Operationalizing recipient-centeredness: three facets of values-driven care in syringe services programs

Abstract Background Syringe services programs (SSPs) offer critical, evidence-based services for people who use drugs (PWUD), including infectious disease and overdose prevention. SSPs operate from harm reduction and health equity frameworks, prioritizing non-coercive care and client autonomy; these values foster engagement among a community often stigmatized or discriminated against in traditional healthcare settings. As SSPs increasingly expand their clinical service offerings, they may encounter tensions among their core values, internal or funder-driven pressures for service expansion, and partnerships with external healthcare systems. Accordingly, we undertook a qualitative study to understand how SSP staff uphold core values and practice recipient-centeredness, as defined by the Consolidated Framework for Implementation Research (CFIR), when engaging PWUD in health services within harm reduction settings. Methods From May 2023 to February 2024, we conducted qualitative interviews with 41 representatives of 27 SSPs serving diverse U.S. jurisdictions. Guided by the CFIR, trained interviewers used semi-structured interview guides to explore SSPs’ health services delivery models. From interviews, recipient-centeredness emerged as a central theme, leading us to employ thematic and narrative analysis to further explore how SSPs defined and operationalized this construct in their programs’ health-related services. Results SSP staff consistently emphasized the centrality of core values guiding their services, particularly recipient-centeredness. SSPs operationalized recipient-centeredness through three primary facets: accessibility, consistency, and non-coerciveness. These facets informed direct service delivery and referral processes, enabling programs to build trust and meet clients’ complex needs. To uphold these facets, SSPs implemented low-barrier service access, mobile outreach, client-centered referrals, and predictable service schedules despite dynamic and sometimes unsupportive contexts. Conclusions This study offers a specific operationalization of recipient-centeredness for the unique and understudied setting of SSPs, identifying accessibility, consistency, and non-coerciveness as key facets of this organizational culture. Understanding these facets yields actionable guidance for supporting SSPs in implementing values-driven public health and prevention programming. These findings may also be relevant for other harm reduction and low-barrier care settings seeking to preserve trust, dignity, autonomy, and effectiveness while delivering evidence-based services. Trial registration NCT06025435