Qualitative Evaluation of Evidence-Based Online Decision Aid and Resources for Osteoarthritis Management: Understanding Patient Perspectives.

OBJECTIVE: To qualitatively examine the experiences with, and impact of, evidence-based online resources in self-management among Australians with osteoarthritis. METHODS: Telephone interviews were conducted with 36 users of a novel osteoarthritis resource, the Osteoarthritis Awareness Hub. Rogers' 5 attributes of innovation (relative advantage, compatibility, complexity, trialability, and observability) and outcomes guided the semistructured interview and analysis. Maximum variation sampling was used, and data saturation occurred after 33 interviews. A coding scheme was agreed upon and all interview data were entered into NVivo for qualitative content analysis. RESULTS: Study participants had high levels of literacy and health literacy. For adoption and implementation of an innovation, the participants' narratives confirmed and underscored the fact that it was important that it come from an authoritative and trusting voice and that its perceived benefits align with participants' values and existing practices (relative advantage and compatibility). The participants also valued seeing the practical benefits of the innovation, such as its capacity to impart quality and balanced new insights and information, and to maintain and monitor their personal progress. Notably, many participants spoke about the mental and physical health benefits that they derived from engagement with the online resources. CONCLUSION: Our study findings confirm that web-based tools can be a useful adjunct to patients adopting self-management strategies. Rogers' theory provides a framework for a deeper appreciation of the how, why, and what questions concerning the adoption and implementation processes, especially among people with good technology and health literacy.

Uptake of wheel-filtration among clients of a supervised injecting facility: Can structured education work?

INTRODUCTION AND AIMS: Wheel-filtration of pharmaceutical opioid tablets is a recognised harm reduction strategy, but uptake of the practice among people who inject drugs is low. The study aimed to: (i) examine perceptions of filtration practices; (ii) provide structured education on wheel-filtration; and (iii) assess uptake of the practice. DESIGN AND METHODS: Frequent opioid tablet injectors (n = 30) attending a supervised injecting facility in Sydney, Australia, received hands-on instruction on wheel-filtration based on recommended practice. Pre-education, post-education and follow-up questionnaires were administered. RESULTS: Wheel-filtration was generally regarded as better than cotton-filtration (the typical method) in terms of perceived effects on health, ease of use and overall drug effect. Sixty-eight percent of those who said they would try wheel-filtration after the education had actually done so. Of those who usually used cotton-filtration, over half (60%) had used wheel-filtration two weeks later. DISCUSSION AND CONCLUSIONS: Uptake of safer preparation methods for pharmaceutical opioid tablets increases after structured education in wheel-filtration. Findings suggest that SIFs are an effective site for this kind of education. Supervised injecting facility workers are uniquely positioned to provide harm reduction education at the time of injection. [Steele M, Silins E, Flaherty I, Hiley S, van Breda N, Jauncey M. Uptake of wheel-filtration among clients of a supervised injecting facility: Can structured education work? Drug Alcohol Rev 2018;37:116-120].

'It's Fast, It's Quick, It Stops Me Being Sick': How to influence preparation of opioid tablets for injection.

INTRODUCTION AND AIMS: Injection of pharmaceutical opioids (PO) among people who inject drugs has increased in many countries. The common method for preparing PO tablets for injection uses heat, resulting in greater particulate matter and therefore increased risk of local infection risk and damage to veins and organs. A cold preparation process has fewer risks, but this preparation method is not commonly used. This study seeks to explore how people who inject PO learn to prepare injections and how health promotion efforts could influence practice. DESIGN AND METHODS: Between March and December 2013, qualitative interviews were undertaken with 33 clients of Sydney's Medically Supervised Injecting Centre who inject PO tablets regarding sources of knowledge and current preparation methods for injection of POs. RESULTS: Overwhelmingly, the most commonly reported source of knowledge around injection of tablets was others who inject. Most participants reported heating the solution as the quickest way to administer the drug. Attitudes to the use of wheel filters varied, with some participants reporting that they would use the filters if they were shown how, while others reported a number of barriers to using filters, including complexity of use. DISCUSSION AND CONCLUSIONS: Harnessing the power of social connections may provide avenues for education about safer injecting of tablets, including the use of wheel filters. Further work is required to debunk myths about the relative potencies of cold versus hot drug solution. Collaborations between harm reduction workers and peer workers would assist in knowledge dissemination regarding safer injecting practices.

Injecting buprenorphine-naloxone film: Findings from an explorative qualitative study.

INTRODUCTION AND AIMS: Experiences of buprenorphine-naloxone (BNX) sublingual film injection are not well documented or understood. We examined how people who inject BNX film seek and share information about this practice, document the methods used to prepare BNX film for injection, and report participants' experiences of this practice. DESIGN AND METHODS: Interviews were (n = 16) conducted with people who indicated that they had injected BNX film since its introduction onto the Australian market. Semistructured interviews were recorded and transcribed. NVivo10 program (QSR International) was used to analyse the data using qualitative description methodology. RESULTS: Participants largely reported similar BNX film preparation techniques, although the texture of BNX film during preparation to inject was reported to be unusual (gluggy), and there were many varied accounts associated with the amount of water used. Physical harms reported as associated with injecting BNX film were described (including local and systemic issues); participants reported injecting the film to enhance its immediate effects, yet generally reported that sublingual administration provided longer-lasting effects. DISCUSSION AND CONCLUSIONS: Understanding knowledge acquisition about injecting new formulations of opioid substitution therapy is crucial in developing more effective harm-reduction strategies. Dissemination by peer networks to those who are currently or planning to inject BNX film regarding the 'gelatine like' texture when mixing, using only cold water and double filtering is important to ensure safer injecting practices. Findings from this study highlight the importance of peer networks for the dissemination of harm-reduction information. Introduction of new formulations internationally requires more qualitative studies to inform safer practices.