Understanding connections between health conditions, social experiences, and broader political factors may enhance drug death prevention efforts. Systems science methods can help identify areas for effective interventions. This study aimed to understand the complex system relating to drug-related deaths in Scotland and identify action areas.
We conducted a systems-informed intervention development study using the 6SQuID Intervention Development framework. We facilitated co-production workshops using soft systems methods, including system mapping, priority setting, and six cohering questions.
This project was funded by the Ministerial Drug Deaths Taskforce, led by the University of Glasgow, and delivered by a team from DigitAS, University of Stirling, Cranfield University, and Torry Medical Practice, Aberdeen.
Network analysis and Gaussian graphical models were used to identify co-occurring variables in three linked, national datasets: Public Health Scotland’s National Drug-Related Deaths Database, Prescribing Information System, and Scottish Morbidity Records for inpatient and day case stays in acute and psychiatric hospitals. The linked data included information on 6,608 drug-related deaths in Scotland between 2009 and 2018. Preliminary findings were integrated into co-production workshops that included clinicians, policy makers, service providers and people with lived/living experience. We described the structure of the system map and linked data using community detection and network metrics.
Analysis of the system map found eight subsystems covering direct causes of drug death, life experiences, stigmatising attitudes, treatment services and public perspectives. Analysis of the linked data found a further 78 subsystems; 58 related to distinct conditions, eight to co-occurring conditions, and 12 to substance use. Assault, and alcohol treatment and harms were distinct subsystems in the linked data, but less prominent in the system map. Workshops identified priority action areas: workforce development, service navigation, and community and connections, with stigma as a system-wide leverage point.
Preventing drug-related deaths can benefit from systems science methods. Considering the whole system when prioritising action areas and designing interventions could hold more potential for change. Future policy and practice should consider how systems-informed approaches to death prevention may operate and interact across multiple levels of the social system.
Outputs
McCann, M., Schofield, J., Baldacchino, AM., Seaman, R., Letina, S., Parkes, T., Barnsdale, L., Matheson, C., Hilton, J., Crofton, A. & Skivington, K., (submitted) Complex system structures related to drug deaths in Scotland: a network analytic approach to navigating linked administrative data and co-produced system maps