Methods: A random sample of 43 CD voice-recorded sessions from 24 intervention groups available from the Community Wise Optimization Trial were included in the analysis. Three session recordings were independently coded by two doctoral research assistants using N-Vivo to develop a coding tree with 100% consensus. The coding tree was then used to code the remaining sessions. The final code list was analyzed to develop themes that indicated potential intervention active ingredients for increasing participants’ critical reflection (i.e. using critical thinking skills to analyze the impact of social determinants of health on health inequities). Quotes that illustrated examples of each theme were transcribed.
Results: Analysis identified four potential active ingredients in CD: 1) Language, 2) image discussions; 3) critical questions; and 4) homework. Language referred to the development of a common language through the use of a glossary and dialogue that captured participants experiences of social and health inequities. The image discussions consisted of participants’ reflections about the intervention images which were developed to capture social determinants of health that impact SUD (e.g., incarceration, stigma, lack of access to quality services). Critical questions (e.g., “How did you come to believe that x is true?”, “What evidence supports this belief?”) were posed by participants and facilitators and seek to move the discussion from belief defending to critically assessing information and the thinking process. Finally, participants were assigned readings that they would discuss at the beginning of each session. Their readings reflected the theme of the session and consisted of findings from ethnographic research on that topic. For example, “Today my whole way of thinking comes from how I don’t want to raise my children... I don’t want them to hear somebody say something about someone and then all of a sudden that’s just the truth. I want them to at least be able to take a look at it and see what’s going on.”
Conclusions and Implications: Critical Dialogue is an evidence-based intervention informed by critical consciousness theory that can be incorporated into social work practice to address the impact of racism, sexism, and classism on maintain health inequities.