Evaluation of an intervention to reduce health professional stigma toward drug users: A pilot study

Abstract

Background: Stigma underpins unfavorable attitudes toward many traditionally underserved groups in health care. Although training for Screening, Brief Intervention, and Referral to Treatment (SBIRT) has been shown to change provider attitudes, none have to date examined the effectiveness of training modules that directly address stigma toward drug users. The aim of this paper is to evaluate the impact of SBIRT training plus the addition of 2 anti-stigma training modules on stigma regarding drug use and drug users among Brazilian health professionals. Participants included community health workers, nursing assistants, nurses and other health professionals.

Methods: A pretest-posttest wait-list design with intervention and comparison cities. The follow-up was 3 months.  Participants included 95 primary health care professionals, of whom 54 received SBIRT training plus training in two anti-stigma modules (intervention group) and 41 received assessments only (comparison group). The posttest was administered 3 months following the training. Baseline and outcome included validated and non-validated measures of general attitudes and beliefs about drug users. In addition, participants responded to vignettes designed to assess stigma in the context of ethical issues, which assessed how much participants attributed responsibility for the onset and resolution of substance abuse to the patients themselves—the degree to which they “moralized” drug use.

Results: There were marked baseline differences between experimental and comparison communities. However, nearly all (range 72%-90%) providers held a uniformly high “moralized” view of drug dependence. These attributions were not changed by the trainings. Likewise, there were no significant differences between intervention and control groups  when we examined how much their stigma toward drug users changed after the anti-stigma module.

Conclusions: This preliminary study found no intervention effects; it did find, however, that most professionals blamed drug users for their addiction. Because SBIRT seeks to embed intervention into settings that have historically overlooked and undertreated substance abuse, we believe that future research is warranted in order to better understand and address stigma. Research could explore what predicts stigmatized views of drug users, and what sorts of interventions reduce stigma.