Abstract
Introduction: Most research on drug use has been conducted in North America and the Global North. The findings from these results cannot easily be generalised to other countries and communities. There is a scarcity of research on drug use and its treatment as conducted in the Muslim world. This thesis addresses the gap in research by focusing on drug use and treatment access in an under-researched population group. It aims to explore the barriers and facilitators to accessing drug treatment services for people who use drugs from the perspective of service providers and users in the Muslim world, with a focus on Oman.Methods and Methodology: This thesis consists of three studies. Study 1 is a narrative systematic review that was conducted in accordance with PRISMA. The protocol was prospectively registered with PROSPERO. The quality of studies was appraised using the Mixed Methods Appraisal Tool (MMAT). Studies 2 and 3 are qualitative studies where the conceptualization of access to health care was used as a theoretical framework. The qualitative studies used focus groups for service providers’ data collection and semi-structured interviews for service users. Thematic analysis was used as an analysis framework and coding was done using NVivo.
Results: The systematic review resulted in organisational and psychological barriers and facilitators with stigma as an overarching theme. The qualitative studies’ findings included six themes: personal attributions, treatment services, stigma, law enforcement, family involvement and religious and cultural beliefs. The three studies reflect the five dimensions and five abilities from the conceptual framework of access to healthcare. They shared several barriers including denial, limited drug treatment services including harm reduction services, lack of women’s treatment services, stigma around people who use drugs including women and their families, fear of legal consequences, lack of family support, and religious and cultural prohibition of drug use. They also shared some facilitators such as Islam being a motivator for recovery and treatment and in supporting harm reduction.
Discussion and Conclusion: The heterogeneity of majority Muslim countries represented in the systematic review reflects the heterogeneity in arrangements for drug use services. The shared barriers and facilitators to access drug treatment in Muslim countries and Oman were specific to Islamic perspectives, such as the absence of harm reduction services including Opioid Substitution Therapy (OST) as a barrier and Islam supporting recovery as a facilitator. Other barriers reportedly shared with non-majority Muslim countries, were of an organisational influence such as the long waiting times for appointments and the lack of available treatment services. This thesis contributes to a broader understanding of how structural, organisational and societal factors including available healthcare services, religion and culture, law enforcement, family and community support can affect access to drug treatment services. The findings can inform policies and interventions to enhance the accessibility and effectiveness of drug treatment services in Oman and other Muslim countries by promoting culturally sensitive, and community centred approaches. Highlighting the importance of multidisciplinary approaches, including telemedicine, localised community care and OST implementation provides an overarching approach to enhancing access to drug treatment services in Oman.
| Date of Award | 1 Dec 2024 |
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| Original language | English |
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| Supervisor | Gail Gilchrist (Supervisor) & Polly Radcliffe (Supervisor) |