Supporting men who use anabolic steroids: A sequential multi-methods study

Background An increasing amount of research exploring use of anabolic androgenic steroids (AAS) has been undertaken over the past three decades and, in recent years, there has been a growing awareness of this form of substance use on a societal level and as a public health problem in the UK. However, there have been few public health interventions aiming to respond to this and there is little evidence-based guidance available to support health professionals working with users. Aim The aim of the research was to identify ways that intervention providers can influence men who use AAS and support them to improve their health and manage risk. To achieve this the research explored factors that influence users’ choices, and identified priorities and opportunities for interventions. Methodology The research followed a sequential design over four studies, where findings informed the development of subsequent studies. Study 1 was a systematic review examining the content and effectiveness of interventions with the intention of influencing AAS use. Study 2 was the development of an evidence-based socioecological framework through which to explore factors that influence AAS users’ behaviours and to identify opportunities for interventions. Study 3 used largely unstructured interviews with 33 stakeholders with a range of expertise and experiences with AAS to identify priorities to address and potential interventions in response to these. Semi-structured interviews in study 4 followed up these findings with 12 men who use AAS who ranged from new users to very experienced users. These qualitative studies were analysed using thematic analysis, which moved from an initial inductive and data driven approach to one that was more deductive as interviews became more structured. The Behaviour Change Wheel model informed the research and in particular the principle of developing an in depth understanding of a behaviour in order to influence it. The findings from the four studies supported the development of a conceptual map exploring the provision of support and information to users. A complex systems approach to understanding health behaviours underpinned the map and identification of potential interventions in response to the priorities identified. Results A range of priorities to support users to improve their health and manage risk emerged. Opportunities to respond to these were identified, supported by the development of the conceptual map of support and information provision. This map is intended for stakeholders to use in the development of effective responses in their local communities. Applying a systems approach to the provision of support to AAS users helps recognise the competing and complex influences on users across the socioecological spectrum and supports a thorough understanding of their behaviours. The findings indicate the need to go beyond the current provision of support services in the form of needle and syringe programmes and steroids clinics to respond to the priorities identified. Involving influential individuals or role models as change agents within users’ social networks and important environments such as gyms will increase opportunity to influence AAS choices and norms, and subsequently reduce risk of poor health outcomes amongst this population