An Evidence-Based Digital Prescription Opioid Safety Toolkit for National Dissemination: Co-design and User Testing (Preprint)
Authors: Waddell Alex , Watterson Jessica , Basur Dhruv , Prawira Christopher Owen , Picco Louisa , Lam Tina , Olivier Patrick , Seguin Joshua Paolo , Kay Liam , Nielsen Suzanne 
Published: January 2025

BACKGROUND

Australia has one of the highest rates of opioid prescribing and prescription opioid-related harm in the world. Although effective for acute pain relief, the use of prescription opioids is a leading cause of preventable morbidity and mortality. Major barriers exist for consumers in identifying their own risk factors and accessing naloxone (an opioid overdose antidote) and overdose prevention education.

OBJECTIVE

This study aimed to co-design a digital Opioid Safety Toolkit for national dissemination through pharmacies to encourage three consumer opioid safety behaviours: 1) the uptake of naloxone, 2) creating a safety plan, and 3) discussing their use of opioids, including any concerns with their healthcare professional.

METHODS

The digital Toolkit was co-designed and developed using a novel approach to digital health intervention design combining the Theoretical Domains Framework (TDF) and Double-Diamond design process. Co-design involved a series of seven iterative workshops with consumers (4) and professionals (3). Workshops focused on identifying barriers and facilitators to each opioid safety behaviour, exploring design preferences, sense checking and ideation of the user flow. User testing was conducted with the penultimate version of the Toolkit.

RESULTS

A total of 13 consumers with lived experience of prescription opioid use participated in up to three workshops and 14 professionals including prescribers, pharmacists, pain specialists, researchers and consumer advocates participated in up to three workshops. A further 15 consumers participated in user testing interviews. Analysis of the workshops identified five TDF domains and subsequent sub-themes – Knowledge; Social/professional role and identity; Environment, context and resources; Social support; and Beliefs about capabilities. Factors identified as promoting safety behaviours included increased public awareness of naloxone and its availability, understanding personal risk (TDF domain of Knowledge); healthcare professional’s role in education and consumers’ experience of stigma (Social/professional role and identity); use of conversational aids to scaffold conversations between consumers and healthcare professionals, and material resources and data ownership (Environment, context and resources). User testing elicited feedback pertaining to the information and resources on the website and the overall user interface and experience.

CONCLUSIONS

The Opioid Safety Toolkit was co-designed with consumers and experts to facilitate opioid safety behaviours. The Toolkit includes evidence-based information on the benefits and harms of prescription opioids, tools for risk assessment and screening, opioid use monitoring, conversation aids, and a safety plan. The Toolkit is being disseminated nationally through Australian pharmacies following a randomised controlled trial that demonstrated the Toolkit promotes safety behaviours, is easy to use and acceptable to those with lived experience of prescription opioid use and professionals.