From the 2021 HVPAA National Conference
Richard Bottner (Dell Medical School at The University of Texas at Austin), Kristin Escamilla, Clarissa Johnston, Christopher Moriates, Victoria Valencia
Background
Stigma generated and reinforced by healthcare practitioners results in shame, reduces access to care, and ultimately fuels the cycle of addiction for people with substance use disorders (SUD). Unfortunately, stigmatizing perceptions related to people with SUD are reinforced in medical education, revealing the “hidden curriculum” of negative bias against this vulnerable population. This approach continues into practice: only 20% of general internists report feeling prepared to screen individuals with SUD and 31% report that individuals with SUD differ from other patients with chronic disease. Stigma results in harm by promoting inaccurate ideologies of people who use drugs and creating policy barriers within institutions, legislation, and regulations. These stigma-mediated systemic challenges contribute to high-cost and poor-outcome approaches to treating addiction in the United States.
Objective
To create an asynchronous virtual experience for interprofessional learners and practicing healthcare professionals specific to reducing stigma of substance use disorders and people who use drugs.
Methods
In 2019, a group of multidisciplinary clinicians from the departments of Internal Medicine, Psychiatry, and Medical Education at Dell Medical School performed an in-depth literature review related to how stigma of OUD limits access to care. The group synthesized the literature into consumable educational content for interprofessional trainees and healthcare practitioners, including original video content of people with lived experience. The content was reviewed by a group of external subject matter experts from across the United States. The University of Texas Center for Health Communication applied evidence-based health communication principles to develop digital content. The interactive modules were built into edX, an open-source educational platform. The work was supported by a grant from the Association of American Medical Colleges.
Results
The Reducing Stigma Education Tools (ReSET) are two online-based modules totaling 90 minutes of educational content. Topics covered include the origins of stigma, comparison of OUD to other chronic medical conditions, and discussion of stigma within a health equity framework. The modules provide actionable items participants can use to reduce stigma including use of appropriate language and motivational interviewing. Continuing medical education credits were approved for physicians, nurses, pharmacists, and social workers. Pre- and post-tests were incorporated to assess changes in knowledge and attitude after participation. The modules launched on August 13, 2020 and the site has over 1,000 registered users since. They are freely available at www.ResetStigma.org.
Conclusions
ReSET is an off-the-shelf interactive resource that can provide widespread education on the impact of stigma and how to eliminate it.
Clinical Implications
To the best of our knowledge, there are currently few freely-available interactive tools to aid in destigmatizing people with substance use disorders and none of which are on a freely available open-source learning platform. In the absence of such education, stigma worsens and contributes to environments where many patients do not seek care until a medical condition is life-threatening, often resulting in complex and expensive hospitalizations. Therefore, reducing stigma may contribute to improved clinical outcomes and decreased costs related to caring for people with substance use disorders.
