Trust and Service Engagement Among People Who Inject Drugs Post-Release

Author: Lise Lafferty Sophia Schroder Alison Marshall Kerryn Drysdale Peter Higgs Mark Stoove Eileen Baldry Paul Dietze Carla Treloar Carla

Theme: Social Science & Policy Research Year: 2022

Background: People who inject drugs are more vulnerable to systemic discrimination than those
experiencing acute health or social needs who are not injecting drug users. Compounding histories of
incarceration further marginalises people most in need of health and social services, making it difficult
for them to address their health and welfare and navigate a sustainable pathway back into the
community. Drawing on Hall’s five components of trust, this analysis seeks to understand trust in
service providers from the perspective of people who inject drugs during the prison post-release
period and how trust fosters (or inhibits) effective service engagement.
Methods: Between September 2018 and May 2020, interviews were completed with 48 adults (33
men, 15 women) recruited from SuperMIX (a longitudinal cohort study in Victoria, Australia). Data
relating to service engagement were coded against the five components of trust: fidelity, competence,
confidence, honesty, and global trust.
Results: Depictions of trust were consistently portrayed within the context of negative experiences,
while trusting provider relationships and interactions were rarely described. Most participants
recounted a stark absence of fidelity (that is, pursuing a patient’s best interests), with some
participants detailing circumstances in which their vulnerability was purposefully, almost strategically,
exploited. These encounters nearly always had the consequence of impeding the participant’s positive
progression in the post-release integration period.
Conclusion: There is an urgent need to prioritise the client in health and social service delivery in the
post-release transition-to-community period and recognise the importance of trust in delivering
effective services to people in marginalised circumstances.
Disclosure of Interest Statement:
LL, SS, KD, AM, EB, and PD have nothing to declare. CT has received speaker fees from Gilead and
Abbvie. PH has received investigator-initiated research funding from Gilead Sciences and Abbvie
Pharmaceuticals for research not connected to this work. MS is a recipient of a NHMRC Senior
Research Fellowship (Commonwealth Government) and has received investigator-initiated funding
from Gilead Sciences, AbbVie and Bristol Myers Squibb for research unrelated to this work.

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