Coproducing and evaluating public health communication of invasive group A streptococcal infection (iGAS) for people experiencing homelessness and people who inject drugs

Abstract

Background: invasive group A streptococcal (iGAS) disease is a rare but serious bacterial infection affecting a broad cross-section of people. Public health advice is routinely provided to close contacts of iGAS cases to encourage early presentation to medical facilities, given the elevated risk of secondary transmission. Despite being at heightened risk, people experiencing homelessness (PEH) and people who inject drugs (PWID) have not been involved in developing this guidance. Materials previously available through Public Health England were not coproduced and therefore may not be accessible, understandable, or actionable for these groups.

Objective: this project (1) explored the experiences and communication needs of PEH and PWID; (2) coproduced iGAS factsheets with PEH and PWID; and (3) evaluated whether the coproduced materials were accessible, understandable, non-stigmatising, and actionable.

Methods: we used the Agile Co-production and Evaluation (ACE) framework to rapidly and iteratively optimise and evaluate iGAS public health materials with PEH and PWID. A multidisciplinary steering group including public health experts, service providers, and researchers guided the study. The protocol was pre-registered (OSF: z4268) and the study is reported in accordance with GRIPP2 long-form guidelines for public involvement.

Results: coproduction activities informed factsheet modifications incorporating simplified language, visual cues, and content relevant to PEH and PWID. Coproducers described the factsheet as eye-catching, easy to read, and person-centred whereas the original version was viewed as having limited relevance to their needs. In the evaluation survey, 32/39 responders preferred the coproduced factsheet, which was rated higher for readability and clarity of guidance. Symptoms of invasive group A streptococcal infection were correctly identified and responders stated that they would follow the advice.

Conclusions: our findings show the potential of rapid, participatory approaches to improve and evaluate the design of public health advice for underserved groups. By applying the ACE framework, we showed that coproduced materials were clearer, more actionable, and better aligned with the needs of PEH and PWID. The process also identified practical steps for health protection teams and highlighted ways to optimise the ACE framework for future use in emergency settings.

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Identifiers

ORCID for Lucy Yardley: orcid.org/0000-0002-3853-883X

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