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The Impact of a Theory-Based Web Intervention on the Intention to Use

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The Impact of a Theory-Based Web Intervention on the Intention to Use University of New Mexico UNM Digital Repository Pharmaceutical Sciences ETDs Electronic Theses and Dissertations 6-9-2016 THE IMPACT OF A THEORY-BASED WEB INTERVENTION ON THE INTENTION TO USE PRESCRIPTION DRUGS FOR NON- MEDICAL PURPOSES AMONG COLLEGE STUDENTS: A RANDOMIZED CONTROLLED TRIAL Rasha Arabyat Follow this and additional works at: https://digitalrepository.unm.edu/phrm_etds Recommended Citation Arabyat, Rasha. "THE IMPACT OF A THEORY-BASED WEB INTERVENTION ON THE INTENTION TO USE PRESCRIPTION DRUGS FOR NON-MEDICAL PURPOSES AMONG COLLEGE STUDENTS: A RANDOMIZED CONTROLLED TRIAL." (2016). https://digitalrepository.unm.edu/phrm_etds/1 This Dissertation is brought to you for free and open access by the Electronic Theses and Dissertations at UNM Digital Repository. It has been accepted for inclusion in Pharmaceutical Sciences ETDs by an authorized administrator of UNM Digital Repository. For more information, please contact [email protected]. Rasha M. Arabyat Candidate College of Pharmacy, Pharm Pract & Admin Sciences Department This dissertation is approved, and it is acceptable in quality and form for publication: Approved by the Dissertation Committee: Dennis W. Raisch, PhD, MS , Chairperson Matthew Borrego, PhD, MS Ajna Hamidovic, PharmD, MS Betsy Sleath, PhD i THE IMPACT OF A THEO RY -BASED WEB INTERVENTI ON ON THE INTENTION TO USE PRESCRIPTION DRUGS FOR NON-MEDICAL PURPOSES AMONG COLLEGE STUDENTS: A RANDOMIZED CONTROLLED TRIAL By RASHA M. ARABYAT B.S., Pharmacy, University of Jordan, 2007 MPH., New Mexico State University, 2012 DISSERTATION Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Pharmaceutical Sciences The University of New Mexico Albuquerque, New Mexico May, 2016 ii DEDICATION This dissertation is dedicated to my husband Bashar, my kids (Ahmad, Omar & Zaha), my parents (Mahmoud & Abla), and my parents-in-law (Rafi & Nadia) iii ACKNOWLEDGMENTS First, I would like to thank Allah for granting me patience, perseverance, and strength to accomplish my dreams. Allah, I could not have finished this dissertation without your guidance. I cannot thank you enough for all your blessings to me and my family, as you says, “And He gave you of all that you asked for, and if you count the blessings of Allah, never will you be able to count them.” [Ibrahim 14:34]. I want to express my sincere gratitude for my mentor, advisor, and committee chair, Dr. Dennis Raisch for believing in me and supporting me through this challenging journey. His passion for research and thirst for learning new things have inspired me to be a better researcher. Despite his demanding schedule, Dr. Raisch was always able to find time to respond to my concerns and questions. I was truly fortunate to be his student, and to work with him as a research and teaching assistant. I would like also to thank the committee members: Dr. Matthew Borrego, Dr. Ajna Hamidovic, and Dr. Betsy Sleath for their valuable comments and suggestions. I am very grateful to all the professors at UNM who taught me graduate courses, especially Dr. Ludmila Bakhireva and Dr. Melissa Roberts from the PEPPOR (pharmacoeconomics, epidemiology, pharmaceutical policy and outcomes research) graduate program. I want to sincerely thank my parents: Mahmoud Arabyat and Abla Abu- Samen who never stopped motivating me to pursue my PhD degree. To my iv lovely sisters: Enas and Noor, and to my brothers: Radwan, Mohammad, and Ghaith who were always supporting and encouraging. Thank you very much from the bottom of my heart. To my parents-in-law Dr. Rafi and Nadia Qawasmeh, I could not have accomplished this dissertation without your help and support. I cannot thank you enough for taking care of my kids for the past year. I would like also to express my sincere gratitude to my sisters-in-law: Rana, Rema, Mays, Areej, and Maram, and my brother in-law Ahmad, as well as Aunt Kafa. Thank you all for being my second and lovely family. I am grateful to my fellow graduate students at the University of New Mexico: Adriana, Cheng, Renee, John, Shikhar, Akshay, and Yuebin. Thank you all for your generous assistance and for your friendship. I would like to express my appreciation and sincere thanks to my husband Dr. Bashar Qawasmeh for his remarkable patience, endless love, and tremendous support. Thank you for always being there when I need you the most. To my kids Ahmad, Omar, and Zaha, please forgive me for missing important milestones in your lives while I was working on my dissertation. I hope I can make it up to you. v THE IMPACT OF A THEORY-BASED WEB INTERVENTION ON THE INTENTION TO USE PRESCRIPTION DRUGS FOR NON-MEDICAL PURPOSES AMONG COLLEGE STUDENTS: A RANDOMIZED CONTROLLED TRIAL By Rasha M. Arabyat B.S. MPH PhD ABSTRACT The nonmedical use of prescription drugs (NMUPD) among college students is escalating at an alarming rate. A limited number of studies have utilized a theoretical framework to understand and change this behavior. The main objectives for this study were (1) to utilize the reasoned action approach (theoretical framework) to design and evaluate an intervention to change students’ intentions toward NMUPD, and (2) to test the predictive validity of the reasoned action approach in understanding NMUPD. Methods: The intervention was designed and tested during a pilot phase. Using a two-group post-test controlled trial, students were randomly assigned to either the intervention group or the control groups. The numbers of respondents in the intervention group were 188, and in the control group were 199. A survey was conducted to test the effectiveness of the intervention and the predictive validity of the reasoned action approach in understanding NMUPD vi Results: Overall, college students have strong intentions to avoid NMUPD. They also have negative attitudes toward NMUPD, high perceived norms that their important referents will not approve their NMUPD, and high perception that NMUPD is under their control. The intervention was able to bring changes in attitudes between the intervention and control groups. However, no changes were observed in intentions, perceived norms, perceived behavioral control, nor in their underlying beliefs. The reasoned action approach major constructs (attitudes, norms, and perceived behavioral control) were successful in explaining 37% of the variance in students’ intentions to avoid NMUPD. The most significant predictor of students’ intentions was perceived norms. The demographic factors that were significantly associated with intentions to avoid NMUPD included previous NMUPD, gender, tobacco use, marijuana use, and alcohol consumption. An analysis restricted to only those who reported NMUPD, showed that students who used stimulants have lower intentions to avoid NMUPD, more favorable attitudes toward NMUPD, but lower perceived norms that their important referents will not approve their NMUPD. Conclusion: The reasoned action approach was successful in predicting students’ intentions to avoid NMUPD, though the theory-based intervention was less successful in influencing and changing these intentions. More research is needed to improve the intervention dissemination and utilization. Future interventions should focus on both reducing the perceived social pressure and the approval of NMUPD, in addition to changing favorable attitudes toward NMUPD into unfavorable attitudes, especially among stimulants users. vii TABLE OF CONTENTS LIST OF FIGURES ...................................................................................................... XIII LIST OF TABLES ....................................................................................................... XIV LIST OF ACRONYMS ................................................................................................. XIX CHAPTER ONE: INTRODUCTION ................................................................................. 1 Overview ........................................................................................................................ 1 Nonmedical Use of Prescription Drug (NMUPD) ......................................................... 3 NMUPD among College Students at a Glance ............................................................ 5 Nonmedical Use of Prescription Drugs in New Mexico ............................................. 7 Theoretical Framework ................................................................................................. 9 Objectives of the Study ............................................................................................... 12 Hypotheses of the Study ............................................................................................ 12 Study Significance ...................................................................................................... 14 Potential Limitations of the Study .............................................................................. 16 CHAPTER TWO: LITERATURE REVIEW .................................................................... 18 Definition of Nonmedical Use of Prescription Medication ....................................... 19 Epidemiology of the NMUPD ...................................................................................... 20 Categories of the Most Frequently Used Prescription Drugs Nonmedically.......... 25 Opioid Analgesics ...................................................................................................... 25 Central Nervous System (CNS) Depressants (Sedatives, Hypnotics, and Tranquilizers) ............................................................................................................
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