Anti-stigma intervention for health and care staff in contact with people who use substances: A process evaluation

Background

People who use substances (PWUS) are among the most stigmatised individuals and groups in society. Healthcare professional (HCP) stigma occurs when PWUS are viewed negatively and/or are treated differently, ignored, or excluded because of the beliefs or perceptions that HCPs hold about them. HCP stigma is a pressing concern in primary care, public health and social care settings, and across a range of HCP roles. Tackling HCP stigma is important because, if left unchallenged, it is associated with increased inequality, health disparities, and a range of negative outcomes for PWUS, as well as for services and society more broadly. HCPs who engage with PWUS can challenge and reduce stigma but, to do so, they need to be able to identify stigma and have the required knowledge, resources and ability to appropriately respond. To support this an anti-stigma course has, in partnership with people who have experienced stigma due to their substance use, been designed for delivery to HCPs working with PWUS. This course combines educational content and contact interventions (i.e. people with lived experience of stigmatisation sharing their stories) to help HCPs understand and recognise stigma and consider ways in which they may change their practice to reduce stigma. This course has been piloted with a total of 55 HCPs, but a formal evaluation of the course is yet to be conducted.

Aim

Our aim is to conduct a process evaluation of an anti-stigma course designed for delivery to HCPs working with PWUS. We have recruited a number of different research/evaluation site in England and Northern Ireland and our aim to understand whether any elements of the course are barriers or facilitators to its success, to identify the contextual factors that influence HCP learning and change, and to understand the mechanisms of impact that participation has on HCP perceptions, cognitions and behaviours in practice. The overarching aim of this project is to identify ways in which the anti-stigma course can be made more effective and efficient in the future to support the reduction of stigma amongst HCPs, and the enhancement of the experiences PWUS have when they engage with services.

Design and methods

During this project we will:

• Deliver the anti-stigma course to HCPs in different roles, from different sectors, and from different geographical areas of the UK
• Administer a survey before and three months after attending the course to understand if/how it changes HCPs beliefs and/or behaviours
• Conduct one-to-one semi-structured interviews with HCPs 4-6 months following course completion to understand their experiences of attending and if/how it has subsequently affected their practice
• Conduct group-based co-production workshops with HCPs 9 months following course completion to help shape, evaluate and optimise the anti-stigma course

Public involvement

This research project has been fundamentally shaped by the experiences, views and contributions of people with lived experience (PWLE) of mental ill health, substance use concerns, a range of personal difficulties (e.g. homelessness, domestic violence, child removal) and those who have experienced stigma in care settings. We, with the support of the Newcastle Lived Experience Recovery Organisation (LERO; a partnership between PWLE and professional representatives of public health, primary care and social care teams; co-applicants), will continue to recruit diverse members to this public involvement group and we will work with and support this group to be actively involved in the research process.

Dissemination

We will work with LERO to disseminate our findings via their group and wider professional networks. Alongside this, we will attend local engagement events and special interest group meetings to share the findings of this project. Specifically, we will engage with organisations and events such as the ARC NENC, the National Stigma Network, FUSE and the Three Schools Seminar Series.  We are also planning to apply for further funding to implement and evaluate the anti-stigma course with a wider range of individuals. Alongside public engagement events we plan to publish our findings in scientific journals and present them at scientific conferences.

Contact us

Dr William McGovern – william.mcgovern@northumbria.ac.uk

Dr Connie Dalton – c.dalton@northumbria.ac.uk