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Table 1 Results from application of the 3-stage framework for co-production and prototyping in the ASSIST + Frank study

From: Development of a framework for the co-production and prototyping of public health interventions

Activity Objectives Results
Stage 1: Evidence review and stakeholder consultation
 Evidence review Identify target age group for interventions and identify target drugs to focus intervention content on. • The Smoking, Drinking and Drug Use survey in Young People showed the use of any drug in the last year almost doubled from 6.8% at age 13, to 12.4% at age 14, and then again to 23.7% at age 15; largely due to increases in the use of cannabis [31];
• Target intervention at 13–14 year olds (Year 9 students);
• Focus intervention content on drugs with >1% prevalence in 13–15 year olds (cannabis, volatile substances, ecstasy, poppers, cocaine, ketamine, mephedrone, and magic mushrooms).
 Consultation with young people’s involvement group Explore thoughts about drug education in school, their conversations about drugs with friends, awareness of Talk to Frank and opinions of the website. • Drug education is typically didactic and should be more interactive;
• Discussions with peers about drugs are frequent;
• Commonly used drugs at their age are alcohol, cannabis, poppers, mephedrone, ketamine and cocaine;
• Talk to Frank was viewed positively, but should be accompanied by other visual resources.
 Consultation with Year 9 students Explore views about drug use in their age group and ideas about content for a drug prevention intervention. • Content suggested included effects of drugs on the body, and the legal consequences of drug possession;
• Specific drugs to focus content on included cannabis, alcohol, steroids, magic mushrooms and legal highs.
 Focus groups with Year 9 students Explore knowledge and risk perceptions of drug use and perceptions of drug use prevalence in their age group. Explore acceptability and age-appropriateness of drug education messages on Talk to Frank website. • Health risks of cannabis are known;
• Legal consequences of cannabis use are less well known;
• Content on impact of drug use on educational achievement directly, or through school exclusions if caught in possession needed;
• Content on impact of drug use on parents worrying about harms (to health, criminal sanctions, schooling exclusions), shame brought to family, and increasing stress would be welcomed;
• Attention to potential iatrogenic effect of Talk to Frank messages on amphetamine use promoting weight loss required.
 Consultations with stakeholders (Drug agencies and professionals who work with young people) Explore awareness of drug education resources and support, and views on appropriate content for a drug prevention intervention. • Cannabis and alcohol are the most commonly used drugs by 13 to 14 year olds;
• New Psychoactive Substances (NPS) are an increasing concern, particularly synthetic cannabinoids; but not in 13 to 14 year olds;
• Staff from drug agencies noted a local problem with anabolic steroids regarding attendance at needle exchange programs. Use is not in 13–14 year olds;
• Existing drug education for 13–14 year olds is either provided in classroom-based sessions, or one-off workshops delivered by a specialist agency or a community police officer;
• There are limited drug education resources available and existing resources such as ‘drugs box displays’ are expensive. Resources require regular updates in response to emerging NPS and changing trends.
 Consultations with Year 8 recipients of ASSIST Explore ideas about peer supporter training and content for a drug prevention intervention. • Content suggested included effects of drugs on the body, how drugs cause ‘highs’, health risks, legal consequences, and harm minimisation;
• Specific drugs to focus content on included cannabis, solvents, magic mushrooms, cocaine, speed, mephedrone, legal highs, and steroids.
 Observations of current ASSIST practice Identify aspects of the intervention that work well and could be adapted for use to deliver a drug prevention intervention and with a Year 9 population. • Flexibility in adapting timings and delivery modes to respond to student engagement is key for successful delivery of training;
• Need for clear objectives noting which are essential to deliver.
 Interviews with intervention delivery team Identify possible influences on intervention feasibility and acceptability. For example, explore aspects of ASSIST that could be adapted for use to deliver a drug education intervention and for use with 13–14 year olds, as well as those which might not lend themselves to adaptation. • Intervention activities need to be interactive;
• Successful implementation of intervention requires flexibility in delivery to meet needs of different groups;
• Some intervention activities required updating (e.g. ASSIST activity using postcards because peers supporters did not know what they were);
• Some intervention activities might be too immature for use with 13–14 year olds;
• Delivery of messages about harms of drug use is much more complex than harms of smoking (more compounds with different effects);
• Concerns around amount of knowledge required to deliver drug prevention intervention.
Stage 2: Co-production
 Meetings of the intervention development group Action research cycle of assessment, analysis, feedback and agreement on the core components of the intervention required to educate peer supporters on the harms of drug use and the skills required to communicate these to their peers. • Findings from Stage 1 suggested long-term harms to health of low-levels of cannabis are less definitive than those of smoking;
• Include content on concerns expressed by young people and harms associated with drug use that they did not know about;
• Shift focus towards these concerns and away from harms to health of the most commonly used drug - cannabis;
• Highlight the potential immediate harms to health from use of glues, gasses and aerosol (i.e. sudden sniffing death);
• Harms associated with drugs being unregulated and illegal: unknown compound and dose, thus unexpected effects are likely;
• Potential consequences of sanctions imposed by schools (temporary, permanent exclusion) and poorer educational achievement;
• Potential consequences of criminal sanctions on travel and future career options;
• Mention harms including increasing parental anxiety, stress and shame;
• Draft intervention manuals and associated resources detailing intervention activities and how these should be delivered were produced.
Stage 3: Prototyping
 Expert review of intervention materials Identify potential problems or weaknesses in intervention materials prior to piloting. • Updating of some intervention activities was welcomed;
• More detail needed in instructions for delivery team;
• Refining of timings for some intervention activities.
 Testing of intervention materials with young people Delivery of intervention. Identification of issues around feasibility and acceptability of newly developed intervention content. • Intervention activities were well received;
• Refinements included amending wording, providing more detailed instruction and objectives, and using smaller groups.
 Training of intervention delivery team Simulation of intervention delivery. Identify issues around feasibility and acceptability of intervention content. • Need for additional drug education training;
• Refinements included amending timings, clarifying ambiguities in instructions, changing format of delivery, adding extra content and removing content.