Table 5 Behavioural analysis of REACT intervention using the COM-B model of behaviour and Behaviour Change Wheel

Handwashing/swabbing

Lack of access to handwashing facilities when injecting in public spaces.

Lack of swabbing of injection site prior to injecting.

Use of swabs to stem bleeding after injecting

Information provision about importance of handwashing, cleaning surfaces and swabbing injection site.

Provision of hand sanitiser and swabs

[30]

[49]

Psychological capability (knowledge or psychological skills to perform the behaviour)

Reflective motivation (self-conscious planning and evaluation)

Physical opportunity (environmental support for behaviour)

Education (increasing knowledge or understanding)

Training (imparting skills)

Persuasion (using communication to induce positive or negative feelings or stimulate action)

Environmental restructuring (changing the physical or social contact)

Enablement (increasing means/reducing barriers to increase capability (beyond education and training) or opportunity

4. Shaping knowledge

4.1. Instruction on how to perform a behaviour

5. Natural consequences

5.1. Information about health consequences

5.5. Anticipated regret

7. Associations

7.1. Prompts/cues

12. Antecedents

12.5. Adding objects to the environment

Use only necessary amount of acid during injection preparation process

Quantity of acid determined by packet size.

Quantity used determined by visual cue of information.

Information provision that excess acid required to dissolve these materials increases injection solution acidity but not psychoactive drug content.

Provision of acid sachets with labelling that stresses ‘a whole sachet is far too much for most injections’ during intervention delivery

[35]

Use of water for injection preparation

Lack of access to sterile water when injecting in public spaces.

Measures such as the closure of public toilets and increased security in pubs and cafes have reduced access to clean water for people experiencing homelessness.

Sterile water for injection is not included in most injection packs because of local budget constraints.

Information provision about hierarchy of water (intervention delivery and leaflet).

Provision of water ampoules/street injecting kits.

[36]

Minimise reuse of equipment (needles, cookers, filters)

Access to sterile equipment not always available

Information provision about limiting reuse of equipment (needles, filters, spoons) and cleaning of equipment if it is reused.

Provision of street injecting kits

[11]

Rotating sites

Advice and information on how to avoid venous sclerosis, and how to find and safely access less visible veins, was desired by the majority

Information provision about rotating sites.

Signposting to specialist healthcare professionals for support to identify veins

[13]