Aims
To inform the development of a psychosocial intervention to reduce BBV risk behaviours among PWID in the UK, a qualitative interview study was conducted exploring:
l why PWID engage in BBV risk behaviours
l the type of psychosocial intervention acceptable to, and required by, PWID to reduce BBV risk behaviours.
Methods
Settings
People who inject drugs aged≥18 years who had injected drugs within the past 4 weeks were recruited from drug treatment and harm reduction centres, needle exchanges (including pharmacy and mobile), sexual health services and homeless hostels in Glasgow, London, Yorkshire and north Wales during May–July 2015. Settings were chosen to reflect the range of settings that PWID attend for substance use and sexual health-related issues and settings attended by particular at-risk PWID who are not engaged with addiction treatment.
Sample
A convenience sample of 60 PWID (15 from each locality) were recruited using a purposive sampling approach to ensure that a variety of perspectives were accessed, including those most at risk (Table 9). Sampling was thus stratified according to known BBV risk variables, including gender, length of time injecting, drugs injected, involvement in sex trading and homelessness.
Service users at each setting were eligible to participate if they were aged≥18 years, had injected illicit drugs [other than image- and performance-enhancing drugs (IPEDs)] within the past 4 weeks and were able to speak English well enough to complete a 45-minute interview. Given inability to provide informed consent, service users were not recruited if/when experiencing withdrawal or intoxication.
Data collection
A number of recruitment approaches were taken to achieve the purposive sampling parameters. Flyers were left in participating services to promote the study to service users. Staff at each of the services also informed eligible service users about the study and either passed on the researcher’s details to those who were interested or, with the service user’s permission, passed their contact details to the researcher, who rang potential participants to discuss the study. Researchers also recruited participants from the waiting rooms in services (except sexual health clinics) using a short screening questionnaire to ascertain study eligibility. All participants received a written study information leaflet (seeAppendix 1) and verbal explanation of the study from the researcher, and were given an opportunity to ask any questions. Participants indicated their consent to participate in the study by signing a consent form (seeAppendix 1). Participants received a £20 voucher in compensation for their time and expenses on completion of the interview.
DOI: 10.3310/hta21720 HEALTH TECHNOLOGY ASSESSMENT 2017 VOL. 21 NO. 72
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Semistructured in-depth interviews were conducted with individual participants within a private room at each setting by trained researchers (DS, AS, NM and ST). Interviews lasted approximately 45 minutes and were audio-recorded with the interviewee’s permission. The interview topic guide (seeAppendix 2) included questions on participants’knowledge and perceptions of BBV transmission (HIV, HCV and HBV), perceptions of personal vulnerability to BBV, influences on the sharing of needles, syringes and other drug-using equipment, influences on sexual risk taking (such as non-condom use), and past interventions they had received on safer drug use and safer sex. Participants were also asked for their suggestions on how to support safer drug use and safer sex in the light of the influences on risk identified and their preferences for the PROTECT psychosocial intervention (content, format, venue, interventionist, duration, barriers/facilitators).
Ethics approval
The study was approved by the National Research Ethics Service Committee South East Coast–Brighton & Sussex (reference number 15/LO/0387).
Data coding and analysis
Interviews were transcribed by professional transcription services and analysed using qualitative framework analysis.223The framework approach allows the description and interpretation of what is happening among
a predesigned sample with a set of a priori issues. The approach involves five key steps: familiarisation with
TABLE 9 Sampling framework and number of participants (n=60)
Sampling parameter Number of participants % of the total
Gender
Male 35 58
Female 25 42
Length of time injecting
<2 years (new PWID) 17 28
≥2 years 43 72
Drugs injected
Mostly heroin/opiates 35 58
Mostly stimulants (cocaine/crack/methamphetamines) 13 22
Mostly both 12 20
Living situation
Alone 18 30
With sexual partner and children 8 13
With sexual partner alone 6 10
With children alone 1 2
With parents 2 3
With family 5 8
With friends/flatmates 6 10
Homeless 22 37
No stable arrangements 1 2
Other living arrangements 2 3
Involvement in sex trading (previous/current) 9 15
UNDERSTANDING PEOPLE WHO INJECT DRUGS’INFLUENCES AND VIEWS
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the data; identifying a thematic framework; indexing the data; charting categories and themes; and mapping and interpretation. The framework approach was developed to answer policy-relevant research questions and can facilitate inductive, deductive or combined approaches to analysis. It is especially amenable to projects where analysis will be conducted by more than one researcher.224
The research team (DS, GG, AS, AM, NM, EH, ST and NC) independently coded the first six interview transcripts, then reviewed the coding at a face-to-face team meeting and collaboratively generated an initial thematic framework. This coding framework was applied to the remaining interviews (indexing) by Davina Swan, April Shaw, Noel Crane and Kideshini Widyaratna. Weekly Skype (Microsoft Corporation, Redmond, WA, USA) meetings were held between the analysts to ensure consistency of coding across the interviews and to agree new codes to be added to the framework. This also included the researchers analysing one interview independently and reviewing how each had coded it to ensure validity. When first-level coding had been completed, Davina Swan and April Shaw reviewed all coding and charted and mapped the data. Qualitative software (NVivo 10, QSR International, Warrington, UK) was used to manage and code the interviews. Several methods were utilised to enhance the validity of our findings: (1) triangulation of data across multiple settings and localities; (2) triangulation of coding across several co-researcher perspectives; (3) presentation of analysis and supporting quotes to service user representatives for feedback/critique (credibility); and (4) identification and questioning of researchers’underlying assumptions at the weekly skype meetings between analysts (reflexivity).225