Reducing Drug-use Harms among Higher Education Students: X Contextual-Behaviour Change Digital Intervention Development Using the Behaviour Change Wheel

Background: Digital harm-reduction interventions typically focus on people with severe drug-use problems, yet, these interventions have a moderate effectiveness on drug-users with lower levels of risk of harm. The difference in effectiveness may be explained by differences in behavioural patterns between the two groupings. Harnessing behavioural theories to understand what is at the core of drug-use behaviours to map the content of new interventions can improve the effectiveness of interventions for lower-risk drug-users. This is the first study to systematically apply the Behaviour Change Wheel (BCW) to understand the components, influencing capabilities, opportunities, and motivations (COM-B) of higher education students to change their drug-use behaviour. This is also the first study which identifies specific patterns of behaviours likely to be most responsive to harm reduction practices through the use of the Theoretical Domain Framework (TDF). Methods: We first conducted an online survey and a Delphi exercise to understand the factors influencing COM-B components of higher education students to change drug-use. Subsequently, we mapped all evidence onto the COM-B and the TDF to identify clusters of behaviours to target for change using a pattern-based discourse analysis. Finally, a series of multidisciplinary group meetings identified the intervention functions- the means by which the intervention change targeted behaviours and the Behavioural Change Techniques (BCTs) involved using the behaviour change technique taxonomy (v.1). Results: Twenty nine BCTs relevant to harm-reduction practices were identified and mapped across five intervention functions (education, modelling, persuasion, incentivization, and training) and five policy categories (communication/marketing, guidelines, regulation, service provision and environmental/social planning). These BCTs were distributed across eight identified saturated clusters of behaviours this intervention attempts to change. Conclusions: The BCTs identified will inform the development of a digitally delivered behaviour change intervention that focuses on increasing mindful decision-making with respect to drug-use and promotes alternatives to drug-use activities. The findings can also inform implementation scientists in applying context-specific harm-reduction practices in higher education. Examples of how the eight identified clusters of target behaviours are mapped across the COM-B components and the TDF are provided, along with suggestions of implementation practices for harm -reduction targeting students in higher education.