Evaluation of overdose prevention trainings in New York City: Knowledge and self-efficacy among participants 12 months after training

ABSTRACT

Background: Prevention of unintentional opioid overdose deaths is effective through overdose prevention trainings (OPTs), in which laypersons are taught overdose response through six actions. This longitudinal study examines trainee knowledge 12 months after OPT completion. Methods: Participants were enrolled following OPT at six sites. At the 12-month follow-up, participants were asked to name the drug overdoses that naloxone reverses and name overdose response actions. A 6-point scale was created and was comprised of the number of correct overdose response actions mentioned (check breathing; administer sternum rub; call 911; give rescue breathing; administer naloxone; put victim in recovery position). Mean knowledge was compared by participant sociodemographic characteristics, confidence, and site of OPT training (indoors versus outdoors). Results: Of 344 OPT participants, 273 were reached at 12 months. Nearly all (99%) participants identified that naloxone reverses heroin overdoes; 77% identified that naloxone reverses opioid analgesics overdoses; and 68% identified that naloxone reverses methadone overdoses. Overdose response actions most frequently mentioned were giving naloxone (86%) and calling 911 (76%). The remaining four actions were mentioned by less than 40% of participants. Overall mean knowledge score was 2.7 out of 6. Mean knowledge scores were higher for college graduates than those with less than college education (3.2 vs 2.6, P < 0.001), for those who felt very confident (mean score [ms] = 2.9), compared to somewhat confident (ms = 2.4) and a little or not at all confident (ms = 1.5) in their ability to reverse an overdose (P < .001), and for indoor-training recipients (3.0 vs 2.5, P = 0.02). There were no differences in mean knowledge scores for trainees by age, race, or gender. Conclusions: These findings suggest the need for several improvements in OPT curriculum, including emphasis on naloxone reversal of opioid analgesic and methadone overdoses, and all 6 rescue actions. Lower knowledge scores among outdoor-trained participants likely reflect session brevity, suggesting that outdoor trainings need to be enhanced.

KEYWORDS:

• Confidence
• knowledge
• naloxone
• overdose
• self-efficacy

Acknowledgments

The authors thank Zina Huxley-Reicher for her hard work developing and evaluating this study.

Author contributions

Dr. Siegler conceived of, designed, and implemented the overall study, and oversaw all aspects of participant recruitment and follow-up, data management and analysis, results interpretation, and manuscript drafting. She made critical revisions to all manuscript drafts. Dr. Kunins provided supervision and oversight of study design, including sample size and population specification, development of recruitment and follow-up strategy, and questionnaire development. With coauthors, she planned the analysis for this manuscript. With coauthors, she interpreted results and developed paper outline and presentation of results. She made critical revisions to all manuscript drafts.

Funding

Funding for study design and implementation, data collection and analysis, and manuscript preparation and approval was provided by the Department of Health and Mental Hygiene. No external funding sources were used.