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Table 4 Key facilitators to implementation of naloxone training and exemplar quotes organized by CFIR domain

From: Application of The Consolidated Framework for Implementation Research to inform understanding of barriers and facilitators to the implementation of opioid and naloxone training on college campuses

Domains

Key facilitators/recommendations

Exemplar quotes

Outer setting

- Students have awareness of opioid epidemic affecting wider NYC community

- Address opioid use-related stigma in trainings

- Administration feels pressure to initiate trainings if peer institutions are doing the same or wants to be seen as leader

- Clarify risk of legal repercussions and mandatory reporters

“We are in a city where these drugs are very prevalent and I feel like there’s definitely a possibility of us coming across someone who ODs here, and wherever we go after college.”—Sorority member

“For example… in the state of New York there’s legislation that there’s an amnesty clause…so if it’s part of administering this [naloxone] that there’s not necessarily going to be a punishment off of that, there might be like basics or counseling or other things but it’s not necessarily a sanction um that can also be helpful… 'cause those questions are gonna come up from students”—Columbia Health staff member

Inner setting

- Simplify and standardize how to access mental health and substance use resources

- Centralize campus communication

- Promote positive norms around seeking mental health and substance use resources

“I think that we need to, in a way, work on all this on campus, to bring the subject to the table in which we can begin to tackle the stigma part of it. (someone: “yeah”) Um and make more of a normal conversation, something that can be easily discussed but there there’s uh somebody, a speaker that comes and talks about uh the epidemic or um addiction or just make it known, available that there’s resources or maybe there’s a safe place where they can go and talk about it”—Recovery Coalition member

Processes

- Integrate and align incentives within existing structures (e.g., Greek life requirements, extra credit in courses)

- Frame trainings as important to NYC community and demonstrating leadership

- Advertise trainings in frequently accessed buildings and through social groups (i.e., fraternities and sororities)

- Engage campus leaders:

Fraternity members recommend fellow fraternity members

Student athletes recommend trainers and coaches

Recovery coalition members recommend professors and senior students

Health staff members recommend choosing specific groups to complete training first to generate “buzz” then disseminate widely

“what if you strategically pick certain groups and like offer it to them first as sort of like, you beta, like, selling the training and then you know that generates maybe like its own little buzz like it kind of has its own thing and then there’s more maybe in the next new student orientation period”—Columbia Health Staff member

It’s also like, we get these big emails with a whole bunch of things and a lot of like, they’re very well designed, but there’s so much information I don’t really care about. Whereas like sometimes like it might take more effort but if I get like a personal email from somebody with like a little yellow arrow, I’ll probably read that and if somebody looks personal, they’re like – ‘Hey, naloxone training, come through’” – I might be more inclined to go to that.—Fraternity member

Individual characteristics

- Students and administrators generally have progressive attitudes towards naloxone use

- Perceived widespread buy-in among students/ administrators to prevent opioid overdose

- Students recognize that opioid use is a problem “back home” in the cities and states that they grew up in

- Empower students and specific student groups to promote safety among peers and community

- Include recognizing overdose and appropriate opportunities to intervene in trainings

“I think there’s no reason why people shouldn’t be trained in it… If there was one case in my four years that I would have been able to use it and save someone’s life I would have been more than happy to have done that training during NSOP [first-year orientation] and carried around the kit necessary to do that”—Fraternity member

“I tend to believe that if the message is about like civil responsibility like help your neighbor people would like be responsive … at least for the good of the greater society and we all need to rely on each other at certain times so like therefore you should know about this, I think that’s like that’s a very positive message and it's also … it doesn’t uh create this like segregation of like “there’s drug users, there’s people…” it’s just like more positive like attitude towards this”—Resident Assistant

Intervention characteristics

- Trainings can be integrated into first-year orientation, broader substance use trainings, and life-saving trainings (e.g., CPR)

- Extracurricular and social group affiliations can disseminate information to reach specific groups

- Educate students about the opioid epidemic in NYC and at the national level to raise awareness of problem

- Widely advertise opportunities to attend trainings through multiple media channels (posters, emails, etc.)

- Tailor trainings to needs and concerns of students

- Incentivize participation; make trainings in-person and convenient

“I think the first thing that you got to do to make any initiative successful is make it more salient and raise people’s attention”—Military veteran

“…it falls on deaf ears 'cause they don’t even think it’s real so you got to find data, you got to find information, you got to bring people together, you got to start having conversations, town halls, make it more salient, create the information, put a report together, tell people, look, this is an issue and then they have to address it”—Military veteran

“…it’d be cool if we get to actually see the use rate on campus and in our area of New York City and then the broader city as well. 'Cause, like it’s hard to sit here and discuss what would work like the best, because I don’t know the underlining [underlying] issue that well”—Fraternity member