title: When the dragon's awake: a needs assessment of people injecting drugs in a small urban centre.
abstract: BACKGROUND
  St. John's, Newfoundland and Labrador is one of the smallest Canadian provincial capitals. Like other Canadian coastal communities, St. John's has been affected by dramatic economic and institutional restructuring that negatively impacted community health. Marginalized populations including people who inject drugs are more negatively affected by the gap between health needs and available services.
  
  
  METHODS
  A mixed methods needs assessment began with a survey and key informant and focus group interviews to determine attitudes, knowledge, and practices of people with current or previous experience injecting drugs. An environmental scan of programmes and services was conducted followed by a community consultation with key stakeholders, community agencies, study participants, the media, and members of the public to share and validate findings, solicit feedback, and gather data about future knowledge transfer activities.
  
  
  RESULTS
  This paper examines two of the five barriers to health and health services for people injecting drugs: First, there was a discrepancy amongst people injecting drugs between awareness and use of safer practices, and second, there was a limited formalized network of health and social programmes and services.
  
  
  CONCLUSIONS
  Accurate and timely information about safer practices, whilst an essential component of a harm reduction approach, is insufficient to reduce the risk of negative health outcomes for people injecting drugs. Funding new programmes and services, although desirable, is not always feasible in small urban centres with limited human and material resources. Recommendations for promoting health, reducing harm, and building local capacity must consider these limitations. Registered nurses are well positioned to provide leadership through collaborative community-based research, education and advocacy.
authors.affiliation: Division of Community Health and Humanities, Faculty of Medicine HSC 2834, Memorial University, St. John's, NL A1B 3V6, Canada. diana.gustafson@med.mun.ca
authors.forename: Diana L
authors.initials: DL
authors.lastname: Gustafson
authors.forename: Lesley
authors.initials: L
authors.lastname: Goodyear
authors.forename: Fran
authors.initials: F
authors.lastname: Keough
mesh_terms: D003625:Data Collection; D005260:Female; D017144:Focus Groups; D040261:Harm Reduction; D007722:Health Knowledge, Attitudes, Practice; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D020380:Needs Assessment; D009523:Newfoundland and Labrador; D024802:Nurse's Role; D015819:Substance Abuse, Intravenous / Q000523:psychology*; D019037:Urban Health Services / Q000600:supply & distribution*