Characterizing 'Atmosphere': exploring determinants of regular service attendance amongst integrated supervised consumption site clients in Vancouver's Downtown Eastside.

BACKGROUND: Research has explored barriers and facilitators to supervised consumption sites (SCS) in Canadian settings. Despite this, little is known about what factors drive individuals to initiate and repeatedly attend specific SCS where multiple SCS options are available, such as in Vancouver's Downtown Eastside (DTES). The aim of this study was to understand the structural, contextual, and operational determinants of regular SCS attendance during Canada's ongoing overdose crisis. METHODS: Rapid-ethnographic fieldwork was conducted over a six-week period at an integrated SCS in Vancouver's DTES. This comprised an initial five-week period of non-participant observation (≈200 h) followed by a community consultation regarding the research design and question protocols. Qualitative data were then collected through five focus groups (n = 25) and 20 semi-structured interviews with regular service attendees with data analysed using thematic analysis. RESULTS: Our findings highlight four important factors related to regular service attendance. The service had a regular clientele who described their attendance as routinized, which they attributed to four distinct factors: (1) the accessible location, (2) the on-site auxiliary health and support services, (3) the diversity of harm reduction provision, and (4) the atmosphere. Exploring the concept of atmosphere in more depth showed that it was characterized by the safety, familiarity, and inclusivity experienced within the service. Together, these factors facilitated a strong sense of belonging among attendees regarding the service and its community of staff and clients. CONCLUSION: Within the context of an ongoing overdose crisis, our findings highlight SCS service characteristics which facilitate routinized engagement including accessibility, wrap-around support, comprehensive and tailored harm reduction, and an inclusive welcoming atmosphere. These insights can inform policy makers and service providers in scaling and developing effective, client-centred SCSs to reduce harm and promote wellbeing.