Reducing Health-Related Stigma Through Narrative Messages

Resistance to anti-smoking messages related to the higher smoking stigma of Korean female smokers

Introduction

The degree of perceived smoking stigma can differ, based on various factors such as gender; this may influence the effect of smoking cessation interventions, including denormalization. This study investigates the gender differences in smoking stigma recognized by Korean smokers and explores the effect of these differences on the success of smoking cessation messages that aim to initiate an identity crisis among smokers. It aims to contribute to effective smoking cessation intervention strategies for female smokers.

Methods

The smoker-gender Implicit Association Test (IAT) was used to measure gender-based smoking stigma; the test comprised photos of people smoking, with positive and negative descriptors. Participants were 120 smokers aged 19-35 years (60 males and 60 females). Participants' cognitive attitudes toward smoking and cessation intentions were assessed at baseline. To investigate the effect of social stigmatization on smokers, participants were asked to watch anti-smoking campaigns that stigmatized either smoking behavior or smokers' self-identity. Cognitive attitudes and cessations intention were used to show differences in gender and message conditions.

Results

The IAT D-score showed that female smokers perceived other female smokers significantly more negatively than they did male smokers, suggesting a higher level of smoking stigma. Female smokers in the socially stigmatizing condition reduced their negativity toward smoking less than those who were not stigmatized. Moreover, cessation intentions did not improve when female smokers received identity-threatening messages, indicating that female smokers tended to resist stigmatizing messages.

Discussions

These findings provide empirical evidence that the gender of Korean smokers is significantly related to differences in smoking stigma. The negative perception and resistance responses of female smokers shown in this study are consistent with the findings of previous studies on the stigma of substance use disorders and addiction. High smoking stigma can also be a risk factor in anti-smoking interventions, including health communication; therefore, these findings should be interpreted with caution.

Assigning Responsibility for Depression and Diabetes: Frame Building Factors in Health Coverage

Although frame building is a crucial part of framing in health communication, it is much less understood than media frames or their effects on audiences (i.e. frame setting). To address this research gap, we analyzed the individual, organizational, and external factors of influence contributing to the media's portrayal of responsibility for two major health issues: depression and diabetes. To identify relevant factors, we conducted 23 semi-structured interviews with German journalists who regularly report on these health issues. Our findings indicate that the way in which media coverage portrays responsibilities in depression and diabetes is affected by a variety of factors. These include individual (journalist role perception, journalistic routines, academic background and personal experiences with depression, diabetes-related knowledge, and personal values and beliefs), organizational (editorial lines, space limits, time limitations and payment, and newsroom structures), and external (health news sources, audience interest, newsworthiness, and social norms) factors. Notably, there are differences between depression and diabetes coverage - especially regarding individual factors - confirming that frame building, similar to framing in general, should be examined with regard to specific issues. Nevertheless, some factors that seem important across different topics could be identified.

"It Doesn't Have to Be All or Nothing": How Individuals Who Use Infant Formula Understand the Breastfeeding Master Narrative

Despite clinical recommendations, only 24.9% of infants in the United States are exclusively breastfed at 6 months of age, and women who use formula report facing stigma and feeling like a failure. Individual experiences are often influenced by master narratives such as "breast is best," and stories can reveal how the discourse may manifest unintended effects, potentially eliciting guilt and shame, which are known to result in negative maternal mental outcomes, including depression and anxiety. The purpose of this research was to use a narrative framework to analyze the stories of women who used formula and determine how they interpreted the master narrative of "breast is best." We conducted interviews with 20 women who had used formula within the first 6 months after giving birth and had an infant no older than 12 months at the time of the interview. Qualitative analysis revealed that women integrated "breast is best" into their stories, and that the master narrative influenced conceptions of themselves as mothers including the bonded mother, the good mother, the shameful mother, and, ultimately, the multitudinous mother. Participants who used formula within the first six months desired that messaging about breastfeeding, particularly in online spaces, move away from all-or-nothing framing and instead show the diversity of infant feeding experiences. It is important to consider how breastfeeding discourse evolves online, considering the unintended effect of stigma, its impact on mental health, and the potential for individuals interacting in these spaces to curate more nuanced narrative messaging about breastfeeding to improve maternal and infant health.

Breaking Taboos in Women's Reproductive Health: The Communication Strategies Used by Top OB/GYN Influencers in Chinese Social Media

Numerous women struggling with health issues dare not go to the hospital due to the stigmatization of obstetric and gynecological diseases in traditional Chinese culture. Social media provide a platform for women to access health information from experts easily. Guided by the doctor-patient communication model, attribution theory, and destigmatization framework, we sought to understand the topics/diseases covered by top OB/GYN influencers on Weibo and the prevalent functions, language style, responsibility attribution, and destigmatization cues used by them. We also examined how these communication strategies predicted followers' engagement behavior. The results showed that women's childbirth-related issues received the highest exposure in the leading OB/GYN influencers' Weibo posts. Influencers' emphasis on building psychological connectedness with their followers was exhibited in the following communication strategies: avoiding using complex medical terminology, drawing equivalences between the outgroup and ingroup, and providing health information. However, using everyday language, responding to emotions, and removing blame served as the three most influential predictors of followers' engagement. Theoretical and practical implications are also discussed.

Racial Disparities in Medical Crowdfunding: The Role of Sharing Disparity and Humanizing Narratives

Americans have increasingly turned to online crowdfunding to pay for healthcare costs, but our understanding of the inequalities in medical crowdfunding remains limited. This study investigates racial disparities in medical crowdfunding outcomes and examines the role of communication in amplifying, altering, or even reducing the disparities. Using data from 1,127 medical crowdfunding campaigns on GoFundMe, the study found that beneficiaries of color received significantly fewer donations than their White counterparts. The differences in donations between racial groups were partly attributable to sharing disparities. Campaigns for beneficiaries of color were shared less via e-mail or social media than campaigns for White beneficiaries. Campaign narratives with more humanizing details about beneficiaries were associated with more donations. However, humanizing details did not predict more shares, nor were they linked to smaller disparities in campaign outcomes between racial groups. Post-hoc analyses showed that more humanizing details were linked to fewer campaign donations for male beneficiaries of color. The findings contribute to the scholarship addressing the intersections of communication and health inequality on digital platforms.

Implementing a tobacco-free workplace program at a substance use treatment center: a case study

BACKGROUND

People with substance use disorders smoke cigarettes at much higher rates than the general population in the United States and are disproportionately affected by tobacco-related diseases. Many substance use treatment centers do not provide evidence-based tobacco cessation treatment or maintain comprehensive tobacco-free workplace policies. The goal of the current work is to identify barriers and facilitators to a successful and sustainable implementation of a tobacco-free workplace program, which includes a comprehensive tobacco-free policy and evidence-based cessation treatment services, in a substance use treatment center.

METHODS

This study is based on an ethnographic approach and uses a qualitative case study design. Data were collected via interviews with staff (n = 6) and clients (n = 16) at the substance use treatment center and site visits (n = 8). Data were analyzed using thematic analysis guided by the extended Normalization Process Theory designed to inform the implementation of innovations in healthcare practice.

RESULTS

Staff at the substance use treatment center supported the implementation of the program and shared a good understanding of the purpose of the intervention and its potential benefits. However, the study identified significant challenges faced by the center during implementation, including widespread tobacco use among clients, contributing to attitudes among staff that tobacco cessation was a low-priority problem due to a perceived lack of interest in quitting and inability to quit among their clients. We identified several factors that contributed to changing this attitude, including provision of tobacco training to staff, active leadership support, low number of staff members who smoked, and access to material resources, including nicotine replacement products. The implementation and active enforcement of a comprehensive tobacco-free workplace program contributed to a gradual change in attitudes and improved the provision of evidence-based tobacco cessation care at the substance use treatment center.

CONCLUSIONS

Substance use treatment centers can integrate tobacco cessation practices in their daily operations, despite multiple challenges they face due to the complex behavioral health and socioeconomic needs of their clients. With proper support, substance use treatment centers can provide much needed tobacco cessation care to their clients who are disproportionately affected by tobacco-related health conditions and systemic health inequities.

The name and frame matters when it comes to public support of opioid prevention programs

BACKGROUND

Opioid overdose is the second leading cause of accidental death. Safe Consumption Sites (SCSs) are very effective harm reduction, but skepticism persists in the U.S. In four U.S. states, legislative attempts failed, except for Rhode Island's "Harm Reduction Center," (HRC), and New York City's "Overdose Prevention Centers" (OPP).

METHODS

We hypothesized that compassion naming and framing would rate higher than safety/security or just-the-facts framing. Our mixed methods design included focus groups and a randomized experiment with an online panel of representative U.S. adults. All rated the title, description, and two or more images related to the program. Focus groups discussed impressions.

RESULTS

Of four packets seen (SCS, OPP, HRC, and SIF), OPP was the clear favorite in both studies. Unexpectedly, offering facts and statistics improved favorability. Compassionate language was a primary driver of favorability, followed by life-saving medical messaging. Imagery of people helping and smiling was liked best. Focus groups' primary concern was about "their backyards," but also, they desired to save lives and reduce suffering.

CONCLUSION

Stigma drove opposition to SCSs, as did conservative political affiliation. We provide finalized marketing packets which will reduce stigma and generate public support for SCSs.

Effects of Positive versus Negative Framing on Stigma toward Individuals Recovering from Methamphetamine Use Disorder during Randomized Brief Video Exposure

Eighty-two Australians (mean age = 30.07; 61% female) were blindly randomized to view either a video edited to depict a positive or negative presentation of individuals in recovery from methamphetamine use disorder. Participants completed the Social Distance Scale for Substance Users, Dangerousness Scale for Substance Users and Affect Scale for Substance Users before and after video exposure. Following video exposure, those exposed to the positive video portrayal reported lower desire for social distance (p < .001), lower perceptions of dangerousness (p = .011), and more favorable affective reactions (p < .001). Participants' previous level of contact with the target group did not predict baseline stigma or moderate the experimental effect. Participants' qualitative responses to the experiment were assessed via content analysis and indicated mainly positive or ambivalent attitudes, unchanged by the video; however, 18% of those receiving the positive video reported attitudes becoming more sympathetic/favorable. Findings suggest that media depictions which include people with methamphetamine use disorder displaying friendliness and recovery narratives may improve community perceptions of people recovering from methamphetamine use disorder, and conversely, unsmiling portrayals focusing on harm done to others increases desire for social distance and perceived dangerousness.

Facilitated telemedicine for hepatitis C virus: Addressing challenges for improving health and life for people with opioid use disorder

BACKGROUND

People who use drugs (PWUD) frequently delay or avoid obtaining medical care in traditional healthcare settings. Through a randomized controlled trial, we investigated facilitated telemedicine for hepatitis C virus (HCV) integrated into opioid treatment programmes. We sought to understand the experiences and meanings of facilitated telemedicine and an HCV cure among PWUD.

METHODS

We utilized purposive sampling to interview 25 participants, 6-40 months after achieving an HCV cure. We interpreted and explicated common meanings of participants' experiences of an HCV cure obtained through facilitated telemedicine.

RESULTS

Participants embraced facilitated telemedicine integrated into opioid treatment programmes as patient-centred care delivered in 'safe spaces' (Theme 1). Participants elucidated their experiences of substance use and HCV while committing to treatment for both entities. Facilitated telemedicine integrated into opioid treatment programmes enabled participants to avoid stigma encountered in conventional healthcare settings (Theme 2). Participants conveyed facing negative perceptions of HCV and substance use disorder. Improved self-awareness, acquired through HCV and substance use treatment, enabled participants to develop strategies to address shame and stigma (Theme 3). An HCV cure, considered by PWUD as a victory over a lethal infectious disease, promotes self-confidence, enabling participants to improve their health and lives (Theme 4).

CONCLUSIONS

Integrating facilitated telemedicine into opioid treatment programmes addresses several healthcare barriers for PWUD. Similarly, obtaining an HCV cure increases their self-confidence, permissive to positive lifestyle changes and mitigating the negative consequences of substance use.

PATIENT AND PUBLIC CONTRIBUTION

In this study of patient involvement, we interviewed patient-participants to understand the meaning of an HCV cure through facilitated telemedicine. Participants from a facilitated telemedicine pilot study provided essential input on the design and outcomes of a randomized controlled trial. Pilot study participants endorsed facilitated telemedicine in a testimonial video. They attended site initiation meetings to guide trial implementation. A Patient Advisory Committee (PAC) ensured that patient participants were active members of the research team. The PAC represented patients' voices through feedback on study procedures. A Sustainability Committee supported public involvement in the research process, including educational opportunities, feedback on implementation, and future sustainability considerations.

Moving beyond eat less, move more using willpower: Reframing obesity as a chronic disease impact of the 2020 Canadian obesity guidelines reframed narrative on perceptions of self and the patient-provider relationship

Obesity is becoming recognized as a complex, chronic medical condition. However, the dominant treatment narrative remains that goal weight can be achieved by eating less, moving more using willpower, placing responsibility for change on the person with obesity (PwO). This study evaluated the impact of revising this narrative, to viewing obesity as a treatable medical condition, on internalized weight bias and perceived patient-provider relationship. PwO were recruited into an online study in which two videos were presented; the first showing a traditional doctor endorsing the eat less, move more approach, and the second showing a doctor describing obesity as a treatable medical condition. After each video participants were asked to imagine that they were being treated by that doctor and completed the Weight Bias Internalization Scale (WBIS) and the Patient-Health Care Provider Communication Scale (PHCPCS). A total of 61 PwO (52% response rate) completed the protocol. Compared to the traditional narrative video, the revised narrative video resulted in significant reductions in WBIS scores and significant increases in the PHCPCS scores and was preferred by participants. Within the context of this small-scale study evidence supports that the revised narrative promoting obesity as a complex, chronic but treatable medical condition that is not the result of personal failure has a positive impact on the perceived patient-provider relationship and is associated with reductions in internalized weight bias. This evidence supports the need to help PwO reframe obesity from a personal failure to a legitimate medical condition worthy of care.

(De)Stigmatizing Depression on Social Media: The Role of Responsibility Frames

Responsibility frames on social media could shape recipients' responses toward people with depression, which is crucial for the public (de)stigmatization of the mental disorder. Thus, the present study examines the effects of different responsibility frames (individual, social, combination) in Instagram-posts about depression on respondents' related attributions as well as their emotional and behavioral reactions toward people suffering from the illness. Our online-experiment (N = 1,015) revealed that frames emphasizing the responsibility of one's social network (e.g. family, friends and professionals) for depression, i.e. social frames, strengthened participants' attributions to the social network, i.e. social attributions, most effectively. Individual frames, however, primarily intensified individual attributions to those affected by depression. Contrary to previous findings, a combination frame did not prove to increase recipients' social attributions more than a one-sided social frame. For emotional and behavioral responses, we did not find any effects of responsibility frames compared to the control group-possibly due to buffering effects of the narrative structure of the Instagram posts.

Effects of social norms and message framing on reducing the stigma of gynecological diseases: A cognitive-affective-behavioral model

This paper presents an experiment exploring message strategies to reduce the stigma of gynecological diseases and promote women's sexual and reproductive health. Drawing on the cognitive-affective-behavioral model of stigma, we propose that social norms and message framing as two message strategies, respectively, address the cognitive and affective components of the stigma of gynecological diseases, which lead to desired changes in the help-seeking intention as the behavioral component. We conducted a 3 (no norm vs. descriptive norm vs. descriptive plus injunctive norms) by 2 (gain-framed vs. loss-framed) between-subject experiment (N = 202). The results reveal that messages with the combination of descriptive and injunctive norms reduce the greatest cognitive components of stigma. Gain-framed messages induced fewer affective components than loss-framed ones. The results suggest that changes in the cognitive and affective components of stigma may sequentially lead to favorable changes in the behavioral component. This study contributes to public understanding of the stigma of gynecological diseases by disentangling the various components and identifying the specific message strategies for stigma reduction.

Strategic Messaging to Promote Policies that Advance Racial Equity: What Do We Know, and What Do We Need to Learn?

Policy Points Many studies have explored the impact of message strategies to build support for policies that advance racial equity, but few studies examine the effects of richer stories of lived experience and detailed accounts of the ways racism is embedded in policy design and implementation. Longer messages framed to emphasize social and structural causes of racial inequity hold significant potential to enhance support for policies to advance racial equity. There is an urgent need to develop, test, and disseminate communication interventions that center perspectives from historically marginalized people and promote policy advocacy, community mobilization, and collective action to advance racial equity.

CONTEXT

Long-standing racial inequities in health and well-being are shaped by racialized public policies that perpetuate disadvantage among Black, Brown, Indigenous, and people of color. Strategic messaging can accelerate public and policymaker support for public policies that advance population health. We lack a comprehensive understanding of lessons learned from work on policy messaging to advance racial equity and the gaps in knowledge it reveals.

METHODS

A scoping review of peer-reviewed studies from communication, psychology, political science, sociology, public health, and health policy that have tested how various message strategies influence support and mobilization for racial equity policy domains across a wide variety of social systems. We used keyword database searches, author bibliographic searches, and reviews of reference lists from relevant sources to compile 55 peer-reviewed papers with 80 studies that used experiments to test the effects of one or more message strategies in shaping support for racial equity-related policies, as well as the cognitive/emotional factors that predict their support.

FINDINGS

Most studies report on the short-term effects of very short message manipulations. Although many of these studies find evidence that reference to race or use of racial cues tend to undermine support for racial equity-related policies, the accumulated body of evidence has generally not explored the effects of richer, more nuanced stories of lived experience and/or detailed historical and contemporary accounts of the ways racism is embedded in public policy design and implementation. A few well-designed studies offer evidence that longer-form messages framed to emphasize social and structural causes of racial inequity can enhance support for policies to advance racial equity, though many questions require further research.

CONCLUSIONS

We conclude by laying out a research agenda to fill numerous wide gaps in the evidentiary base related to building support for racial equity policy across sectors.

Who is Responsible? Attribution of Responsibility in the Context of Dementia: A Content-Analysis of Framing in Media Coverage

Dementia is currently one of the most significant public health challenges from a medical as well as a societal perspective. The number of people living with dementia is increasing, and there is conflicting evidence in terms of preventive measures and risk factors. The available therapies can slow down but neither stop nor reverse the condition. Educating the public about these circumstances is thus of utmost relevance. As the mass media are a major source of health-related information, this study uses a quantitative content analysis to examine the extent to which responsibility framing occurs concerning risk and protection factors for dementia. Besides the established levels of individual and society, this study considers the level "social network" as an independent level to account for the supporting role of relatives and friends in the care of people living with dementia. The results show that protection factors for dementia are reported more frequently than the risk factors of the condition. Further, attribution of responsibility for risk factors tended to be at the individual level, while protection was the responsibility of society and the social network.

Video-based e-learning program for schoolteachers to support children of parents with mental illness: a cluster randomized trial

BACKGROUND

Some children of parents with mental illness need support. This study aimed to develop and test the effectiveness of an e-learning program for training elementary schoolteachers to support children of parents with mental illness.

METHODS

The program, which included a 30-min video-based e-learning program, aimed to help schoolteachers gain basic knowledge about mental illness and children of parents with mental illness, recognize children in need of support, and gain confidence in supporting them. A school-based cluster randomized controlled trial was conducted, and the schools were randomly divided into intervention and control groups. The teachers at these schools signed up for the program and participated individually. The outcome measures for the schoolteachers were evaluated at three time points: baseline (T1), post (T2), and one month later (T3). Along with the Sense of Coping Difficulty subscale (primary outcome measure), the following self-developed outcome measures were used: actual behaviors and attitude toward supporting children, knowledge, and self-assessment of program goals achievement. The Sense of Coping Difficulty subscale results at T3 were compared between the groups. Effectiveness over time was assessed for all the outcome measures. The interaction between baseline and intervention effects on the Sense of Coping Difficulty subscale was analyzed. As a part of the process evaluation, open-ended text responses were analyzed qualitatively.

RESULTS

Baseline responses were collected from 87 participants in the intervention group and 84 in the control group. The total score of the Sense of Coping Difficulty subscale at T3 was significantly lower in the intervention group than in the control group (p = 0.007). Over time, a significant effect was observed on the Sense of Coping Difficulty subscale, actual behavior, knowledge of onset timing and probability of onset, and achievement of all program goals. Exploratory analysis was particularly effective for those who encountered a high level of difficulty in supporting children. The participants' text responses indicated that they planned to look carefully at children's backgrounds and stay close to them in the future.

CONCLUSIONS

The program was effective for schoolteachers in supporting children of parents with mental illness.

TRIAL REGISTRATION

UMIN000045483; 14/09/2021.

Community-Centered Patient Journey Map in Opioid Use Disorder: A Tool to Address Compassion Fatigue among Community Pharmacists

Community pharmacists have become increasingly exposed to opioid use disorders in recent decades. However, both pharmacist training and traditional practice environments have not been adequate to prepare the pharmacist for both the patient care needs and regulatory barriers of patients experiencing opioid use disorders (OUD). As a result, there is a need to increase pharmacists' awareness of both the overall patient experience as they navigate their OUD and the role of the community pharmacy as a touchpoint within that experience. To this end, a Community-Centered Patient Journey in Drug Addiction Treatment journey map was developed with expert insights, clinical experience, and in-depth interviews (conducted in spring of 2021) with 16 participants enrolled in licensed opioid treatment programs in Tennessee. Patients, policymakers, clinicians, and academic researchers were involved in the map development. Lived experiences of key informants were captured via in-depth interviews. A consensus decision-making approach was used throughout the patient journey map development process. The final patient journey map illustrates a non-linear pathway, describes the central role of the patient's community, and emphasizes three major "pain points" within the system (access, adherence, and affordability). Future research should investigate the impact of such a journey map on pharmacy personnel's knowledge, attitudes, and behaviors.

The Influence of Stigmatizing Messages on Danger Appraisal: Examining the Model of Stigma Communication for Opioid-Related Stigma, Policy Support, and Related Outcomes

Drug overdose is a leading cause of injury and death in the United States, and opioids are among the most significant of causes. For people with opioid use disorders (OUDs), opioid stigma can lead to devastating consequences, including anxiety and depression. Still, mass media may stigmatize people with OUDs by ascribing stigmatizing labels (e.g., "opioid addict") and other stigma features to those individuals. However, it is unclear how these stigmatizing messages influence public perceptions of people with OUDs and public support for rehabilitation and Naloxone administration policies. The model of stigma communication (MSC) provides a framework for understanding these relationships. This study used the MSC in two online factorial experiments, the first among college undergraduates (N = 231) and the second among Amazon Mechanical Turk workers (N = 245), to examine how stigmatizing messages about people with OUDs influence stigma-related outcomes. Results reveal that opioid stigma messages influence different outcomes depending on the content of those messages. Classification messages with a stigmatizing mark (e.g., "Alex appears unkempt") and label (e.g., "opioid addict") led to greater perceptions of dangerousness and threat in both studies. High stigma classification messages also led to an increased desire for behavioral regulation and social distance in Study 2. Structural equation modeling in Study 1 also supported the applicability of the MSC in the opioid context. Implications for health communication theory development and practice are discussed.

“Masks do not work”: COVID-19 misperceptions and theory-driven corrective strategies on Facebook

Purpose

One of the most prolific areas of misinformation research is examining corrective strategies in messaging. The main purposes of the current study are to examine the effects of (1) partisan media (2) credibility perceptions and emotional reactions and (3) theory driven corrective messages on people's misperceptions about COVID-19 mask wearing behaviors.

Design/methodology/approach

The authors used a randomized experimental design to test the hypotheses. The data were collected via the survey firm Lucid. The number of participants was 485. The study was conducted using Qualtrics after the research project was exempt by the Institutional Research Board of a large University in the US. The authors conducted an online experiment with four conditions, narrative versus statistics and individual versus collective. The manipulation messages were constructed as screenshots from Facebook.

Findings

The findings of this study show that higher exposure to liberal media was associated with lower misperceptions, whereas higher credibility perceptions of and positive reactions toward the misinformation post and negative emotions toward the correction comment were associated with higher misperceptions. Moreover, the findings showed that participants in the narrative and collective-frame condition had the lowest misperceptions.

Originality/value

The authors tested theory driven misinformation corrective messages to understand the impact of these messages and multiple related variables on misperceptions about COVID-19 mask wearing. This study contributes to the existing misinformation correction literature by investigating the explanatory power of the two well-established media effects theories on misinformation correction messaging and by identifying essential individual characteristics that should be considered when evaluating how misperceptions about the COVID-19 crisis works and gets reduced.

Peer review

The peer review history for this article is available at: https://publons.com/publon/10.1108/OIR-11-2021-0600

Influence and effects of weight stigmatisation in media: A systematic

BACKGROUND

The lack of a comprehensive understanding of the role of mass media in perpetuating weight stigma hinders policy formulation. We reviewed the influence of mass media on weight stigmatisation and the effectiveness of media-based interventions designed to prevent or reduce stigma.

METHODS

We conducted a systematic review across seven databases from inception to December 2021. Included studies assessed exposure to or impact of weight stigma in mass media or examined interventions to reduce stigma through media in populations 12+ years. We synthesised data narratively, categorising studies based on similarity in focus to produce a set of integrated findings. The systematic review is registered in PROSPERO (No. CRD42020176306).

FINDINGS

One-hundred-and-thirteen records were eligible for inclusion from 2402 identified; 95 examined the prevalence of stigmatising content in mass media and its impact on stigma. Weight stigma was prevalent across media types, with the dominant discourse viewing overweight and obesity as an individual responsibility and overlooking systemic factors. Exposure to stigmatising content was found to negatively influence attitudes towards people with overweight or obesity. Few studies considered methods of reducing stigma in the media, with only two testing media-based interventions; their results were promising but limited.

INTERPRETATION

Weight stigma in media content is prevalent and harmful, but there is little guidance on reducing it. Future research focus needs to shift from assessing prevalence and impacts to weight stigma interventions.

FUNDING

None.

Interpersonal Communication May Improve Equity in Dementia Risk Education

ISSUE ADDRESSED

Encouraging people to adopt life-long habits that reduce dementia risk is necessary to manage the growing global prevalence of this condition and is, therefore, a global health priority. Current initiatives promoting risk-reducing behaviour primarily attract participants from a limited range of backgrounds, even if widely available. This may inadvertently increase health inequities, as the people who are most likely to develop dementia are the people who are least involved in risk-reduction initiatives. Interpersonal communication can effectively disseminate health messages to demographically diverse populations and may therefore broaden the reach of dementia risk reduction information.

METHODS

Coding reliability thematic analysis was used to categorise reports of information sharing provided by participants from one global online dementia risk education initiative, the [course - name removed for blinding]. These reports of information sharing were provided in response to the feedback question: "If you have already applied your [course] learning, please tell us how".

RESULTS

Information was reportedly shared with a wide range of people, including those from demographic groups that are under-represented among [course] participants. Information about specific risk factors was shared, along with general information about the course and/or dementia risk reduction. Some participants also reported that the people they shared information with were initiating risk-reducing behaviours.

CONCLUSION

Interpersonal communication has the potential to disseminate dementia risk reduction information to, and promote behaviour change among, a broad group of people at risk of dementia, thereby increasing equity in dementia risk education.

Is My Story Better Than His Story? Understanding the Effects and Mechanisms of Narrative Point of View in the Opioid Context

Sharing the stories of people whose lives are impacted by Opioid Use Disorders (OUDs) can be a promising strategy to reduce stigma and increase support for beneficial public policies. Since a story can be told from a first-person or third-person point of view (POV), this study sought to (1) determine the relative persuasive effects of narrative POV and (2) identify the underlying psychological mechanisms, including character identification and psychological reactance, of such narratives. A one-way between-subjects experiment was conducted among a college student sample (N = 276). Narrative POV was manipulated by describing a college student's OUD experience from either the first- or third-person POV. Findings demonstrated that POV did not influence identification but had a significant effect on reactance. Specifically, the first-person (vs. third-person) POV narrative led to lower reactance, which was associated with participants' decreased desire to socially distance themselves from people with OUDs and stronger support for public health-oriented policies regarding OUDs. This study sheds light on the mixed findings revealed in the literature and has practical importance in health message design in the current opioid epidemic.

Narrative messages, information seeking and COVID-19 vaccine intention: The moderating role of perceived behavioral control

Purpose

The main purposes of the current study are to examine 1) the influence of narrative vs statistics messages on COVID-19 related information seeking and COVID-19 vaccine intention and 2) the moderating role of perceived behavioral control (PBC).

Design

Data for a between-subject randomized experiment were collected online. The manipulation messages were presented as screenshots from the CDC’s Facebook page.

Setting

The participants were recruited from Amazon MTurk.

Subjects

A total of 300 subjects participated in the study, who were 18 years and above (M = 38.40).

Measures

Intention to seek information, COVID-19 vaccine intention, and PBC.

Analysis

To test the hypotheses, we utilized Hayes’s (2014) PROCESS for SPSS (Model 1). For intention to seek information, the main effect of the message manipulation (narrative vs statistics) [b = −2.10, t (300) = −4.14, P < .001] and the interaction [b = .41, t (300) = 3.88, P < .001] were significant. For vaccine intention, the main effects of message manipulation [b = 1.64, t (300) = −2.61, P < .005] and the interaction [b = .34, t (300) = 2.64, P < .005] were significant.

Results

Our research found that narrative messages were more persuasive for both information seeking and vaccine intention. But this was true only in the case of individuals whose PBC was low.

Conclusions

Our findings have critical implications for vaccine promotion research.

Selecting evidence to frame the consequences of adverse childhood experiences: testing effects on public support for policy action, multi-sector responsibility, and stigma

While clinical and public health researchers have produced a high volume of research evidence about the consequences of ACEs, there is limited research on public understanding of ACEs or how to most effectively communicate about this body of science. The objective of this study was to determine which messages describing evidence about the consequences of adverse childhood experiences (ACEs) affect public perceptions. We conducted an online experiment with a nationally-representative sample of U.S. adults in July-August 2020. Participants were randomized to control groups receiving messages describing ACE prevalence or resilience, or treatment groups receiving messages describing consequences of ACEs on mental health and substance use, economics, racial equity, or biology. We compared respondents' perceptions of prevention policies and likelihood of policy engagement, attributions of multi-sector responsibility, and blame and stigma across experimental groups. Messages about economic consequences increased respondents' support for policy and attributions of multi-sector responsibility relative to control groups, while also increasing parental blame. The message describing racial equity lowered respondents' perceptions of importance of state policy action and attributions of responsibility to health care. None of the messages affected stigmatizing attitudes. Describing the economic consequences of ACEs on public systems boosts public support for policy action. More research is needed on how the public responds to messaging connecting systemic racism with childhood adversity and health.

'The Lay Gaze'-Rural Norwegian men's assessment of others' health based on pictures

In this article, we explore lay men's understanding of the relationship between other's bodily appearance and health-'the Lay Gaze'. We applied the theoretical concepts of biopower, medical gaze, bodyism and healthism-the ideology where one feature is that a slim body is equivalent to a healthy body-and interviewed 18 adult and elderly men in rural Norway, representing a heterogeneous group regarding age, ethnicity and education. To explore the interviewees' subjective perception or 'gaze', the interviewees were presented with eight pictures of different people. Our main findings were, first, that the sample of a relatively heterogeneous group of adult and elderly lay men in rural Norway talk similarly about body appearance and health and follow the healthism discourse with an embedded association between body appearance and health assessment. Second, we found some variation regarding how interviewees define other standards for the elderly and black people.

The spring 'stay at home' coronavirus campaign communicated by pending accounts

The UK government instruction to stay at home exemplifies how governments do things by saying things in a crisis. The force of the government slogan was amplified by its intertextual circulation in wider public discourse to produce an alignment between the duty of government to protect citizens, the spiritual mission of the Church and the public information role of the press. By analysing the rhetorical and sequential structure of promotional discourse with recourse to speech act, narrative and routine theory, we show how its authors concurrently use cognitive and empathetic interpellations to induce subjectivation, configuring pending accounts which not only involve recipients in scripts for restoring order (if … then … programming constructions) but also implicate them in restorative storylines (just as there and then … so here and now … mimetic constructions). The result is to overlay on the official inducement new voices of hope, conditioned by participation in a collaborative community, naturalising compliance.

Commentary: Addiction, Stigma, and Neurodiversity

The addictions are subject to a great deal of stigma, the constituents of which include negative attributions such as being immoral, weak-willed, or sick. Negative outcomes include exclusion from positive life opportunities. In this commentary, I briefly discuss the definition of stigma, descriptors of addiction-related stigma, and negative consequences. Solutions to reduce addiction-related stigma are mentioned including providing greater interpersonal exposure to persons recovering from addiction, corrective information education, altering the language used to describe and classify persons who have suffered from addiction, and possibly viewing addiction vulnerability as an example of neurodiversity, as opposed to a character flaw or a disease. Suggestions for future research on reducing addiction-related stigma are suggested.

It's not just the money: The role of treatment ideology in publicly funded substance use disorder treatment

Medications for opioid use disorder (MOUD) are a first-line treatment for opioid use disorder, yet national surveys indicate that most substance use treatment facilities do not offer MOUD. This article presents the results of a qualitative analysis of interviews with leaders from 25 treatment organizations in Philadelphia, Pennsylvania, that investigated attitudes and barriers toward MOUD. Most treatment organizations that we interviewed are adopting at least one MOUD, suggesting that Philadelphia exceeds the national average of organizations with MOUD capacity. Leaders indicated that both practical resources and ideological barriers thwart adoption and implementation of MOUD in publicly funded substance use disorder treatment agencies. Organizations that had recently adopted MOUDs revealed facilitators to MOUD adoption, such as strong leadership that champions the implementation to staff and redefining recovery from substance use disorders throughout the organization. This study's findings highlight that clients, clinicians, and leadership need to address both practical and ideological barriers to expanding MOUD use.