Abstract
Background: Skin and soft tissue infections (SSTI) among people who inject drugs (PWID) are a public health concern. This study aimed to co-produce and assess the acceptability and feasibility of a behavioural intervention to prevent SSTI.
Methods: The Person-Based Approach (PBA) was followed which involves: (i) collating and analysing evidence; (ii) developing guiding principles; (iii) a behavioural analysis; (iv) logic model development, and; (v) designing and refining intervention materials. The latter utilised co-production activities with target group representatives and key collaborators to obtain feedback on the intervention. The intervention, harm reduction advice cards to support conversation between service provider and PWID and resources to support safer injecting practice, was piloted with 13 PWID by four service providers in Bristol and evaluated using a mixed-methods approach. Semi-structured interviews were conducted with 11 PWID and four service providers. Questionnaires completed by all PWID recorded demographic characteristics, SSTI, drug use and treatment history. Interviews were analysed thematically and questionnaires analysed descriptively.
Results: Published literature highlighted structural barriers to safer injecting practices, such as access to hygienic injecting environments and injecting practices associated with SSTI included: limited handwashing / injection-site swabbing and use of too much acidifier to dissolve drugs. Co-production activities and the literature indicated vein care and minimisation of pain as PWID priorities. The importance of service provider-client relationships and non-stigmatising delivery were highlighted through the co-production work. Providing practical resources was identified as important to address environmental constraints to safer injecting practices.
Most participants receiving the intervention were White British, male, had a history of SSTI and on average were 43.6 years old and had injected for 22.7 years. The intervention was well-received by PWID and service providers. Intervention content and materials given out to support harm reduction were viewed positively. The intervention appeared to support reflections on and intentions to change injecting behaviours, though barriers to safer injecting practice remained prominent.
Conclusions: The PBA ensured the intervention aligned to the priorities of PWID. It was viewed as acceptable and mostly feasible to PWID and service providers and has transferability promise. Further implementation alongside broader harm reduction interventions is needed.
Methods: The Person-Based Approach (PBA) was followed which involves: (i) collating and analysing evidence; (ii) developing guiding principles; (iii) a behavioural analysis; (iv) logic model development, and; (v) designing and refining intervention materials. The latter utilised co-production activities with target group representatives and key collaborators to obtain feedback on the intervention. The intervention, harm reduction advice cards to support conversation between service provider and PWID and resources to support safer injecting practice, was piloted with 13 PWID by four service providers in Bristol and evaluated using a mixed-methods approach. Semi-structured interviews were conducted with 11 PWID and four service providers. Questionnaires completed by all PWID recorded demographic characteristics, SSTI, drug use and treatment history. Interviews were analysed thematically and questionnaires analysed descriptively.
Results: Published literature highlighted structural barriers to safer injecting practices, such as access to hygienic injecting environments and injecting practices associated with SSTI included: limited handwashing / injection-site swabbing and use of too much acidifier to dissolve drugs. Co-production activities and the literature indicated vein care and minimisation of pain as PWID priorities. The importance of service provider-client relationships and non-stigmatising delivery were highlighted through the co-production work. Providing practical resources was identified as important to address environmental constraints to safer injecting practices.
Most participants receiving the intervention were White British, male, had a history of SSTI and on average were 43.6 years old and had injected for 22.7 years. The intervention was well-received by PWID and service providers. Intervention content and materials given out to support harm reduction were viewed positively. The intervention appeared to support reflections on and intentions to change injecting behaviours, though barriers to safer injecting practice remained prominent.
Conclusions: The PBA ensured the intervention aligned to the priorities of PWID. It was viewed as acceptable and mostly feasible to PWID and service providers and has transferability promise. Further implementation alongside broader harm reduction interventions is needed.
| Original language | English |
|---|---|
| Article number | 114 |
| Journal | Harm Reduction Journal |
| Volume | 20 |
| Issue number | 1 |
| DOIs | |
| Publication status | Published - 22 Aug 2023 |
Bibliographical note
Funding Information:We are extremely grateful to the people who inject drugs and service providers who took part in this study for their assistance and participation. We would like to thank our target group representatives and staff at Bristol Drugs Project for their feedback on the prototype intervention and the clients, collaborators including colleagues from the UKHSA, professionals and service provider organisations who provided feedback and insights that contributed to this work.
Funding Information:
JK is partly funded by National Institute for Health Research Applied Research Collaboration West (NIHR ARC West) and NIHR Health Protection Research Unit in Behavioural Science and Evaluation. HF was supported by the University of Bristol RED fund. GM was supported by the South West Public Health Training Scheme and Bristol, North Somerset and South Gloucestershire Clinical Commissioning Group Research Capability Funding. DH and CL’s time on the project was supported by the Bristol Health Partner’s Drug and Alcohol Health Integration Team. This study was partly supported by the University of Bristol RED fund, ESRC Impact Acceleration Award, Bristol Health Partners Drug and Alcohol Health Integration Team (HIT) and the National Institute for Health and Care Research (NIHR) Health Protection Research Unit (HPRU) in Behavioural Science and Evaluation at the University of Bristol, in partnership with the UK Health Security Agency. The views expressed are those of the author and not necessarily those of the NIHR, the Department of Health and Social Care, or UKHSA.
Publisher Copyright:
© 2023, BioMed Central Ltd., part of Springer Nature.