Harm Reduction, Magnet Content, and the Future of Health Promotion
Meeting people who use drugs ‘where they’re at’ is a core principle in the practice of harm reduction. Programs are carefully designed to be culturally competent, respectful of dignity, and non-judgmental in their effort to reduce harms associated with drug use. One of the challenges facing the harm reduction community is that health promotion information often comes in the form of media that are health-specific, and that rely upon their audience’s interest and engagement in health-seeking behaviors. Research on stage-based models of behavior change suggests that 80% of people who use drugs are in Precontemplation or Contemplation stages, while 20% are in the Preparation stage, and yet our communications strategies towards people who use drugs predominantly focus upon those in the latter group. The apparent discrepancy between the harm reduction community’s communication strategies and the stage-based distribution of their audience presents an opportunity to reflect upon how we can ‘meet people where they’re at’.
An emergent approach to address this challenge is found in programs that employ ‘magnet content’ strategies for distribution of harm reduction and health promotion resources. These programmes use non-health-specific content to attract and engage their audience, while also providing links to health and wellness resources. The intent is to appeal to social, economic and entertainment interests of people who use drugs as a means to extend beyond those with active interest in health information, and to deliver health promoting resources as a complement to otherwise engaging media.
An example of this strategy can be found at our StreetRx platform, a website that gathers information on the street prices of pharmaceutical drugs. After a strong debut in the United States, a group of epidemiologists, harm reductionists and informatics specialists have created an updated version of the web site that asks UK visitors a simple question: Did you get a good deal?
Visitors can view, post and rate prices in a format that offers price transparency in an otherwise opaque black market. All submissions are anonymous, localization is set to the city level, and the feedback is shared via a simple price rating scale. This gives users access to information and assurance of privacy, while preventing the site from being used to make deals or set up stings. The site appeals to the economic interests of people who buy and sell diverted prescription drugs, while also serving as a source of information on overdose prevention, emergency response and addiction recovery. Links to health and wellness information are subtle but frequently used, with the US version of the site making over ten thousand referrals to external resources in the last year. The appeal of this approach to health promotion is that it establishes visitors as subject matter experts with valuable information and insights to share, and cultivates a frame of autonomy, competence and relatedness that Self Determination Theory tells us will be conductive to high-quality engagement with health- and information-seeking behaviors.
StreetRx also uses a magnet content strategy to generate insights for harm reduction programmes and epidemiological research. Using the wisdom of the crowd, the site is able to identify differences in the appeal of conventional versus abuse-deterrent drug formulations, regional variances in diverted drug prices and changes in the localized price and availability of newly released products. Information on populations’ drug preferences helps harm reductionists to tailor outreach information to local needs, and assists epidemiologists and policymakers to understand the effects of pricing, prescribing and access rules on the diversion of prescription drugs. In a 2013 paper on ‘Crowdsourcing Black Market Prices For Prescription Opioids’, researchers from Epidemico and RADARS found that StreetRx data were strongly correlated with conventional key informant sources and prices on the online Silk Road market.
The research also showed that street prices effectively followed the hierarchy of equianalgesic potency across a complex and changing array of formulations.
These insights were made availble through the active participation of tens of thousands of site visitors. They are the result of engaging the curiosity, candour and expert knowledge of people who use drugs without relying upon users’ interest in health per se.
As harm reductionists strive to reach a larger population of people who use drugs, and truly meet people ‘where they’re at’, we should look towards communication strategies that have appeal beyond health-specific interests. By leveraging information-seeking behaviours focused on pursuit of entertainment, social engagement or economic interest, we can position health and wellness information as a natural complement to our audience’s perceived needs. These strategies are not alternatives to conventional health promotion and harm reduction messaging, but rather, augmentations that expand our reach and create opportunities for wider engagement in efforts to generate and share information that serves the public’s health.