Evaluation of Harm Reduction Practices and Policies Aimed at Reducing Infectious Disease Risks and Substance Use Disorders in Rural Communities

Evaluation of Harm Reduction Practices and Policies Aimed at Reducing Infectious Disease Risks and Substance Use Disorders in Rural Communities

Focus Group Facilitator’s Guide

(Introduction)

“Hello, thank you for taking the time to participate in today's discussion. My name is [NAME] and I am with The MayaTech Corporation, contracted with The US Department of Health and Human Services (HHS), Office of Regional Health Operations (ORHO). We are working with ORHO to identify facilitators for and barriers to implementing harm reduction¹ or risk mitigation strategies in rural communities. Harm reduction or risk mitigation approaches includes a spectrum of strategies that includes safer use, managed use, abstinence, meeting people who use drugs “where they’re at,” and addressing conditions of use along with the use itself. Because harm reduction demands that interventions and policies designed to serve people who use drugs reflect specific individual and community needs, there is no universal definition of or formula for implementing harm reduction.¹

We are working with ORHO to better understand the challenges and needs of individuals with lived experiences of HIV, viral hepatitis, sexually transmitted infections (or STIs), and/or substance use disorders, particularly those living in rural communities. Your experiences and insights are invaluable to us in identifying effective strategies to support you and others like you who experience similar challenges.

(Consent)

"As a reminder, your participation in this discussion does not involve any extraordinary risks. Your participation in this discussion is voluntary, and you have the right to stop at any time or refrain from answering any questions without loss of your consultant fee or of losing any health services you may currently receive. By agreeing, you acknowledge that you understand your rights as a participant. Your responses will be kept confidential and may contribute to our research into effective strategies, though your personal information will not be shared. The total time for this discussion is estimated to be 90 minutes.

Do you have any objections to us recording this discussion to ensure accuracy in our notes? Do you have any questions before we proceed?"

(Facilitated Discussion)

1. Personal Experiences and Health Journey

• "Can you share your personal journey with substance use and how it is connected with risks or experiences of HIV, hepatitis, STIs, or overdose?"

  • Probe: "What specific experiences stand out to you as particularly impactful on your life?"

  • Probe: "Can you describe how these moments influenced your decisions or perspective?"

2. Access to Care and Support

• "How have you accessed healthcare services related to substance use, HIV, hepatitis, or STIs?"

  • Probe: "Were there any particular services or resources that you found especially helpful?"

• "What barriers or challenges have you encountered in seeking and receiving care and support?"

  • Probe: "Can you provide specific examples of these challenges and how they affected you?"

• "Have you encountered barriers to accessing support services like rehabilitation or support groups?"

• "Have you faced challenges in securing housing or public services? Why do you think you have experienced these challenges?”

• “How would you describe the treatment you receive from your provider(s)?

3. Awareness, Education, and Community Dynamics

• "What kind of information or education have you received regarding substance use, HIV, hepatitis, STIs?"

  • Probe: "Do you feel this information was helpful? Why or why not?"

  • Probe: “How did you receive this information or from whom?”

• "Have you experienced stigma related to your experiences with substance use, HIV, hepatitis, or STIs? How has this impacted your life?"

  • Probe: "In what ways has stigma affected your relationships, work, or access to services?"

4. Harm Reduction Effectiveness and Challenges

• "What has been helpful to you in managing your substance use, HIV, hepatitis, or STIs?"

  • Probe: " Are there any you would recommend to others?"

• "What has been less helpful or what did not work for you?”

  • Probe: "How have you navigated these challenges, and what support was or wasn't available?"

• “What kind of support do you wish were available to help you deal with these health issues?”

5. Environmental Influences and Systemic Factors

• "How does the environment and community you live in affect your experiences with substance use and associated health risks?"

  • Probe: "Are there aspects of your community that have made managing these risks easier?"

  • Probe: “Are there aspects of your communities that have made managing these risks more difficult?”

• "Have you noticed any community resources or support systems that have helped you manage health risks associated with substance use?"

• "Do you feel that community attitudes towards substance use, and health risks affect your ability to seek help or support?"

• "Are you aware of any laws or policies that impacted your access to services and support for substance use, HIV, hepatitis, or STIs?"

  • Probe: "Can you give examples of specific policies or systemic issues that have had a direct impact on you?"

6. Future Perspectives and Additional Insights

• "Looking towards the future, what are your concerns and needs in relation to substance use, HIV, hepatitis, or STIs?"

  • Probe: "What kinds of support or changes would you like to see to address these concerns?"

• "Is there anything else about your experiences that you think is important to share?"

  • Probe: "Are there any stories or insights you feel are often overlooked or misunderstood by others?"

III. Closing and Additional Thoughts

"Thank you for sharing your experiences with us. Your insights are incredibly valuable in shaping our understanding and approach to harm reduction in rural communities. If you have additional thoughts or feedback after this discussion, please feel free to reach out.

1 https://harmreduction.org/about-us/principles-of-harm-reduction/