Service Evaluation of Scotland's Take-Home Naloxone Programme

Appendix 4: Interview topic guides

Service Provider Interview Topic Guide

Explain:

• the purpose of the research - to identify
  1. how the THN programme is working
  2. effective practice
  3. how participants experience the programme
  4. key outcomes
• that this is one of four case study areas where in-depth interviews are being undertaken with service providers, service users, family / carers and friends, non-participants
• that participants have anonymity
• that participants' responses will not be shared with anyone other than the research team
• that what participants say will be used to inform a report to the Scottish Government to inform the development of the Naloxone programme but that they will not be identifiable in the report in any way.

Section1: Train the Trainers Training: delivery & content

1. Who provided the TTT you received, and when was it delivered?

2. How effective did you feel the TTT was at supporting you to provide training on Naloxone and/or at supporting you to supply Naloxone?

3. In your view, did the training content cover all the information you need to feel confident about providing Naloxone training and/or storing and supplying Naloxone? Y/N?

• If no, what additional content do you feel you would have benefited from and what, if any, concerns/queries do you have relating to providing Naloxone training and/or storing and supplying Naloxone?

4. (For those involved in supply only) Did the training cover all the information you need to use the PGD? Y/N

• If no, what additional content do you feel you would have benefited from and what, if any, concerns/queries do you have relating to use of the PGD?

5. What, if anything, do you think could have been done differently about the way the training was delivered to increase its effectiveness for you?

Section 2: Recruitment

6. Which factors support recruiting people at risk of opioid overdose to:
a) receive Naloxone training; and then go on to
b) receive a supply of Naloxone?

Prompt for challenges reaching those most vulnerable, and those who don't engage with drug treatment services. Also prompt for barriers to recruitment, for example attitudes of people at risk, attitudes of others (including family, carers, colleagues), fear of police, loss of tenancy, fear of being identified as a person with problem drug use, size and nature of kit, location/nature of programme delivery.

7. Which factors hinder recruiting people at risk of opioid overdose?

8. In your view, how could recruitment of those most at risk of opioid overdose be improved in your Health Board/ADP area?

9. Which factors support recruiting carers, family members and friends of people at risk of opioid overdose to receive Naloxone training? In your opinion, what would improve recruitment?

10. Which factors hinder recruiting carers, family members and friends of people at risk of opioid overdose?

Section 3: Naloxone training and supply

11. What, if any, are your organisation's/local programme's standard procedures for:

• referring people for Naloxone training and/or supply?
• patient monitoring and follow up (including finding out if a THN kit has been used)?
• provision and monitoring of repeat supplies?

12. Overall, what do you feel is working well about your local THN programme? What is working less well?

13. What, if any, challenges have you experienced when providing Naloxone training and/or supplying Naloxone to people at risk of opioid overdose? How are these challenges addressed locally?

14. (Other than recruitment) What, if any, challenges have you experienced when training carers, friends and family members of people at risk of opioid overdose? How are these challenges addressed locally?

Section 4: Impact

15. Can you give examples of how your local THN programme impacts on:
a) people at risk of opioid overdose?
b) families, friends & carers of people at risk of opioid overdose?
c) you and your colleagues?

eg contact with services, awareness of O/D signs, ability to deal with O/D

Section 5: Partnership working

16. Which professionals and agencies are involved in your local THN programme?

Depending on where respondents is based, prompt for links with police, prison (if community setting), ambulance services, drug agencies, other areas, as well as involvement of GPs and hospital doctors if not specifically mentioned.

Do they think others should be involved?

17. How does this partnership working support local programme delivery?

18. Are there any factors that encourage or discourage particular professional groups or partner agencies from engaging with the programme?

Prompt for perceptions of the programme by partners and how this influences involvement.

Section 6: Successes, facilitators & sustainability

19. What do you see as the key strengths / successes to date of the local THN programme in your area? How have you measured this success? (e.g., audit, evaluation, feedback?)

20. What has facilitated this success?

21. What do you see as the key weaknesses to date of the local THN programme in your area? How have you identified these?

22. What support have you received locally and how have you found this?

Prompt for support from Local Coordinator and other forms of local support

23. What support have you received nationally and how has this helped you in your role (eg national Naloxone website)?

24. What, if any, further support would you benefit from?

25. What do you see as the future of your local THN programme?

Thank you for your time.

Interview guide for people at risk of opioid overdose who have participated in the THN programme (training and/or supply)

Interview pre-amble for researchers

1.) Explain:

• the purpose of the research
• that participants have anonymity
• that participant's responses will not be shared with anyone other than the research team
• that what participants' say will be used to inform a report to the Scottish Government to inform the development of the Naloxone programme but that they will not be identifiable in the report in any way
• that participants can end the interview at any time
• that participants can have a friend present, if they wish
• that there is a £10 voucher to thank them for their involvement

2.) Invite questions from participants

3.) Gain signed consent to proceed with the interview

Participant details

We should know from the intermediary organisation which sampling criteria the service user fulfils e.g., training only, training & supply, declined participation in training.

Gather the following information - reassure the participant this is for our purposes only to ensure we are interviewing a cross-section of people with various relevant experiences and that this information will not be shared with anyone outside of the research team.

• What age are you?
• Note gender
• Note location
• What drug support services do you use (if any), eg needle exchange?

Interview questions

1. How did you hear about the THN programme?

Prompt for through organisation (which one?)/ marketing materials (which & from where)/ family or friend (do they know how they heard about it?)

If through an organisation, family or friend, ask: how was the Naloxone programme described/explained to you? How did you feel about someone suggesting you engage with the programme?

If through marketing materials (poster, leaflet, website, social media, radio ads for international overdose awareness day) ask: what did you understand the programme to be about from the materials?

2. What did you think about the THN programme when you first heard about it?

3. After hearing about the THN programme, what made you want to attend the training?

4. What did you learn from the training?

Prompts: confidence to recognise signs of an opioid overdose, confidence to deal with an overdose situation and/or to use Naloxone in an overdose situation? If no, what other information would have been useful for you to receive?

5. Could anything about the training have been improved?

6. Did you receive a THN kit after the training? Y/N

(If no), was this

• because you were given a certificate / authorisation to collect one later from a healthcare professional at an alternative site
• because you didn't want to take a naloxone kit

Can you tell me why you didn't want to take a naloxone kit?

Prompts:

• Did anything put you off?
• Have you thought about asking for a supply since?
• Can you see yourself wanting a kit at any point in the future?
• What would encourage you to take a kit?
• Would you know how to get a kit if you did decide you wanted one?

(If yes):

What do you think of the kit?

Is there anything you would change about it?

Do you usually carry your kit? Why/why not?

• If not, where do you usually keep your kit?

Have you used your kit?

• If yes, can you tell me briefly what happened and what you did? (prompt for if they called an ambulance; how the call was handled; how the ambulance staff handled the situation; if the ambulance was not called, why not)
• How did you feel about using the kit?
• How would you feel about using the kit again in future if you were in a similar situation again?
• Have you obtained a replacement kit?

7. Overall, what do you think about the THN programme?

8. What do you think about Naloxone?

9. Do you know anyone else who has used Naloxone?

10. What do other people you know think about the THN programme?

11. What do you think would encourage more people to:
a) Complete Naloxone training?
b) To carry a THN kit?

12. Would you recommend undertaking Naloxone training and /or getting a THN kit to anyone you know?
If no: why not?
If yes: why? And who would you recommend it to?

13. Do you have any more comments on the programme?

Thank you for your time.

Interview guide for people at risk of opioid overdose and carers/family members who have declined participation in the THN programme

Interview pre-amble for researchers

1.) Explain:

• the purpose of the research
• that participants have anonymity
• that participant's responses will not be shared with anyone other than the research team
• that what participants' say will be used to inform a report to the Scottish Government to inform the development of the Naloxone programme but that they will not be identifiable in the report in any way
• that participants can end the interview at any time
• that participants can have a friend present, if they wish
• that there is a £10 voucher to thank them for their involvement

2.) Invite questions from participants

3.) Gain signed consent to proceed with the interview

Participant details

We should know from the intermediary organisation which sampling criteria the service user fulfils e.g., training only, training & supply, declined participation in training.

Gather the following information - reassure the participant this is for our purposes only to ensure we are interviewing a cross-section of people with various relevant experiences and that this information will not be shared with anyone outside of the research team.

For people at risk of opioid overdose:

• What age are you?
• Note gender
• Note location
• What drug support services do you use (if any), eg needle exchange?

For carers & family members

• What age are you?
• Note gender?
• Do you know anyone at risk of opioid overdose?

Interview questions

1. (assumption is that they are aware of the THN programme as this would be a pre-selection criteria) How did you hear about the THN programme?

Prompt for through organisation (which one?)/ marketing materials (which & from where)/ family or friend (do they know how they heard about it?)

If through an organisation, family or friend, ask: how was the Naloxone programme described/explained to you? How did you feel about someone suggesting you engage with the programme?

If through marketing materials (poster, leaflet) ask: what did you understand the programme to be about from the materials?

2. What do you think about the idea of:
a) Naloxone?
b) the THN programme?

3. What do other people you know think about the THN programme?

4. Has anyone offered you training on Naloxone? Y/N

(The answer should be yes, as this is part of the selection criteria, however we may end up with a few individuals who say no so Qs added in case of this)

If no:

• Would you be interested in attending training? Why/Why not?
• (For PDUs only) Would you be interested in having a THN kit? Why/why not?

If yes:

• Can I ask why you didn't attend the training?
• Is there anything that would have encouraged you to attend the training?
• (For PDUs only) Would you ever consider having a THN kit? Why/why not?
• How likely are you to get involved in the programme in future?

5. Do you know anyone who has attended training? If yes, what did they think of it?

6. Do you know anyone who has/carries a THN kit? How they feel about having the kit?

7. Would you recommend the programme to anyone you know? Who to and why?

8. Do you have any more comments on the programme?

Thank you for your time.

Interview guide for families/carers/friends of people at risk of opioid overdose who have participated in the THN programme (training and/or supply)

Interview pre-amble for researchers

1.) Explain:

• the purpose of the research
• that participants have anonymity
• that participant's responses will not be shared with anyone other than the research team
• that what participants' say will be used to inform a report to the Scottish Government to inform the development of the Naloxone programme but that they will not be identifiable in the report in any way
• that participants can end the interview at any time
• that participants can have a friend present, if they wish
• that there is a £10 voucher to thank them for their involvement

2.) Invite questions from participants

3.) Gain signed consent to proceed with the interview

Participant details

We should know from the intermediary organisation which sampling criteria the service user fulfils e.g., training only, training & supply, declined participation in training.

Gather the following information - reassure the participant this is for our purposes only to ensure we are interviewing a cross-section of people with various relevant experiences and that this information will not be shared with anyone outside of the research team.

• What age are you?
• Note gender
• Note location

Interview questions

1. How did you hear about the THN programme?

Prompt for through organisation (which one?)/ marketing materials (which & from where)/ family or friend (do they know how they heard about it?)

If through an organisation, family or friend, ask: how was the Naloxone programme described/explained to you? How did you feel about someone suggesting you engage with the programme?

If through marketing materials (poster, leaflet, website, social media, radio ads for international overdose awareness day) ask: what did you understand the programme to be about from the materials?

2. After hearing about the THN programme, what made you want to attend the training?

3. What did you learn from the training?

Prompts: confidence to recognise signs of an opioid overdose, confidence to deal with an overdose situation and/or to use Naloxone in an overdose situation? If no, what other information would have been useful for you to receive?

4. Could anything about the training have been improved?

5. How confident do you feel about using a Naloxone kit?

6. What do you think of the kit?

7. Is there anything you would change about it?

8. Do you know where [the person with problem drug use you know] keeps their kit?

9. Have you used a kit?

• If yes, can you tell me briefly what happened and what you did? (prompt for if they called an ambulance; how the call was handled; how the ambulance staff handled the situation; if the ambulance was not called, why not)
• How did you feel about using the kit?
• How would you feel about using the kit again in future if you were in a similar situation again?

10. Overall, what do you think about the THN programme?

11. What do you think about Naloxone?

12. What do other people you know think about the THN programme?

13. What do you think would encourage more families/carers/friends of people who use drugs to complete Naloxone training?

14. Would you recommend undertaking Naloxone training and/or getting a THN kit to any families/friends/carers of people who use drugs you know?

If no: why not?
If yes: why? And who would you recommend it to?

15. Do you have any more comments on the programme?

Thank you for your time.