Using Positive Empathy Interventions to Reduce Stigma Toward People Who Inject Drugs

"Politics Versus Policy": Qualitative Insights on Stigma and Overdose Prevention Center Policymaking in the United States

BACKGROUND

Federal, state, and municipal governments in the United States have been reluctant to authorize overdose prevention centers (OPCs), which are evidence-based approaches for preventing overdose deaths and blood-borne pathogen transmission.

METHODS

From July 2022 to February 2023, we explored how stigma manifests in OPC policymaking by conducting in-depth interviews with 17 advocates, legislators, service providers, and researchers involved with OPC advocacy and policymaking in Rhode Island, California, Pennsylvania, and New York.

RESULTS

We found that although jurisdictions differed in their OPC policymaking experiences, stigma manifested throughout the process, from planning to authorization. Participants described OPCs as a tool for destigmatizing overdose and substance use, yet confronted institutionalized stigma and discriminatory attitudes toward people who use drugs (PWUD) and harm reduction from multiple sources (eg, politicians, media, and members of the public). Opposition toward OPCs and harm reduction approaches more broadly intersected with public discourse on crime, homelessness, and public disorder. Employed stigma-mitigation strategies included humanizing PWUD, publicizing the benefits of OPCs to the wider community, and strategically engaging media.

CONCLUSION

These findings illustrate the importance of understanding stigma at different stages of the policymaking process to better facilitate authorization and eventual implementation of OPCs in the United States.

Does social empathy moderate fear-induced minority blaming during the COVID-19 pandemic?

This study investigated the minority-blaming phenomenon in South Korea during the COVID-19 pandemic. The pandemic amplified fear, discrimination, and structural inequalities among minoritized groups during the COVID-19 pandemic. This study identified who was blamed for the spread of COVID-19 and the sociodemographic characteristics associated with this blame. Additionally, it examines the roles of individual and interpersonal fear and social empathy in minority blaming. We measured the fear of COVID-19 at both individual and interpersonal levels. Individual fear was assessed through personal health concerns, while the fear of transmitting the virus to others was measured as interpersonal fear. Social empathy was defined by macro perspective-taking, cognitive empathy, self-other awareness, and affective responses. The study was conducted through an online survey involving a quota sample of 1,500 South Korean participants aged 19-69 years, based on age, gender, and residential area. The response was collected in December 2020, when mass infections in specific communities received attention from mass and social media before the national spread of the COVID-19 pandemic. Analytical strategies, including OLS and hierarchical regression models, were employed to examine the roles of socioeconomic factors, individual and interpersonal fear, and social empathy in minority blaming. This study found varying correlations between sociodemographic factors and attitudes toward ethnic, religious, sexual, economic, and age-minority groups. Individual fear of contracting COVID-19 was associated with increased blame across all minority groups. In contrast, interpersonal fear was associated with increased blame only for ethnic and religious minority groups. Similarly, social empathy presented mixed associations, as it displayed a buffering role on blaming ethnic, religious, and sexual minorities when considered alongside interpersonal fear, yet mildly intensified blame for economic and age minorities. These findings provide an understanding on fear-induced minority blaming during the pandemic and the potential role of social empathy in mitigating blame.

Psychiatrists’ occupational stigma conceptualization, measurement, and intervention: A literature review

Psychiatrists require frequent contact with and treatment of patients with mental illnesses. Due to the influence of associative stigma, psychiatrists may also be targets of stigma. Occupational stigma warrants special consideration because it significantly affects psychiatrists' career advancement, well-being, and their patients’ health. Given that there is no complete summary of this issue, this study reviewed the existing literature on psychiatrists' occupational stigma to clearly synthesize its concepts, measurement tools, and intervention strategies. Herein, we emphasize that psychiatrists’ occupational stigma is a multifaceted concept that simultaneously encompasses physically, socially, and morally tainted aspects. Currently, standardized methods to specifically measure psychiatrists’ occupational stigma are lacking. Interventions for psychiatrists’ occupational stigma may consider the use of protest, contact, education, comprehensive and systematic methods, as well as the use of psychotherapeutic approaches. This review provides a theoretical basis for the development of relevant measurement tools and intervention practices. Overall, this review seeks to raise public awareness of psychiatrists' occupational stigma, thereby promoting psychiatric professionalism and reducing its stigma.

Medical cannabis and stigma: A qualitative study with patients living with chronic pain

AIMS AND OBJECTIVES

To explore the ways in which stigma is experienced, and what strategies are used to manage stigma among patients using medical cannabis to ease suffering from chronic pain.

BACKGROUND

Various jurisdictions have legalised medical cannabis in recent decades. Despite increasing prevalence and more liberal attitudes towards medical cannabis, it is possible that patients who use medical cannabis experience stigma.

DESIGN

A phenomenological qualitative study.

METHODS

Fifteen patients living with chronic pain and licensed by the Israeli Ministry of Health to use medical cannabis to treat pain symptoms for at least 1 year participated in semi-structured interviews. Transcribed data were analysed using thematic analysis to identify themes related to stigma. The manuscript is in correspondence to SRQR EQUATOR checklist.

RESULTS

Expressions of stigma were more related to 'felt' than 'enacted' stigma. Stigma related to decisions to delay onset of medical cannabis treatment and the ways in which participants managed medical cannabis use during their everyday lives. Participants dissociated themselves from recreational cannabis users, by presenting themselves as responsible normative individuals and engaging in a form of normalisation known as 'normification', emphasising their own discrete and controlled medical cannabis use and cannabis' benefits.

CONCLUSIONS

Patients experienced 'felt' stigma which had consequences for their self-presentations and medical cannabis use. This suggests that medical cannabis is not normalised in Israel and interventions may be needed to handle stigma related to medical cannabis.

RELEVANCE TO CLINICAL PRACTICE

The findings emphasise the effects of 'felt' stigma on patients. Aiming to increase the effectiveness of medical cannabis treatment and reducing harms, we suggest that particular focus should be placed on managing stigma at the intrapersonal level. In addition, there may be a need to address stigma at the societal level including social interactions with friends, family and medical personnel.

Reducing Public Stigma Towards Psychosis: A Conceptual Framework for Understanding the Effects of Social Contact Based Brief Video Interventions

BACKGROUND AND HYPOTHESIS

Public stigma reduces treatment-seeking and increases the duration of untreated psychosis among young people with psychosis. Social contact-based video interventions have been shown to be effective at reducing stigma; however, more research is needed regarding very brief interventions less than 2 minutes long, which are suitable for social media platforms and particularly relevant for young adults. We recently conducted three randomized control trials and demonstrated the efficacy of such videos to reduce stigma toward individuals with psychosis among young adults of the general public. However, it is unclear what elements contributed to the effectiveness of these very brief interventions.

STUDY DESIGN

The present article proposes a conceptual framework to discern what elements contributed to the efficacy of these interventions. We first review the existing literature describing social contact-based interventions and how they impact the cognitions, emotions, and behaviors of participants.

STUDY RESULTS

Then, using this lens, we suggest an alternate observation of the data from our studies by examining changes in stigmatizing views across time, rather than utilizing mean scores and conceptualizing how key characteristics of our interventions helped reduce stigma. We also highlight future research directions, including the need to look at mediators and moderators of change and the need to examine behavioral outcomes.

STUDY CONCLUSIONS

By hypothesizing how these interventions are proposed to work, this framework is intended to provide a roadmap for further development of brief video-based interventions to reduce stigma.

Adaptación y validación de la Escala Disposicional de Empatía Positiva a población adolescente argentina

La empatía positiva implica una expresión de felicidad o alegría, la cual es resultado de comprender la condición emocionalpositiva de otra persona y compartirla. El objetivo de esta investigación fue evaluar las propiedades psicométricas de laadaptación de la Escala Disposicional de Empatía Positiva (Dispositional Positive Empathy Scale) en población adolescenteargentina. El instrumento sobre el cual se realizó la adaptación está compuesto por siete ítems, originalmente en idiomainglés. La muestra (n = 303) estuvo conformada por 95 varones (31%) y 208 mujeres (69%), con edades entre 11 y 17 años,estudiantes de secundaria. Se estudió la validez de constructo realizando un análisis factorial confirmatorio y la invariancia de la escala en relación con el sexo y edad de los participantes. Se comprobó la validez convergente con la conducta prosocial hacia diversos objetivos, las diferencias de los niveles de empatía positiva entre los sexos y en distintos grupos de edad y los niveles de fiabilidad (Ω = .78). Los resultados indican que la escala es unidimensional, coincidiendo con la versión original. Se encontró un buen ajuste del modelo a los datos (cfi = .98; tli = .96; nnfi = .96; nfi = .95; rmsea = .05). El modelo permaneció constante en ambos sexos y grupos de edades. La empatía positiva se relacionó con la prosocialidad y se encontraron diferencias según sexo y edades. Los hallazgos dan cuenta de que las características psicométricas de la adaptación de la Escala Disposicional de Empatía Positiva a población adolescente argentina son satisfactorias.

Perceived stigma, barriers, and facilitators experienced by members of the opioid use disorder community when seeking healthcare

INTRODUCTION

Healthcare professionals, particularly nurses, have negative attitudes towards individuals with opioid use disorder (OUD) and these attitudes can contribute to suboptimal care. The aim of this study was to identify stigma, barriers and facilitators experienced by members of the OUD community when interacting with the healthcare system.

DESIGN

A qualitative exploratory design used semi-structured focus group interviews to address the study aim.

METHODS

Following IRB approval, purposive sampling was used to recruit participants with a history of OUD, family caregivers of individuals with OUD, and support group leaders from regional recovery groups to provide a broad perspective of stigmatizing issues and barriers to care. Focus group discussions were conducted, and video recorded using web-based conferencing software. Transcripts from the focus groups and field notes were analyzed and coded into themes.

RESULTS

Both structural and social determinants of health were identified by participants as stigmatizing and/or barriers to care. Thematic content analysis resulted in eight themes: stigmatizing language, being labeled, inequitable care, OUD as a chronic illness, insurance barriers, stigma associated with medications for OUD (MOUD), community resources, and nursing knowledge and care.

CONCLUSION

Members of the OUD community are challenged by both internal and external stigma when seeking healthcare. Stigma negatively affects public support for allocation of resources to treat OUD. Interventions aimed at reducing stigma are critical to support effective OUD treatment and prevent barriers to OUD care.

CLINICAL RELEVANCE

Understanding the complex relationships between stigma and structural determinants of health will allow nursing science to develop educational interventions that provide the next generation of nurses with the knowledge, skills, and attitudes needed to advance health equity for individuals with OUD.

Exploring the question of financial incentives for training amongst non-adopters of MOUD in rural primary care

BACKGROUND

Medication for opioid use disorder (MOUD) includes administering medications such as buprenorphine or methadone, often with mental health services. MOUD has been shown to significantly improve outcomes and success of recovery from opioid use disorder. In WV, only 18% of providers including physicians, physician assistants, and nurse practitioners are waivered, and 44% of non-waivered providers were not interested in free training even if compensated. This exploratory research seeks to understand intervention-related stigma in community-based primary care providers in rural West Virginia, determine whether financial incentives for training may be linked to levels of stigma, and what level of financial incentives would be required for non-adopters of MOUD services provision to obtain training.

METHOD

Survey questions were included in the West Virginia Practice-Based Research Network (WVPBRN) annual Collective Outreach & Research Engagement (CORE) Survey and delivered electronically to each practice site in WV. General demographic, staff attitudes and views on compensation for immersion training for delivering MOUD therapy in primary care offices were returned. Statistical analysis included logistic and multinomial logistic regression and an independent samples t-test.

RESULTS

Data were collected from 102 participants. Perceived stigma did significantly predict having a waiver with every 1-unit increase in stigma being associated with a 65% decreased odds of possessing a waiver for buprenorphine/MOUD (OR = 0.35; 95% CI  0.16-0.78, p = 0.01). Further, t-test analyses suggested there was a statistically significant mean difference in perceived stigma (t(100) = 2.78, p = 0.006) with those possessing a waiver (M = 1.56; SD = 0.51) having a significantly lower perceived stigma than those without a waiver (M = 1.92; SD = 0.57). There was no statistically significant association of stigma on whether someone with a waiver actually prescribed MOUD or not (OR = 0.28; 95% CI  0.04-2.27, p = 0.234).

CONCLUSION

This survey of rural primary care providers demonstrates that stigmatizing beliefs related to MOUD impact the desired financial incentive to complete a one-day immersion, and that currently unwaivered providers endorse more stigmatizing beliefs about MOUD when compared to currently waivered providers. Furthermore, providers who endorse stigmatizing beliefs with respect to MOUD require higher levels of compensation to consider such training.