Co-producing a peer-led health conversation tool for the health services workforce to facilitate safer use of anabolic–androgenic steroids

Abstract

Background: Illicit anabolic–androgenic steroid (AAS) use poses physical and psychosocial risks. These issues are exacerbated by inadequate public health responses and well-meaning yet inadequately trained health workers. This study presents the development of a collaboratively designed health conversation tool, which equips health workers’ with a number of questions and strategic information to promote well-informed use for people who use AAS. Methods: This qualitative, multi-stage study co-produced a health conversation, a guided conversation tool that aims to incorporate a brief assessment, knowledge provision, sharing of harm reduction strategies and advice for health workers engaging with people who use AAS in community settings. The iterative co-design process followed a five-stage pedagogical approach (ideation, planning, creation, programming and sharing), guided by semi-structured interviews with 25 people who use AAS and a workshop focus group of 6 experienced AAS peers for further refinement. Guided discussion included exploration or harms, health enhancement and required resources. Qualitative responses were synthesised via inductive analysis to identify key themes, from which the conversation was developed and then tested with the AAS peer group. Results: There were two core findings from this research. Firstly, insights gained from people who use AAS in the key current practices related to safer use of these drugs. Secondly, based on these insights, a health conversation tool was co-produced, which encompasses a brief assessment, gauging people’s experiences with AAS, confidence in their knowledge, and support systems. The tool provides health workers with a suite of harm reduction strategies to offer to people who use AAS, such as proper injection techniques, considerations regarding their usage strategy, and suggestions for health monitoring. Conclusions: The collaborative design process ensured the health conversation tool reflected the lived-living experiences and priorities of people who use AAS, specifically fostering trust and engagement. This peer-driven approach filled gaps in harm reduction services, promoting informed decisions regarding AAS use as well as some health strategies. Expanding the peer workforce and integrating digital platforms can enhance the reach and sustainability of tailored harm reduction interventions for AAS and other communities.