Co-design of harm reduction materials for people who inject drugs to implement research findings

Abstract

Background: Equipment used by people who inject drugs (PWID) either has a needle which is fixed to the syringe or can be detached and replaced. Detachable low dead space syringes (LDSS) have been developed, with less space between the needle and plunger (referred to as dead space) than traditional detachable equipment. This equipment can help protect PWID from harm of infection as less blood is transferred if equipment is shared. Our previous research found that detachable LDSS are likely to be acceptable to PWID, and we produced recommendations for their introduction in needle and syringe programmes (NSP) in the United Kingdom (UK). We held a national stakeholder meeting to discuss how to accelerate the pace and scale of the rollout and uptake of detachable LDSS. This commentary reflects on the involvement of PWID as co-designers of harm reduction materials to implement these research findings in a way that supports the uptake of LDSS equipment by NSP and service users. We present the user-centred design process, peer reflections on the project, and lessons learnt by the team working with the peers.

Main body: Peers and stakeholders translated the research into easy to understand messages following a consultation with NSP across the UK. Working with Linnell Publications over three workshops, peers selected their preferred design style and informed the language, messages, and overall look of the designs. The peers ensured the designs avoided images and language with negative connotations, humour, and unequivocal language. Peers said that they found the process enjoyable and informative-leading to increased awareness of harm reduction practices. The facilitators took steps to ensure the views of the peers were heard throughout. They reflected on the importance of involving PWID meaningfully throughout the project. Without the peers, the designs would be less effective and engaging to their target audience.

Conclusion: We conclude that placing peers at the heart of this research implementation project was essential to ensure the materials are appropriate and engaging and do not stigmatise or alienate the intended audience unintentionally. We recommend that others planning similar work include peers within the entire project to support their meaningful contribution.

Keywords: Co-design; Harm reduction; Involvement; Low dead space syringes; Needle and syringe programmes; Peers; People who inject drugs.

Fig. 1

User-centred design process. Adapted from https://www.usability.gov/what-and-why/user-centered-design.html. Diagram displaying the user-centred design process followed in the project

Fig. 2

Style sheets. Eleven design style sheets created by the designer and presented to the peers in the first workshop. The peers selected style sheets 9 and 10

Fig. 3

Initial design. One example of the first draft designs discussed in the second workshop

Fig. 4

Final designs. The seven final designs available to download here are (https://www.exchangesupplies.org/shopsect_linnell_publications.php): ‘Dead space—what is it?’: this poster is designed to inform people about dead space, clearly illustrating what it is. ‘Dead space compared’: this poster shows the dead space in various types of injecting equipment, to help service users make an informed choice. ‘Less bugs, more drugs’: this poster displays the benefits of using low dead space equipment. These benefits were identified through the research. ‘Dead space, viruses, sharing’: this poster combines the message about choosing the lowest dead space possible for where people inject, with broader harm reduction messages. ‘Take, return, repeat’: this poster is designed to encourage the return of used equipment to needle and syringe programmes. ‘Be wise, sterilise’: this poster explains that rinsing low dead space equipment is more effective and gives the steps for sterilising equipment. ‘Naloxone saves lives’: this poster aims to encourage naloxone use, while increasing awareness that low dead space needles are not compatible with Prenoxad kits