A novel approach to co-design of digital health interventions for implementation and dissemination: Co-design of a digital Prescription Opioid Safety Toolkit

Background: Australia has one of the highest rates of prescription opioid use and related harm in the world. Despite a $10 million government investment in provision of the overdose-antidote naloxone, less than 2% of those at risk of prescription opioid harm were estimated to have received it. Prior research has shown that despite many people being worried about their opioid use, less than 5% had spoken to a healthcare professional about their concerns. This study presents the co-design of a digital opioid safety toolkit for national dissemination through pharmacies to encourage consumers engagement in opioid safety behaviours including 1) naloxone uptake, 2) creating a safety plan, and 3) discussing their opioid prescription with their healthcare provider.

Methods: The digital opioid safety toolkit was co-designed and developed using a novel approach to digital health intervention design combining the Theoretical Domains Framework (TDF), Behaviour Change Techniques (BCTs) and Double-Diamond design process. Co-design involved seven iterative workshops with consumers and healthcare experts, followed by user testing of the toolkit. Workshops focused on identifying barriers and facilitators to each opioid safety behaviour, exploring design preferences, sense checking and ideation of the user flow.

Findings: 13 consumers and 11 healthcare experts participated in up to four and three online co-design workshops, respectively. Six facilitators were identified as priorities including consumers’ knowledge of the need for opioid safety, public knowledge on the use of naloxone, personalisation, support from healthcare providers, normalising naloxone use, and data ownership. Barriers included stigmatising language, lack of knowledge of risks and benefits and alternatives to opioids, and lack of healthcare provider support. The co-designed digital opioid safety toolkit includes BCTs to address each barrier and facilitator. Preliminary randomized control data (RCT) shows increased naloxone uptake and high satisfaction among participants. A national dissemination campaign is planned.

Implications for D&I Research: A multi-faceted implementation and dissemination approach to safer opioid use must include consumers and healthcare experts. This study utilised a novel approach to co-designing a digital opioid safety toolkit by combining the TDF, BCTs and Double Diamond design process. The approach provides a framework for the design of digital health interventions for researchers and practitioners.