Department of Medicine, Section of Infectious Diseases, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, 801 Massachusetts Avenue, 2nd Floor, Boston, MA, 02118, USA.
Alpert School of Medicine at Brown University, Division of Infectious Diseases, Providence, RI, USA.
Harm Reduct J. 2023 Dec 6;20(1):177. doi: 10.1186/s12954-023-00886-8.
Harm reduction strategies can decrease morbidity and mortality associated with substance use. Various barriers limit conversation around substance use between clinicians and patients. Graphic medicine techniques can inform and encourage patient-centered conversations about substance use. We describe the co-development of a harm reduction-focused graphic medicine comic that depicts the infectious risks associated with injection drug use and patient-centered approaches to providing education about potential risk mitigation strategies.
We formed a co-design group of veterans with lived experience with substance use, physicians, health services researchers, and community-based harm reduction leaders. Over the course of ten sessions, the co-design team developed a storyline and key messages, reviewed draft content and worked with a graphic designer to develop a comic incorporating the veterans' input. During each session, co-design leads presented drafts of the comic and invited feedback from the group. The comic was edited and adapted via this iterative process.
The comic depicts a fictionalized clinical vignette in which a patient develops an injection-related abscess and presents to their primary care provider. The dialogue highlights key healthcare principles, including patient autonomy and agency, and highlights strategies for safer use, rather than emphasizing abstinence. Feedback from co-design group participants highlights lessons learned during the development process.
Graphic medicine is ideally suited for a patient-centered curriculum about harm reduction. This project is one of several interventions that will be integrated into VA facilities nationally to support incorporation of harm reduction principles into the care of persons who inject drugs.
减少伤害策略可以降低与物质使用相关的发病率和死亡率。各种障碍限制了临床医生和患者之间关于物质使用的对话。图形医学技术可以为关于物质使用的以患者为中心的对话提供信息和鼓励。我们描述了一种以减少伤害为重点的图形医学漫画的共同开发，该漫画描述了与注射毒品使用相关的感染风险，以及针对潜在风险缓解策略提供教育的以患者为中心的方法。
我们成立了一个由具有物质使用经验的退伍军人、医生、卫生服务研究人员和社区减少伤害领导者组成的共同设计小组。在十次会议中，共同设计团队制定了故事情节和主要信息，审查了草案内容，并与图形设计师合作开发了一本包含退伍军人意见的漫画。在每次会议中，共同设计负责人都会展示漫画的草稿，并邀请小组提出反馈。通过这个迭代过程对漫画进行编辑和改编。
漫画描绘了一个虚构的临床情景，其中一名患者因注射相关脓肿而出现，并向他们的初级保健提供者就诊。对话强调了关键的医疗保健原则，包括患者的自主权和代理权，并强调了更安全使用的策略，而不是强调禁欲。来自共同设计小组参与者的反馈突出了在开发过程中吸取的教训。
图形医学非常适合以患者为中心的减少伤害课程。该项目是将整合到全国 VA 设施中的几项干预措施之一，以支持将减少伤害原则纳入注射毒品使用者的护理中。
