Other Titles
Understanding Methadone Referral Intention: The Roles of Attitudes, Norms, and Perceived Behavioral Control in Practice [Poster Title]
Abstract
Nurses are often the first point of contact for individuals with opioid use disorder, yet screening and referral rates for methadone treatment vary among healthcare providers. To address this gap, our study explored how provider demographic factors, practice characteristics, and Theory of Planned Behavior constructs predict intentions to screen for opioid use disorder and refer patients to methadone treatment. A national survey of n=1,033 providers (registered nurses, nurse practitioners, physicians, and physician assistants), assessed attitudes, norms, perceived control, opioid stigma, vicarious trauma, and screening intention. Hierarchical regression analyzed predictors across demographic, theoretical, and contextual factors.
Registered nurses exhibited a significantly lower intent to screen or refer compared to prescribers (Nurse Practitioners, Physicians, and Physician Assistants) (β = –0.118, p = .019). The initial model, which incorporated both demographic and practice-related characteristics, explained 3.8% of the variance in intention (F(14, 1018) = 2.90, p < .001). Adding TPB constructs (Model 2) increased variance explained to 56.4% ( F(17,1015) = 77.14, p < .001). Perceived behavioral control was the strongest predictor (β = .562, p < .001), followed by favorable attitudes (β = .178, p < .001) and supportive subjective norms (β = .121, p < .001). Once psychological determinants were included, initial nursing differences were no longer significant, suggesting mediation through TPB constructs. Model 3 added contextual factors and increased variance explained to 57.5% (F(19,1013) = 72.02, p < .001). Finally, opioid-related stigma negatively predicted intention (β = –.081, p < .001), while provider level of vicarious trauma positively predicted intention (β = .071, p < .001).
Findings reveal actionable implications for healthcare providers. The strong influence of perceived behavioral control, combined with the negative impact of stigma and varying intentions among different nursing roles, suggests that referral behavior may be shaped more by modifiable psychological factors than by providers' background. Once attitudes, norms, and perceived control were included, the initial differences between registered nurses and prescribers were no longer significant, suggesting that improving these determinants may offset role-based disparities.
Notes
References:
1. Ajzen, I. (1991). The theory of planned behavior. Organizational Behavior and Human Decision Processes, 50(2), 179–211.
2. Parish, C. L., Feaster, D. J., Pollack, H. A., Horigian, V. E., Wang, X., Jacobs, P., ... & Metsch, L. R. (2023). Health care provider stigma toward patients with substance use disorders: protocol for a nationally representative survey. JMIR research protocols, 12(1), e47548.
3. Coffee Z, Linde-Krieger L, Carter GA, et al. Trauma-Related Stress and Resilience in a Multistate Sample of Methadone Treatment Staff. Substance Use: Research and Treatment. 2025;19. doi:10.1177/29768357251383239
4. Hatch-Maillette M.A., Peavy KM, Tsui JI, Banta-Green CJ, Woolworth S, Grekin P. Re-thinking patient stability for methadone in opioid treatment programs during a global pandemic: Provider perspectives. J Subst Abuse Treat. 2021 May;124:108223. doi: 10.1016/j.jsat.2020.108223. Epub 2020 Dec 5. PMID: 33342667; PMCID: PMC8005420.
5. Alexander, K., Smith, J. M., Gerolamo, A. & Bernhardt, J. (2023). The impact of nursing on health outcomes of people receiving medication for opioid use disorder: An integrative review. Journal of Nursing Scholarship, 55, 721–729. https://doi.org/10.1111/jnu.12858
Sigma Membership
Alpha
Lead Author Affiliation
Indiana University, Bloomington, Indiana, USA
Type
Poster
Format Type
Text-based Document
Study Design/Type
Cross-Sectional
Research Approach
Quantitative Research
Keywords:
Substance Use Disorders, Opioid Analgesics, Health Screening, Methadone--Therapeutic Use, Referral and Consultation, Public and Community Health, Primary Care
Recommended Citation
Carter, Gregory and Miller, Wendy, "Predicting Providers Intent to Screen for Opioid Use Disorder and Refer to Methadone Treatment" (2026). International Nursing Research Congress (INRC). 29.
https://www.sigmarepository.org/inrc/2026/posters_2026/29
Conference Name
37th International Nursing Research Congress
Conference Host
Sigma Theta Tau International
Conference Location
Toronto, Ontario, Canada
Conference Year
2026
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.
Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Date of Issue
2026-07-26
Predicting Providers Intent to Screen for Opioid Use Disorder and Refer to Methadone Treatment
Toronto, Ontario, Canada
Nurses are often the first point of contact for individuals with opioid use disorder, yet screening and referral rates for methadone treatment vary among healthcare providers. To address this gap, our study explored how provider demographic factors, practice characteristics, and Theory of Planned Behavior constructs predict intentions to screen for opioid use disorder and refer patients to methadone treatment. A national survey of n=1,033 providers (registered nurses, nurse practitioners, physicians, and physician assistants), assessed attitudes, norms, perceived control, opioid stigma, vicarious trauma, and screening intention. Hierarchical regression analyzed predictors across demographic, theoretical, and contextual factors.
Registered nurses exhibited a significantly lower intent to screen or refer compared to prescribers (Nurse Practitioners, Physicians, and Physician Assistants) (β = –0.118, p = .019). The initial model, which incorporated both demographic and practice-related characteristics, explained 3.8% of the variance in intention (F(14, 1018) = 2.90, p < .001). Adding TPB constructs (Model 2) increased variance explained to 56.4% ( F(17,1015) = 77.14, p < .001). Perceived behavioral control was the strongest predictor (β = .562, p < .001), followed by favorable attitudes (β = .178, p < .001) and supportive subjective norms (β = .121, p < .001). Once psychological determinants were included, initial nursing differences were no longer significant, suggesting mediation through TPB constructs. Model 3 added contextual factors and increased variance explained to 57.5% (F(19,1013) = 72.02, p < .001). Finally, opioid-related stigma negatively predicted intention (β = –.081, p < .001), while provider level of vicarious trauma positively predicted intention (β = .071, p < .001).
Findings reveal actionable implications for healthcare providers. The strong influence of perceived behavioral control, combined with the negative impact of stigma and varying intentions among different nursing roles, suggests that referral behavior may be shaped more by modifiable psychological factors than by providers' background. Once attitudes, norms, and perceived control were included, the initial differences between registered nurses and prescribers were no longer significant, suggesting that improving these determinants may offset role-based disparities.
Description
Nurses play an essential role in screening patients for opioid use disorder and referring them to methadone treatment; however, patient screening and referral remain suboptimal. This national, cross-sectional study identified healthcare provider-specific predictors of referral intention, including perceived behavioral control, attitudes, stigma, and norms. Findings highlight modifiable clinical workforce development targets to strengthen evidence-based opioid use disorder care.