Evaluation of the 'Know the Score' Harm Reduction Campaign Materials

A telephone survey commissioned by Exchange Campaigns
and conducted by Cultural Intelligence Ltd.
June 2002

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Summary
This report gives full details of a telephone survey into the responses of 126 Scottish Drugs Agencies to the dissemination of 3 sets of harm reduction drug information campaign materials by the Scottish Executive in the spring of 2002.

The respondents were overwhelmingly supportive of the materials and all 3 campaigns were felt to be appropriate and effective - with over 90% reporting that they were very appropriate or appropriate for the work of their agency, and over 90% feeling the materials would be very effective or effective in changing the behaviour of the target audience.

This approach to meeting the health information needs of drug users in Scotland was wholeheartedly endorsed by the respondents, many of whom also suggested other topics that could be addressed through targeted information campaigns. Top of the list for further campaigns were the issues of alcohol and drug use, and hepatitis C.

All responses are listed in the appendix

Introduction
In the spring of 2002 The Scottish Executive commissioned Exchange Campaigns to adapt and distribute a range of health promotion campaign materials to agencies in Scotland which work with drug users.

Materials were distributed to a list of 176 agencies supplied by the Scottish Executive.

May 2002 Exchange Campaigns commissioned Cultural Intelligence to conduct independent follow up research with the agencies.

The main aims of the evaluation project were:

• To research the initial response of the agencies to the materials they had received.
• To consider the extent to which the material will be of value in the work of the agencies.
• To establish when they may need further supplies of the materials and what ordering mechanisms would be most appropriate.
• To obtain the agencies views with regard to what other topics might most valuably be addressed in a similar way.

Method
Computer Aided Telephone Interviewing (CATI), was selected as the most effective way of achieving a comprehensive response. A short telephone questionnaire was developed by Cultural Intelligence and approved by Exchange Campaigns and The Scottish Executive.

Telephone survey proved to be a very effective method of gathering information: the contacts were very happy to respond if called at a convenient time, this may have been partly due to the fact that respondents were overwhelmingly positive about the materials they had been supplied with.

The campaign materials
There are 3 sets of materials designed to enable services to run targeted health promotion messages for drug users.

The campaigns address the issues of:

• od (Overdose)
• B3 Be Free (Hepatitis B vaccination)
• Break the Cycle (Prevention of initiation to injecting)

The materials include posters, loose leaflets, pads of leaflets for use in by field workers or for peer interventions).

Response
126 interviews were completed during office hours in the month of June. As contact names were not provided, some time was spent establishing who in each agency would be the best person to speak to.

Almost all contacts provided were people who spend much of their time working directly with clients. It was therefore found necessary to call and book appointments for many of the interviews.

It is estimated that each interview required 4 calls before a successful interview was achieved.

Of the 31 agencies for whom responses are not recorded, 18 had not received their packs, the remainder were either not possible to arrange an interview with, or did not feel the materials were relevant to them. 11 agencies could not be contacted because there was no telephone contact number available on the database supplied.

The questionnaire
Distribution of over 600 cases of printed materials to addresses all over Scotland is a significant exercise in logistics so agencies were first asked:

Did the campaign materials arrive intact?

Only 18 said that they had not received the materials. These services have all now been contacted and materials and/or an order form sent.

All those who received the materials said that they arrived intact.

Respondents were asked to what extent they found the materials appropriate to the work of their particular agency?

Over 90% of respondents thought the materials from all 3 campaigns were either 'very appropriate' or 'appropriate' to the work of the agency.

An additional question was included to ask agencies who did not think the materials were appropriate:

If not, why not?
The high levels of satisfaction for the materials meant there were only a few responses to this question. Some of the responses illustrate a lack of training or understanding from the respondents of how the materials can be best used.

The responses were:

'Material could be useful on road shows. Most people come looking for counselling on alcohol and drugs. We leave the material out so those users can pick it up. Not a lot have been picked up so far.'

'People who come through here are already drugs users.'

'Only useful for visitors. Only if doing external work with schools. Not suitable for residential.'

'We are a rehabilitation clinic and the Information is too late by then.'

'Work with under 16 year olds and most have not heard of heroin and Hepatitis and injecting.'

'Harm reduction. General information is quite important as general rule but did not apply to our programme as we run it.'

'We work with whole families and have not used any of the material.'

Respondents were then asked:

What is your general impression of the materials?
The response to this question was overwhelmingly positive. Respondents particularly liked the look and feel of the materials and the fact that they communicate clear messages using appropriate language.

They were also very impressed with the handy size and general usability of the materials.

Several agencies commented on how rare it is for them to receive materials of such good quality.

Typical comments were:

'Good, we have certainly made good use of the material in terms of promotion. As a drug service we incorporate a full range of things'

'Up to date and very attractive to clients.'

'Very good. No adverse reaction to it. Even people working in field have said it is good stuff. Plain simple language those clients can understand. Taken material away in their pockets. Makes them think.'

'Quality good easy to understand not too much writing eye catching graphics generally very good.'

'Very informative booklet preventing overdose found some useful small tips myself. Also clients found interesting. Nicely laid out. We could do with more of these.'

'Very impressed. Good quality and exactly what we need'

'Impressed. General content and layout excellent. Easy to read, easy to understand'

To get an impression of how effective the materials would be in achieving their aims of reducing overdose deaths, increasing hepatitis B immunisation and preventing initiation to injecting we asked:

To what extent do you think the materials will contribute to behaviour change in clients?
On the whole respondents found it very difficult to answer to this question because, although playing a valuable role, the materials can only work in the context of a range of interventions.

Also, many felt it too soon to comment.

However, despite this, around 9 out of 10 respondents, felt that the materials would be effective or very effective, and responses to this question varied little between the three sets of material campaigns.

This kind of distribution of materials to services is a new development, we wanted to assess future demand for the materials, so respondents were asked:

When do you think you will need more material for the three campaigns?
Many found it difficult to estimate, particularly as some of the Agencies had only recently begun to use the materials. Responses ranged from 'immediately' to six months time. Exchange Campaigns have contacted those agencies who wanted more materials immediately and, in accordance with the wishes of the majority of services who preferred the option of a quarterly reminder flyer/order form (see overleaf), will mail out a flyer to all agencies in September.

Which of the following methods of receiving more packs in the future would best suit you?

Automatically receive a reminder order form in about three months time - 63.5%

Receive packs every 4 months - 16.7%

Just use the order form sent with the pack when you need more - 8.7%

No reply/don't know - 11.1%

Agencies clearly feel that it will be preferable to receive a reminder for re-supply rather than rely on them reordering when supplies are exhausted. We recommend a reminder and order form be sent out in September.

Respondents were then asked:

What issues do you think should be addressed in a similar way?
Of the 86 agencies that made unprompted suggestions, 28% suggested material that addresses alcohol misuse.

Other frequent suggestions were for:

• Materials that advise the families of drug users (including children whose parents misuse drugs) (13%);
• Hepatitis C (11%);
• Materials aimed at young people (9%); and
• Materials for those engaging in solvent abuse (5%)

Having taken details of the unprompted response, we then asked respondents to consider the value of some key issues we had identified.

Please tell us how useful you would find campaigns on the following topics?

Information on all the areas suggested was felt to be important with over 90% of respondents thinking campaigns on alcohol and drug use and hepatitis C, and over 80% thinking sharing injecting equipment and vein care, would be 'very useful' or 'useful.'

The survey then turned to the issue of training.

Respondents were asked if they had done any staff training as part of implementing the campaigns?
15 agencies (11.9%) had undertaken training specifically around the campaigns, 100 agencies (79.4%) had not undertaken any specific training and 11 (8.7%) respondents did not reply or did not know. Some respondents noted that the materials supplied contained comprehensive briefing notes which gave staff enough information to use the materials effectively.

Respondents whose said that they had undertaken training were asked who organised the training?

Many services had included it in their in-house training programmes, typical responses being:

• Training being carried out all the time but not specifically on Know the Score.
• Staff training all the time
• I gave a presentation on the materials in various local offices on what contents were and how we could use them
• Discussed at team meeting but not particular courses
• A number of agencies cited training courses provided by STRADA.

Respondents were then asked:

Do you think your staff would attend courses designed to help them implement the campaigns?
103 (81.7%) said they thought their staff would attend courses designed to help them implement the campaigns, only 11 (8.7%) said they didn't think their staff would attend such training and 12 (9.5%) didn't know.

Respondents were enthusiastic about the notion of receiving additional training to maximise the impact of the campaign materials.

We have compiled details of the 103 agencies who expressed an interest in training, so that Exchange Campaigns can supply this to the Scottish Executive / STRADA.

At the end of the interview, respondents were asked:

Are there were any other points you would like to make?
Many of the respondents we telephoned were keen to conclude the interview with further positive feedback about the materials they had received.

Typical responses are set out below:

Further positive feedback on the materials:

'Think it is very positive the change in direction and think good literature colourful and should be extended.'

'Been the most useful educational pack that we have had that I can remember for injecting and drugs workers. Thoughtful. Small bits for people to put in pocket and posters. Back up packs excellent.'

Expressions of thanks and support for the resources:

'Been the most useful educational pack that we have had that I can remember for injecting drug users and drugs workers. Thoughtful. Small bits for people to put in pocket and posters. Back up packs excellent.'

'Thank you we are so grateful because we do not have any money to buy resources. Thank you so much'

'It has prompted me to arrange first aid courses in what to do in overdose situations'

'Thank goodness Scottish Executive has decided on prevention'

'Material really good. Staff really liked it.'

'More substance in it'

Further support for the notion of training

They have been distributing their leaflets to the doctors attached to their clinic.

They hope to run courses to use the material properly and would welcome training.

Would welcome the training and everyone in office would be interested in attending courses

Could you accelerate training as soon as possible as we are doing this now and looking at our staff development training. Scottish Executive have other info about courses. Most interested in further training.

Need more information. Would be helpful if Exchange Campaigns contacted STRADA at Glasgow University.

Constructive criticism and ideas for the future:

We are seeing a lot of groin injection some comes down to fact summertime is coming up and not wanting to show marks on arms in summer. Vein damage Lack of understanding about not inject into arteries.

More awareness would be beneficial to workers and clients as well. Re tablets being crushed down for injecting.

Needle fixation. Is there such a thing and more information?

Major thing we find are clients moving from heroin to crack and cocaine.

More information needed on these specifically.

Most definitely vein care issues.

From client point of view drugs and mental health problems need to be addressed.

Any kind of harm reduction or educational leaflets to give to clients would be welcomed.

Hep C training required. Basic information people need to have.

Hep C more prevalent and they need to be aware of it.

We need Alcohol leaflets for older people. We have mountains of drug information and alcohol gets left out.

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Know the Score materials are available free of charge to drug services in Scotland.
For an order form please call Helen Phillips on 01305 262244.