A comparative analysis of provincial/territorial harm reduction policymaking in Canada: Key informant interviews

Regions: Inuvialuit Settlement Region, Gwich'in Settlement Area, Sahtu Settlement Area, Dehcho Region, North Slave Region, South Slave Region

Tags: social sciences, policy development

Principal Investigator: Wild, T. Cameron (1)
Licence Number: 16193
Organization: University of Alberta
Licenced Year(s): 2017
Issued: Dec 10, 2017
Project Team: Elaine Hyshka (Co-PI, University of Alberta), *see attached consent sheet for full research team

Objective(s): To determine through key informant interviews what the current state of provincial/territorial harm reduction policy is in Northwest Territories (NWT); what the key barriers and facilitators are to the establishment of harm reduction services in NWT; and how key policy stakeholders frame the acceptability and scope of harm reduction interventions.

Project Description: The proposed research will undertake interviews with key informants to answer the following research questions: what is the current state of provincial/territorial harm reduction policy in Northwest Territories (NWT)?; what are key barriers and facilitators to the establishment of harm reduction services in NWT?; and how do key policy stakeholders frame the acceptability and scope of harm reduction interventions?

Potential individual and organizational stakeholders will be identified through consultation with a national reference group of experts. The national reference committee is an informal group of policy makers, service providers, and researchers with an interest in harm reduction from across the provinces and territories. Members of this group have signed up to receive updates on the study and to provide feedback on the preliminary findings. This group will be asked to recommend one or two key stakeholders in each jurisdiction who have an in-depth understanding of the harm reduction policy context and history in their particular province/territory. Eligible respondents will include senior and mid-level managers within health-related provincial, regional or municipal departments and agencies, medical officers of health, executive directors of harm reduction programs, representatives from local and/or provincial drug user advocacy groups and other leaders in the harm reduction, blood borne pathogens, addiction, and mental health sectors. Informants will also include senior officers in law enforcement, community groups and or other local leaders. In all cases, the research team will strive to purposefully sample in order to recruit a diverse mix of well-informed stakeholders who play a significant role in shaping harm reduction policy making in each province/territory.

Email invitations will be sent to potential key informants explaining the objectives of the study and why they have been invited to participate. Potential participants will have the option of viewing a basic version of the interview guide in advance and will be asked to provide informed consent to participate, including consent to record the interview. During the interviews with key stakeholders who were initially recommended by the national reference group, participants will be asked to provide the names and/or contact information for other potential key informants in their jurisdictions. To ensure a robust response rate, the research team will also ask individuals who choose not to participate to recommend someone else who might be suitable.

A semi-structured interview protocol will be administered to consenting participants and will last approximately 1-1.5 hours. Participants will be free to refuse to answer any questions they do not wish to cover or stop the interview at any time without penalty (as it outlined in the informed consent). Interviews will be conducted by telephone and recorded. Interviewers will compile descriptive and analytic field notes during and after each interview to record contextual details and analytical insights. All recorded interviews will be transcribed verbatim, and interviews conducted in French (by either the bilingual research assistant or a French-speaking research team member) will be translated and transcribed to facilitate analysis.

All efforts will be taken to ensure the anonymity of the key informants without sacrificing clarity in the data. In cases where a key informant is at a higher risk of being identified because of the position they occupy (e.g. executive director of a singular harm reduction program in a jurisdiction), this will be discussed with them prior to the interview as part of the informed consent process. At the request of the participant, findings can be reviewed prior to publication of our results. The research team recognize this is particularly important if an employment position puts an individual at risk of being personally identified.

The expectation is that key informants will provide personal opinions and perspectives, not simply official positions of their organizations. Data analysis will occur concurrently with data collection. A limit of 72 interviews (with a minimum of 5 and 10 key informants in smaller [e.g., PEI] and larger [e.g., Ontario] jurisdictions respectively) is consistent with other national-level health policy studies involving key informants from government and non-profit sectors.

This phase of the research aims to involve only 2-3 individuals from NWT as key informants. Further to this, any interested individuals are invited to join our National Reference Committee, an informal group of policy makers, service providers, and researchers with an interest in harm reduction from across the provinces and territories. Members of this group can sign up to receive updates on the study and to provide feedback on preliminary findings.

The research project has already attracted an excellent group of prominent knowledge users in Canada’s harm reduction sector. Collectively they will continue to support the project by providing invaluable insider perspectives on harm reduction policy making processes, guiding the development of the research protocols to ensure the findings are policy relevant, and connecting the research team with potential key informants. The research team intend to actively recruit additional knowledge users as the project progresses, with the overall aim of securing at least one interested knowledge user in each of the 13 provinces and territories, including the NWT.

The project governance structure entails a steering committee of co-applicants and knowledge users meeting monthly, to plan and discuss the day-to-day aspects of the research. All co-applicants and knowledge users will meet quarterly by teleconference. This will support integrated knowledge transfer (KT) and ensure that the knowledge users are actively engaged in the project from implementation to completion, and will have access to emergent findings, which will enable immediate and ongoing uptake of research results in every province and territory.

The end-of-grant KT objectives include providing decision makers, non-profits and interested individuals with an accurate picture of harm reduction policy making in each province/territory, and informing development of harm reduction policy across Canada. The provincial/territorial case reports and national-level report will be published on a project website, as well as any additional outputs that are generated from this research, which will be accessible by any interested members of the public. The research team will utilize the knowledge users’ connections and disseminate web links to these reports through their organizations’ strong distribution channels. The research team will also send links and information to the Canadian AIDS Treatment Information Exchange, the Canadian Nurses’ Association, and Canadian Public Health Association, which all have members’ working in the area of harm reduction. Additionally the research team plan to contact each of the policy stakeholders identified during the research phase directly by email, and provide them with 1) their provincial/territorial case report, 2) the national-level report, and 3) a lay language brief comparing their province/territory to the other jurisdictions.

To date, the research team have published two academic articles on previous phases of this research (policy analysis) and have sent out newsletters to the National Reference Committee with lay language briefs in French and English, including most recently, an infographic of research results to date. The research team have also presented findings at seven key conferences and events, including the 25th Harm Reduction International Conference in May 2017. While most of the results will combine data sources, the team intend to write at least two academic papers which focus on findings of the key informant interviews alone. These will focus on barriers and facilitators to harm reduction services, and understanding how key informants frame harm reduction and illicit drug use. The team do not expect to conduct these analyses at the individual case level, but rather broader geographic zones, due to sampling size limitations.

The fieldwork for this study will be conducted from December 11, 2017 to December 31, 2017.