The Design of a Digital Behaviour Change Intervention for Third-Level Student Illicit Substance Use: A Persona Building Approach

Illicit substance use among third-level students is an issue of increasing concern. Digital behavioural change interventions have been developed to target this population, but reports of their effectiveness are mixed. The importance of end-user involvement in digital intervention development has been well established, but it appears that many interventions in this area did not engage end-users during development. This absence may have affected engagement, undermining their potential effectiveness. This paper describes the process and contributions of a persona-building approach in the development of a digital behaviour change intervention tailored to the needs of third-level students. Nine exploratory persona-building workshops were carried out with 31 students, and 7 project team members to develop personas for heavy, occasional and non-substance using third-level students. Early analysis has identified five archetypes which will contribute to the design of an acceptable and user-friendly intervention, and to the identification of targeted behavioural change techniques

Reducing the Individual, Institutional and Societal Harms from Student Drug Use

[EN] Drug use among higher education students can cause harm to the individual, their institution, and the wider society. Academic performance, physical and mental health, institutional reputation, crime and unemployment can all be impacted by student drug use. Tackling this is a challenge, and is often compounded by limited student health and counselling capacity and the student’s reluctance or unwillingness to seek support. Digital brief interventions have shown promise in reducing harm from substance use, and provide an opportunity to meet students where they are, delivering always-on, confidential support and intervention. However, limited interventions for drug use are available for students, and many struggle with engagement and retention. Our team have developed a novel brief intervention, using best practices in digital intervention development, and behavioural change to overcome some of these challenges. We describe the development of our intervention and discuss how implementation could result in tangible benefits to the individual, institution, and society.Dick, S.; Dillon, B.; Vasiliou, V.; Davoren, M.; Dockray, S.; Heavin, C.; Linehan, C.... (2021). Reducing the Individual, Institutional and Societal Harms from Student Drug Use. En 7th International Conference on Higher Education Advances (HEAd'21). Editorial Universitat Politècnica de València. 465-472. https://doi.org/10.4995/HEAd21.2021.13060OCS46547

Changing the Wheels on a Moving Car: Leveraging a Content Management System to Develop an Extensible Digital Intervention

Drug use among higher education students is a pertinent public health issue, with around a quarter of students reporting current use of an illicit drug. MyUSE is an algorithmic, digitally delivered intervention aimed at reducing harms from drug use among higher education students. While many digital interventions around this topic exist, previous work has failed to employ behavioral science in a systematic way. MyUSE focuses on user-centered design (UCD), targeting relevant behavioral changes which are translated into digitally delivered components. This paper describes the challenges of working in an interdisciplinary project team and presents the software-based solutions applied to overcome them. The methodology described demonstrates how sharing the implementation workload can promote synergistic interdisciplinary work in parallel. By providing a flexible centralized platform to manage content and ideas, certain technical requirements become clearly defined and addressed

A new clinical algorithm embedded in a contextual behavior change intervention for higher education student drug use

Illicit drug use among higher education populations is a recognized public health issue. Brief personalized digital behavior change interventions with targeted harm-reduction can facilitate immediate support for this population. To make the intervention tailored to students’ needs, we built a clinical algorithm, informed by relevant behavior change theories and with system design features. Given the lack of previously relevant harm-reduction at student population level, functioning with the use of an algorithm, the aim of this work is twofold. We firstly explain how we developed the clinical algorithm using an empirical data synthesis approach. Secondly, we illustrate how the algorithm is implemented within the first prototype of an intervention named MyUSE, by providing an example on how the clinical algorithm is used to allocate users into different personalized intervention components. The prototype is currently in its final development phase and subsequent work will focus on examining its usability, feasibility, and effectiveness

Approaches to mobile health evaluation: a comparative study

A major challenge faced by mobile health (mHealth) is identifying an evaluation technique which provides a rigorous evaluation while capturing the unique characteristics of the intervention. This study investigates traditional and emerging methods of mHealth evaluation, identifying existing gaps. This research is a useful first step toward developing an evaluation technique which will facilitate implementation and enable mHealth to reach its potential in accelerating socio-economic development, particularly in Low and Middle Income countries (LMICs)

A systematic review of the effectiveness of digital interventions for illicit substance misuse harm reduction in third-level students

Background: Illicit substance misuse is a growing public health problem, with misuse peaking among 18–25 year-olds, and attendance at third-level education identified as a risk factor. Illicit substance misuse has the potential to harm mental and physical health, social relationships, and impact on academic achievements and future career prospects. Digital interventions have been identified as a vehicle for reaching large student populations and circumventing the limited capacity of student health services for delivering face-to-face interventions. Digital interventions have been developed in the area of alcohol and tobacco harm reduction, reporting some effectiveness, but the evidence for the effectiveness of digital interventions targeting illicit substance misuse is lacking. This review aims to systematically identify and critically appraise studies examining the effectiveness of digital interventions for illicit substance misuse harm reduction in third-level students. Methods: We systematically searched ten databases in April 2018 using keywords and database specific terms under the pillars of “mHealth,” “substance misuse,” and “student.” To be eligible for inclusion, papers had to present a measure of illicit substance misuse harm reduction. Included articles were critically appraised and included in the qualitative synthesis regardless of quality. Results: A total of eight studies were included in the qualitative synthesis. Studies reported harm reduction in terms of substance misuse or initiation, as consequences or problems associated with substance misuse, or as correction of perceived social norms. Overall, five out of the eight studies reported at least one positive outcome for harm reduction. The critical appraisal indicated that the study quality was generally weak, predominantly due to a lack of blinding of study participants, and the use of self-reported substance misuse measures. However, results suggest that digital interventions may produce a modest reduction in harm from illicit substance misuse. Conclusions: The results of this review are positive, and support the need for further high-quality research in this area, particularly given the success of digital interventions for alcohol and tobacco harm reduction. However, very few studies focused solely on illicit substances, and those that did targeted only marijuana. This suggests the need for further research on the effectiveness of this type of intervention for other illicit substances. Trial registration: This review is registered on PROSPERO, ID number: CRD42018097203

The Drug Use in Higher Education in Ireland (DUHEI) Survey 2021: Main Findings

The overall aim of the DUHEI Survey was to determine the prevalence and correlates of drug use among the student population in the Republic of Ireland, to inform future policy and practice in the area. The survey population included undergraduate and postgraduate students aged 18 years and over in publicly funded HEIs. The sampling strategy used ensured that a random representative sample of the student population was invited to participate in the survey. The questionnaire used validated scales where available and comprised 10 sections covering: Demographics; Student Life; Drug Use; Readiness to Change; Behaviour Change; Cognitive Enhancers; Student Wellbeing; Social Norms; COVID-19 and Drug Use; Drug and Alcohol Recovery. Twenty-one publicly funded HEIs in the Republic of Ireland participated in DUHEI. Data collection was completed in early 2021, and over 11,500 participant responses were included for analysis. The report presents the findings and makes recommendations for future actions

The successes and challenges of harmonising juvenile idiopathic arthritis (JIA) datasets to create a large-scale JIA data resource

Background CLUSTER is a UK consortium focussed on precision medicine research in JIA/JIA-Uveitis. As part of this programme, a large-scale JIA data resource was created by harmonizing and pooling existing real-world studies. Here we present challenges and progress towards creation of this unique large JIA dataset. Methods Four real-world studies contributed data; two clinical datasets of JIA patients starting first-line methotrexate (MTX) or tumour necrosis factor inhibitors (TNFi) were created. Variables were selected based on a previously developed core dataset, and encrypted NHS numbers were used to identify children contributing similar data across multiple studies. Results Of 7013 records (from 5435 individuals), 2882 (1304 individuals) represented the same child across studies. The final datasets contain 2899 (MTX) and 2401 (TNFi) unique patients; 1018 are in both datasets. Missingness ranged from 10 to 60% and was not improved through harmonisation. Conclusions Combining data across studies has achieved dataset sizes rarely seen in JIA, invaluable to progressing research. Losing variable specificity and missingness, and their impact on future analyses requires further consideration

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London