App-based financial incentives to encourage naloxone carriage

INTERVENTION: The study will involve four inter‐linked stages which are summarised below: Stage 1: Understanding Target Behaviour The aim of work stream 1 is to examine the barriers and challenges associated with the carriage of Take‐Home Naloxone (THN) to inform intervention development. Four focus groups with individuals supplied with take‐home naloxone and who use opioids (N=20‐30) will be conducted to explore individual experiences of carrying THN, expectations and acceptability of using mCM to increase carriage. Two focus groups will be conducted in London, and two focus groups will be conducted in Derby with 5‐8 participants in each group. Focus groups will be conducted face‐to‐face at the recruitment site. Three focus groups of providers and commissioners (N=10‐15). These focus groups will take place on MS Teams and will include naloxone providers who are based in Derby and London. These focus groups will explore clinical needs and priorities, and expectations, along with the acceptability of mCM to increase carriage. Posters in these services will explain the study and invite people to contact the research team. Anyone who expresses interest will be contacted by a researcher and asked a few brief screening questions to check that they feel stable in their mental health and substance use, and that taking part will not cause difficulty. Before the group discussion begins, participants will sign a consent form and complete a short form with basic background information, including what type of naloxone they currently carry. Service providers and commissioners will also take part in separate focus groups. These will be held online via Microsoft Teams to make participation easier for staff based across different regions. Stage 2: Developing the mCM intervention to ensure constant carriage The aim of work‐stream 2 is to design and develop a mobile Contingency Management (mCM) intervention that encourages and supports regular carriage of take‐home naloxone (THN), and to assess its usability and acceptability. This work‐stream adapts an existing CM approach, previously used to promote medication adherence and substance‐use reduction, to a new target behaviour (carrying naloxone), a new population (people who use opioids and already have THN), and a new remote delivery method (a smartphone app). We will explore the real‐world contexts in which people may carry naloxone, including practical and social factors that could help or hinder this behaviour. Insights from the literature, focus groups, and stakeholder discussions from Stage 1 will guide decisions about which intervention components need modification and which established CM elements should be retained. Development will be informed by the COM‐B model, recognising that behaviour is shaped by capability, opportunity, and motivation. This will help us identify what needs to change for individuals to routinely carry naloxone. The digital health partner, CMI, has an established CM technology platform that will be adapted for this purpose. The app will automate behaviour monitoring, calculation of rewa CONDITION: Opioid overdose ; Mental and Behavioural Disorders PRIMARY OUTCOME: Recruitment rate: The number and percentage of eligible participants recruited during the 4‐month recruitment period, measured using study recruitment records at the end of 4‐month recruitment period The number of eligible service users recruited during the 4‐month recruitment period, measured using study recruitment records at the end of 4‐month recruitment period SECONDARY OUTCOME: Acceptability of remote payment options: Acceptability of remote payment options, measured using semi‐structured interviews, conducted at the end of the 6‐week intervention period Adherence to mCM app prompts: The number and percentage of participants responding to app prompts, including the number of days/prompts to which participants respond, during the 6‐week intervention period measured using mCM app usage data, at the end of the 6‐week intervention period Barriers and facilitators to THN carriage: Participants’ experiences of, and barriers and facilitators to, carrying take‐home naloxone (THN), measured using semi‐structured interviews, conducted at the end of the 6‐week intervention period Barriers and facilitators to using the mCM app: Participants’ experiences of, and barriers and facilitators to, using the mCM app, measured using semi‐structured interviews, conducted at the end of the 6‐week intervention period Quality of naloxone verification photographs: The number and percentage of successful camera uploads of naloxone where the photograph is of sufficient quality for verification, during the 6‐week intervention period measured using mCM app records and verification data, at the end of the 6‐week intervention period Technical problems: The number and type of technical problems encountered when using the mCM, during the 6‐week intervention period measured using technical problem logs/support records, at the end of the 6‐week intervention period Usability of the mCM: Usability of the mCM, measured using the 10‐item System Usability Scale (SUS) at the end of the 6‐week intervention period Verification of naloxone carriage: The number and percentage of participants providing verification of naloxone carriage, including the number of days/prompts for which verification is provided and the time taken to provide verification, during the 6‐week intervention period measured using mCM app records, at the end of the 6‐week intervention period INCLUSION CRITERIA: 1. Aged 18+ years of age 2. Able to provide written informed consent 3. Own a smartphone with mobile data and can bring it on the day of enrolment 4. Individuals who use opioids 5. Individuals who have been supplied with take‐home naloxone and can verify their kit at enrolment