Development of a co-designed tobacco harm reduction toolkit for use within the homeless sector

无家可归者的吸烟率非常高，这导致了严重的健康和经济问题。无家可归者服务机构在使用减少危害的方法支持服务使用者做出更安全的选择（例如，为注射毒品的人提供干净的针头）方面有着悠久的历史。减少烟草危害（THR）是指旨在通过以更安全（非吸烟）的方式提供尼古丁来减少吸烟危害的许多方法，例如通过电子烟或尼古丁替代疗法（NRT）。然而，这种方法在无家可归者部门中没有得到很好的理解或整合，工作人员没有信心支持他们的客户戒烟。这项研究旨在创建一个“THR工具包”-一套资源，例如吸烟和vaping政策模板，对话指南和治疗信息传单，将与使用和从事无家可归者服务的人共同设计。这将是英国首次尝试这种类型的项目，并将为那些来自不同背景，彼此没有很好联系的人提供机会，共同开发这种资源。多年来，我们一直在为无家可归的人开展THR项目。我们对英国无家可归者的吸烟行为和做法进行了第一次调查;我们发现戒烟的愿望很高，但机会很少。在另一项研究中，我们发现，接受无家可归者服务的吸烟者会接受并使用免费的电子烟来尝试戒烟，但无家可归者中心工作人员对THR的了解很少。还强调需要使用以人为本、非污名化的语言。目前，我们正在对英国无家可归者中心的无烟和电子烟政策进行调查，由英国癌症研究所资助。一个新出现的关键发现是，无家可归的慈善机构希望开发一个基于证据和服务用户为中心的方法THR。到目前为止，还没有针对这一群体独特的健康需求的资源。我们与有无家可归生活经验的人和在无家可归者部门工作的人合作，建议开发一个THR工具包，可用作资源指南。该项目有几个阶段：第一阶段：我们将制作一部关于吸烟和THR的短片，使用我们以前项目中已经有的视频片段。这将被用作焦点小组的起点，以促进讨论。第二阶段：我们将举办三个讨论小组，每个小组有6-10名服务用户（有无家可归经历的人），三个小组，每个小组有6-10名无家可归者中心的工作人员。在每组开始时，将播放短片，并要求参与者讨论他们的反应，特别注意“接触点”，即情绪激动或吸烟史中的关键时刻/提供THR支持。我们还将围绕我们感兴趣的几个主题征求意见：1）THR的理解和经验; 2）好的THR看起来和感觉是什么样的; 3）有效和富有同情心的无家可归者服务THR政策看起来和感觉是什么样的; 4）以人为本的术语和语言是首选的。第三阶段：我们将邀请一些参与讨论小组的服务使用者（~4）和工作人员（~4）加入一个由公共卫生和环境部、吸烟与健康行动（ASH）（~2）和研究小组的代表组成的共同设计小组沿着。该团队将举行2-3次会议，共同设计THR工具包。一个艺术家抄写员将视觉捕捉每个组事件。THR工具包的材料将通过共识方法（例如，投票），商定的资源将由设计公司制作。第四阶段：THR工具包草案将在一个无家可归者服务机构中进行测试，并将在推出一个月后与5名服务用户和5名工作人员进行访谈。THR工具包和反馈将用于塑造未来的研究，以探索它如何有效地支持人们减少烟草危害。

Smoking rates are exceptionally high amongst people who are homeless which causes severe health and financial problems. Homeless services have a long history of using harm reduction methods to support service users to make safer choices (e.g. offering clean needles for people who inject drugs). Tobacco harm reduction (THR) refers to a number of approaches designed to reduce the harms of smoking by providing nicotine in a safer (non-smoked) way e.g. through e-cigarettes or nicotine replacement therapy (NRT). However, this approach is not well understood or integrated within the homeless sector and staff do not feel confident to support their clients to stop smoking. This study aims to create a 'THR toolkit' - a set of resources e.g. smoking and vaping policy templates, conversation guides and treatment information leaflets, which will be co-designed with people who use and work in homeless services. This will be the first attempt at this type of project in the UK and will generate an opportunity for those from a range of backgrounds, not well connected to each other, to develop this resource together. We have been working on THR projects with people who experience homelessness for several years. We ran the first survey of smoking behaviour and practices of people who are homeless in Great Britain; we found desire to quit was high but opportunities were scarce. In another study we found that people accessing homeless services who smoked, would accept and use a free e-cigarette to try and quit smoking, but knowledge of THR among homeless centre staff was poor. The need to use person centred, non-stigmatising language was also highlighted. At the moment we are running a survey of smoke free and vaping policies across homeless centres in the UK, funded by Cancer Research UK. An emerging key finding is that homeless charities wish to develop an evidenced based and service user focused approach to THR. To date, no resources exist aimed at this group's unique health needs. Working with people with lived experience of homelessness and those who work in the homeless sector, we propose to develop a THR toolkit which can be used as a resource guide. The project has several stages: Stage one: We will produce a short film about smoking and THR using video footage we already have from our previous projects. This will be used as a starting point in the focus groups to prompt discussion. Stage two: We will run three discussion groups, each with 6-10 service users (people who have experience of being homeless) and three, each with 6-10 staff from homeless centres. At the start of each group, the short film will be shown and participants will be asked to discuss their responses, paying particular attention to 'touchpoints' i.e. emotionally charged or key moments in their smoking histories/provision of THR support. We will also ask for views around several themes we are interested in: 1) understanding and experience of THR; 2) what good THR would look and feel like; 3) what an effective and compassionate homeless service THR policy would look and feel like; 4) what person-centred terms and language are preferred. Stage 3: We will ask some service users (~4) and staff (~4) who participated in the discussion groups to join a co-design group along with representatives from PHE, Action on Smoking and Health (ASH) (~2) and the research team. The team will meet on 2-3 occasions to design the THR toolkit together. An artist scribe will visually capture each group event. Materials for the THR toolkit will be developed by consensus methods (e.g., voting) and the agreed resources will be produced by a design company. Stage 4: The draft THR toolkit will be tested in one homeless service and interviews will be carried out with 5 service users and 5 staff, one month after its introduction. The THR toolkit and feedback will be used to shape a future study to explore how well it works to support people to reduce harm from tobacco.