Development of Cracks in the Ice Resources for Aboriginal and Torres Strait Islander Peoples, a Culturally Appropriate Evidence-Based Online Community Toolkit About Crystal Methamphetamine: Mixed Methods Study.

Background: Crystal methamphetamine ("ice") is a drug of significant concern across Australia; however, access to culturally appropriate, community-led, and co-developed resources is limited for Aboriginal and Torres Strait Islander communities. Objective: To meet this need, the Cracks in the Ice Resources for Aboriginal and Torres Strait Islander peoples web-based toolkit was developed to support Aboriginal and Torres Strait Islander peoples, families, and communities affected by crystal methamphetamine. Methods: The community-led development of the toolkit was overseen by an expert advisory group and involved a broad-reaching, inclusive, and iterative process, with three phases over a 6-year period (from funding in 2016 to launch in 2021). The development phases with, and for, Aboriginal and Torres Strait Islander communities involved (1) initial focus groups (30-45 min, n=15) conducted by an Aboriginal researcher across 6 locations including metropolitan cities, rural regional towns, and towns servicing remote Aboriginal communities across Australia; (2) content and web development in collaboration with First Nations digital agencies; and (3) beta-testing of the web-based toolkit via a 15-25 minute online survey to evaluate the toolkit's acceptability, relevance, and usability. Results: Phase 1 community consultations (n=166) highlighted the need for culturally appropriate information and resources about methamphetamine use harms, impacts, and support options. This guided phase 2, where resources were developed to address knowledge gaps (eg, drug effects) and practical needs of communities (eg, yarning about drugs), along with content-specific meaningful First Nations artwork, interactive features, and other resources. Phase 3 beta-testing results were positive, with Aboriginal and Torres Strait Islander end users (n=73) reporting that the toolkit was easy to navigate and provided appropriate and relevant information. The majority (67/73, 91.8%) of participants reported that it was clear what information the toolkit provided, and most (54/73, 73.9%) were "very likely" to recommend it to others. Areas for improvement were identified (eg, explanation of artwork development and improving the clarity of text) and addressed before launch. The web-based toolkit was officially launched on July 21, 2021 (reach as of June 2025: >2.74M page views, >1.44M unique website users, and >366K hard copy resources distributed to >1793 organizations across Australia). Conclusions: It is critical that First Nations health resources are community-led and iteratively co-developed with experts and health workers supporting communities. Conducted over 6 years and involving >240 Aboriginal and Torres Strait Islander community members, Elders, experts, and health workers, such a process was used to develop this culturally appropriate, relevant, and acceptable web-based toolkit about crystal methamphetamine for Aboriginal and Torres Strait Islander peoples. While focused on an area of high need within Australia, this process provides an effective and strengths-focused roadmap to achieve this in other areas of health and in other countries working with First Nations peoples.