substance abuse treatment. Design and recruitment: This study was a naturalistic prospective follow-up study of a sample of 3063 participants in 203 municipalities via five consecutive online surveys. Of the 21 Swedish regions, we included 20. All participants, representing 79.5% of the population, were employed in substance abuse treatment/care within social work and psychiatry. We used individual background variables and factors in the organizational readiness for change (ORC) questionnaire for prediction. Methods: We calculated descriptive statistics using SPSS 24.0. We applied latent profile analysis (LPA) to identify respondents with distinct growth profiles across five assessment points. Next, we calculated multilevel growth curve analyses using full information maximum likelihood analysis (FIML) in Mplus 8.3. In the analyses, we nested "within-person change" (level 1) in "between-persons analysis" (level 2). We, in turn, nested these in municipalities/regions (level 3). We included both respondents and organizational predictors in levels 2 and 3. We tested four statistical models in the multilevel analyses to predict the outcome. Results: The annual response rate was 59% on average across the five years. Respondents were a homogenous group with regard to education and years of employment, and two thirds were women. We identified four different trajectories nationwide, which showed different growth profiles for the use of methods and assessment instruments. Our results showed a larger between-region variation than within-region variation in outcome indicators. Some regions were more successful than others over the five years. At the respondent level, the years of employment in treatment work was associated with increased use of assessment instruments, while the ORC factor, institutional resources, predicted decreased use of assessment instruments. Specialist competence and the ORC factors staff attributes (job satisfaction, efficacy, and influence) and institutional resources predicted increased use of psychosocial treatment methods. The ORC factor organizational climate was positively associated with increased cross-sectional collaboration activities.

This thesis contains four empirical studies. The data derives from an evaluation project named Knowledge to Practice (KtP) that aimed to disseminate and implement the Swedish National Guidelines for Alcohol and Substance Abuse in Substance Use Disorder-treatment from 2010–2014. The aim of this thesis was to identify key determinants affecting implementation.

The data collection consisted of:

- Web surveys that were distributed annually from 2010–2014 to a panel of 3,852 respondents working in substance abuse treatment in social services and health care

- Web surveys distributed to approximately 10,000 participants in the national core curriculum course. Surveys were distributed before the start of the course and immediately after the course ended. A follow-up web survey was distributed one year later

- Semi-structured surveys for all regions’ user organizations to answer in focus groups

- Interviews with process managers in every region

The aim of Study I was to describe KtP's efforts and the situation in 2012. Web surveys were distributed to a panel of 3,852 respondents and 10,000 participants from core curriculum courses. Process managers from all 21 regions were interviewed. Study II used an instrument named Organizational Readiness for Change (ORC).The aim was to: (a) identify clusters of employees with different ORC profiles and (b) investigate whether belonging to a specific profile predicted the use of therapy methods, assessment instruments and cross-sectional collaboration. The ORC instrument was part of an annual web survey to a panel of 3,852 respondents.The aim of Study III was to evaluate, via a four-year follow-up study, whether user organizations continued existing after national support concluded and if their influence within social services and health care was implemented over time. The aim of Study III was to evaluate, via a four-year follow-up study, whether user organizations continued existing after national support concluded and if their influence within social services and health care was implemented over time. The aim of Study IV was to evaluate the extent of the dissemination and implementation work organised by KtP and whether there was increased use of treatment methods, assessment instruments and changes in cross-sectional collaboration between authorities. Factors associated with success were studied on three organizational levels: regional, municipal and individual. Results show that setting and person-related determinants, as measured by the ORC instrument, predicted implementation of assessment instruments and treatment methods. Profiles with high scores on institutional resources, staff attributes and organizational climate and low scores on motivational readiness were associated with more successful implementation. Respondent-level specialist competence and the ORC factors of staff attributes and institutional resources were related to the use of treatment methods. The ORC factor of organizational climate was related to the increase of cross-sectionalcollaboration at a respondent level. Years of employment working with substance users predicted increased use of assessment instruments and in contrast, the ORC factor institutional resources available were negatively related to instrument use. No predictors were found at the region/municipality level. The majority of respondents were positive to the national guidelines and found them useful in their daily work. They also reported positive attitudes to the KtP project. In 2011, two-thirds of the process managers from Sweden's 21 counties assessed that KtP's most important results were access to education and method support. The one-year follow-up web survey distributed to the participants in core curriculum courses showed that memory retention of the course content was fair. Eighty per cent of the respondents gave the correct answer to seven out of nine questions. User organizations still existed in most regions and they reported increased influence in the field of substance use treatment, both in social services and within health care services.

Organizational climate and related factors are associated with outcome and are as such of vital interest for healthcare organizations. Organizational Readiness for Change (ORC) is the questionnaire used in the present study to assess the influence of organizational factors on implementation success. The respondents were employed in one of 203 Swedish municipalities within social work and psychiatric substance/abuse treatment services. They took part in a nationwide implementation project organized by the Swedish Association of Local Authorities and Regions (SALAR), commissioned by the Swedish National Board of Health and Welfare. Aim: The aims were: (a) to identify classes (dusters) of employees with different ORC profiles on the basis of data collected in 2011 and (b) to investigate ORC profiles which predicted the use of assessment instruments, therapy methods and collaborative activities in 2011 and 2013. Design and recruitment: The evaluation study applied a naturalistic design with registration of outcome at consecutive assessments. The participants were contacted via official e-mail addresses in their respective healthcare units and were encouraged by their officials to participate on a voluntary basis. Statistics: Descriptive statistics were obtained using SPSS version 23. A latent profile analysis (LPA) using Mplus 73 was performed with a robust maximum likelihood estimator (MLR) to identify subgroups (clusters) based on the 18 ORC indexes. Results: A total of 2402 employees responded to the survey, of whom 1794 (74.7%) completed the ORC scores. Descriptive analysis indicated that the respondents were a homogenous group of employees, where women (72.0%) formed the majority. Cronbach's alpha for the 18 ORC indexes ranged from alpha = 0.67 to alpha = 0.78. A principal component analysis yielded a four -factor solution explaining 62% of the variance in total ORC scores. The factors were: motivational readiness (alpha = 0.64), institutional resources (alpha = 0.52), staff attributes (alpha = 0.76), and organizational climate (alpha = 0.74). An LPA analysis of the four factors with their three distinct profiles provided the best data fit: Profile 3 (n = 614), Profile 2 (n = 934), and Profile 1 (n = 246). Respondents with the most favorable ORC scores (Profile 3) used significantly more instruments and more treatment methods and had a better collaborating network in 2011 as well as in 2013 compared to members in Profile 1, the least successful profile. Conclusion: In a large sample of social work and healthcare professionals, ORC scores reflecting higher institutional resources, staff attributes and organizational climate and lower motivational readiness for change were associated with a successful implementation of good practice guidelines for the care and treatment of substance users in Sweden. Low motivational readiness as a construct may indicate satisfaction with the present situation. As ORC proved to be an indicator of successful dissemination of evidence-based guidelines into routine and specialist healthcare, it can be used to tailor interventions to individual employees or services and to improve the dissemination of and compliance with guidelines for the treatment of substance users. (C) 2017 Elsevier Inc. All rights reserved.