Encountering stigma in clinical settings is an obstacle to care for individuals with opioid use disorder, delaying help-seeking and resulting in suboptimal treatment. This study tested different approaches to a visual messaging campaign – both with and without personal narratives from a patient, clinician, or healthcare administrator – in reducing stigma among healthcare providers.
l
National drug overdose mortality rates have surged to over 100,000 annually in recent years, with opioids implicated in about 3 out of every 4 of these deaths. While FDA-approved medications for opioid use disorder, such as methadone and buprenorphine, are available, stigma remains a significant barrier to their adoption. Many individuals with opioid use disorder are hesitant to seek out treatment due to fears of discrimination, and stigma perpetuated by healthcare professionals further contributes to suboptimal care (e.g., less interest in prescribing opioid use disorder medications).
Research has shown that the language used to describe substance-related conditions shapes beliefs and attitudes about their causes and potential solutions. Exposure to stigmatizing terminology (e.g., “substance abuser”) is associated with greater support for punitive responses to opioid use disorder, rather than treatment-focused approaches. Yet, the use of stigmatizing language remains common in clinical settings. Efforts to reduce the use of stigmatizing language and enhance healthcare providers’ understanding of the effectiveness and utilization of opioid use disorder medications are critically needed. Educational initiatives and health communication campaigns implemented in clinical settings may help to achieve this goal.
Healthcare professionals are frequently exposed to messaging from various sources, including patients, colleagues (i.e., other clinicians), and healthcare administrators. However, the extent to which the source of a message influences its impact on reducing clinicians’ stigma toward individuals with opioid use disorder remains unclear.
Identifying which messengers are most effective could inform efforts to design stigma reduction campaigns. For example, healthcare professionals may relate more to messages from other healthcare professionals, as perceived similarity with narrative characters is linked to higher engagement. Conversely, messages delivered by patients with opioid use disorder may elicit greater empathy in healthcare professionals. This study tested different stigma-reduction message frames – focused on either the use of non-stigmatizing language in clinical settings or the effectiveness of opioid use disorder medications – and various message sources (a patient with opioid use disorder, healthcare provider, healthcare administrator) for reducing stigmatizing attitudes toward individuals with opioid use disorder among healthcare providers.
This randomized clinical trial included a national sample of 1842 US healthcare professionals recruited through online survey panels. The sample was 47 years old, on average, and predominantly female (72%) and non-Hispanic White (73%), with nurses (27%) and physicians (25%) representing the largest healthcare professional subgroups.
Participants were randomly assigned to 1 of 8 exposure groups or a no exposure control group (9 possible conditions in total; see table below), with approximately 200 participants in each group. Each experimental group was exposed to 1 of 2 possible message themes:
1) Words matter – emphasized the importance of using non-stigmatizing language, or
2) Medication treatment works – highlighted the effectiveness of FDA-approved medications for opioid use disorder treatment
Each experimental group was exposed to a visual messaging campaign alone or a visual messaging campaign combined with a narrative vignette delivered from the perspective of either a patient with opioid use disorder, clinician, or healthcare administrator. Thus, each participant in an experimental group was exposed to 1 of 4 conditions (visual campaign only, visual + patient vignette, visual + clinician vignette, or visual + administrator vignette) for one of two message themes (words matter or medication treatment works). See figure below for more details.
Primary outcomes were assessed via an online survey administered immediately after participants were exposed to the stigma-reduction messages and measured stigma toward people with opioid use disorder, such as preferences for social distance from people with opioid use disorder (e.g., “Willingness to have a person with opioid use disorder marry into your family”), blame attributions (e.g., “Individuals with opioid use disorder have only themselves to blame for their problem”), and support for government spending on opioid use disorder (e.g., “Favor for increasing government spending on treatment for opioid use disorder”). Control group participants answered the same questions but without any exposure to stigma-reduction messaging prior to the assessment. Participants responded to these items using a 5-point Likert scale to indicate their level of agreement or disagreement with each statement. Participants also rated the level of warmth they felt toward people with opioid use disorder on a 0-100 scale. Participants assigned to 1 of the 4 words matter message theme groups were also presented with items asking them to evaluate the level of appropriateness for using various opioid use disorder-related terms in clinical settings. Terms included stigmatizing language (e.g., “addict”) and recommended alternatives (e.g., “person with substance use disorder”). They were also asked if they would be willing to sign a pledge committing to the use non-stigmatizing language. Participants in the 4 medication treatment works message theme groups answered questions related to their perceptions of opioid use disorder medication treatment (e.g., effectiveness, social distance from people using opioid use disorder medication). For the analysis, the researchers compared stigma levels between the experimental groups and the no-exposure control group to determine which messaging strategies were more or less effective in reducing stigma.
Adding a personal narrative from a patient with opioid use disorder enhanced campaign effectiveness
Participants exposed to the words matter or medication treatment work visual campaigns alone did not have significant reductions in stigmatizing attitudes and beliefs relative to the control group. However, those exposed to the combined words matter visual campaign and opioid use disorder patient vignette reported significantly lower levels of unwillingness to have a person with opioid use disorder marry into the family (see figure below) and higher levels of warmth toward people with opioid use disorder relative to those in the control.
Similarly, exposure to the medication treatment works visual campaign paired with the opioid use disorder patient vignette was associated with reduced social distance from people with opioid use disorder, including both lower levels of unwillingness to have a person with opioid use disorder marry into the family (see figure below) and to have a person with opioid use disorder as a neighbor, along with higher warmth rating compared to controls.
Notably, adding the opioid use disorder patient vignette to the visual campaigns for both message themes produced significantly greater reductions in stigma compared to the visual campaigns alone. Additionally, combining the visual campaigns with a healthcare administrator vignette resulted in higher warmth ratings toward individuals with opioid use disorder compared to controls. However, adding clinician vignettes to the visual campaigns provided no additional benefit for either type of message theme.
Exposure to the words matter campaign combined with vignettes reduced endorsement of stigmatizing language
Compared to the control group, the words matter visual campaign combined with patient vignette group was less likely to endorse several stigmatizing opioid use disorder-related terms, such as “addict,” “substance abuse,” “dirty,” and “clean,” as being appropriate for use in clinical settings. Similarly, those assigned to the words matter visual campaign combined with either the clinician vignette or healthcare administrator vignette also had lower levels of endorsed stigmatizing terminology. The combination of the words matter visual campaign and narrative vignettes resulted in greater awareness of stigmatizing language compared to the visual campaign alone. However, relative to the no exposure control group, none of the conditions increased willingness to sign a pledge committing to the use non-stigmatizing language in clinical settings.
Narratives emphasizing medication effectiveness had limited impact on attitudes specifically toward those taking medications
Exposure to the medication treatment works visual campaign paired with either the opioid use disorder patient vignette or the healthcare administrator vignette, but not the clinician vignette, was associated with significantly higher feelings of warmth toward individuals receiving medication to treat opioid use disorder. However, unlike the increases in positive attitudes it produced toward those with opioid use disorder more generally (see Figures above), the medication treatment works message frames did not shift other stigma-related outcomes, such as social distance from people receiving medication to treat opioid use disorder, compared to the control group. Descriptively, the control group (measuring attitudes in the absence of any intervention) had more positive attitudes toward those taking medication than toward those with opioid use disorder more generally (e.g., 71 vs. 41% regarding unwillingness for someone to marry into family and 45 vs. 21% for unwillingness to have someone as a neighbor).
This randomized clinical trial tested the effectiveness of different message themes and sources for reducing stigma toward individuals with opioid use disorder among a large, national sample of US healthcare professionals. The study assessed the effects of 2 message themes (words matter and medication treatment works) delivered through visual campaigns alone or in combination with text-based narrative vignettes from 3 perspectives: patients with opioid use disorder, clinicians, or healthcare administrators.
Findings suggest that standalone visual campaigns have limited impact on reducing healthcare provider stigma directed at individuals with opioid use disorder. However, combining visual campaigns with first-person narratives, especially for those from patients with lived experiences of opioid use disorder and recovery, was more effective in reducing stigmatizing attitudes. This finding aligns with prior research based on the narrative engagement framework, which highlights that health communication messages addressing substance use are more engaging and effective when delivered through first-person narratives. Prior research has also shown that first-person accounts of substance use disorder recovery are prevalent on social media platforms (e.g., TikTok), where individuals share their lived experience and offer encouragement to others. However, little is known about the reach of these messages on social media platforms with hundreds of millions of users and their potential impact on reducing stigma among broader audiences.
While combining visual elements with narrative vignettes in stigma-reduction messaging effectively increased recognition of stigmatizing opioid use disorder-related terminology (e.g., “addict”) as inappropriate in clinical settings, it did not lead to immediate changes in behavioral intentions. For instance, none of the experimental exposures significantly increased participants’ willingness to sign a pledge committing to the use of non-stigmatizing language over the control condition. Similarly, the medication treatment works message framing had limited impact on reducing stigmatizing beliefs and attitudes toward those taking medications, such as social distance toward individuals receiving medication for opioid use disorder or support for policies to improve access to medications for opioid use disorder. That said, the more positive attitudes toward those taking medications for opioid use disorder versus those with opioid use disorder more generally, supports prior research showing the portraying a substance use disorder as treatable helps to reduce stigma. It is possible that there was simply not as much room to improve on these comparatively more positive attitudes toward those taking medications with a stigma reduction campaign.
These findings underscore that while combining visual campaigns with narrative vignettes to encourage the use of non-stigmatizing language or highlight the effectiveness of medication can address some dimensions of stigma, more comprehensive strategies are necessary – particularly those that focus on changing healthcare providers’ behaviors, not just their knowledge and attitudes. Scaling effective stigma-reduction communication campaigns across diverse clinical settings could foster greater willingness among healthcare providers to treat individuals with opioid use disorder, including through the use of empirically-supported medications. This, in turn, could reduce barriers to care and improve treatment quality for those affected by opioid use disorder.
This randomized study tested various messaging strategies on the reduction of stigmatizing attitudes toward individuals with opioid use disorder among healthcare professionals. Findings indicate that standalone visual campaigns had limited impact on reducing healthcare provider stigma. However, when visual campaigns were paired with first-person narratives – particularly those from patients with lived experiences of opioid use disorder and recovery – messaging was more effective in reducing stigmatizing attitudes. Yet, narratives focused on the effectiveness of opioid use disorder medications had limited impact. These results highlight that while combining visual campaigns with narrative vignettes show promise in reducing healthcare professional stigma, more comprehensive strategies are needed to combat the persistent stigma toward individuals with opioid use disorder within the medical field.
Kennedy-Hendricks, A., McGinty, E. E., Summers, A., Krenn, S., Fingerhood, M. I., & Barry, C. L. (2022). Effect of exposure to visual campaigns and narrative vignettes on addiction stigma among health care professionals: A randomized clinical trial. JAMA Network Open, 5(2). doi: 10.1001/jamanetworkopen.2021.46971.
l
National drug overdose mortality rates have surged to over 100,000 annually in recent years, with opioids implicated in about 3 out of every 4 of these deaths. While FDA-approved medications for opioid use disorder, such as methadone and buprenorphine, are available, stigma remains a significant barrier to their adoption. Many individuals with opioid use disorder are hesitant to seek out treatment due to fears of discrimination, and stigma perpetuated by healthcare professionals further contributes to suboptimal care (e.g., less interest in prescribing opioid use disorder medications).
Research has shown that the language used to describe substance-related conditions shapes beliefs and attitudes about their causes and potential solutions. Exposure to stigmatizing terminology (e.g., “substance abuser”) is associated with greater support for punitive responses to opioid use disorder, rather than treatment-focused approaches. Yet, the use of stigmatizing language remains common in clinical settings. Efforts to reduce the use of stigmatizing language and enhance healthcare providers’ understanding of the effectiveness and utilization of opioid use disorder medications are critically needed. Educational initiatives and health communication campaigns implemented in clinical settings may help to achieve this goal.
Healthcare professionals are frequently exposed to messaging from various sources, including patients, colleagues (i.e., other clinicians), and healthcare administrators. However, the extent to which the source of a message influences its impact on reducing clinicians’ stigma toward individuals with opioid use disorder remains unclear.
Identifying which messengers are most effective could inform efforts to design stigma reduction campaigns. For example, healthcare professionals may relate more to messages from other healthcare professionals, as perceived similarity with narrative characters is linked to higher engagement. Conversely, messages delivered by patients with opioid use disorder may elicit greater empathy in healthcare professionals. This study tested different stigma-reduction message frames – focused on either the use of non-stigmatizing language in clinical settings or the effectiveness of opioid use disorder medications – and various message sources (a patient with opioid use disorder, healthcare provider, healthcare administrator) for reducing stigmatizing attitudes toward individuals with opioid use disorder among healthcare providers.
This randomized clinical trial included a national sample of 1842 US healthcare professionals recruited through online survey panels. The sample was 47 years old, on average, and predominantly female (72%) and non-Hispanic White (73%), with nurses (27%) and physicians (25%) representing the largest healthcare professional subgroups.
Participants were randomly assigned to 1 of 8 exposure groups or a no exposure control group (9 possible conditions in total; see table below), with approximately 200 participants in each group. Each experimental group was exposed to 1 of 2 possible message themes:
1) Words matter – emphasized the importance of using non-stigmatizing language, or
2) Medication treatment works – highlighted the effectiveness of FDA-approved medications for opioid use disorder treatment
Each experimental group was exposed to a visual messaging campaign alone or a visual messaging campaign combined with a narrative vignette delivered from the perspective of either a patient with opioid use disorder, clinician, or healthcare administrator. Thus, each participant in an experimental group was exposed to 1 of 4 conditions (visual campaign only, visual + patient vignette, visual + clinician vignette, or visual + administrator vignette) for one of two message themes (words matter or medication treatment works). See figure below for more details.
Primary outcomes were assessed via an online survey administered immediately after participants were exposed to the stigma-reduction messages and measured stigma toward people with opioid use disorder, such as preferences for social distance from people with opioid use disorder (e.g., “Willingness to have a person with opioid use disorder marry into your family”), blame attributions (e.g., “Individuals with opioid use disorder have only themselves to blame for their problem”), and support for government spending on opioid use disorder (e.g., “Favor for increasing government spending on treatment for opioid use disorder”). Control group participants answered the same questions but without any exposure to stigma-reduction messaging prior to the assessment. Participants responded to these items using a 5-point Likert scale to indicate their level of agreement or disagreement with each statement. Participants also rated the level of warmth they felt toward people with opioid use disorder on a 0-100 scale. Participants assigned to 1 of the 4 words matter message theme groups were also presented with items asking them to evaluate the level of appropriateness for using various opioid use disorder-related terms in clinical settings. Terms included stigmatizing language (e.g., “addict”) and recommended alternatives (e.g., “person with substance use disorder”). They were also asked if they would be willing to sign a pledge committing to the use non-stigmatizing language. Participants in the 4 medication treatment works message theme groups answered questions related to their perceptions of opioid use disorder medication treatment (e.g., effectiveness, social distance from people using opioid use disorder medication). For the analysis, the researchers compared stigma levels between the experimental groups and the no-exposure control group to determine which messaging strategies were more or less effective in reducing stigma.
Adding a personal narrative from a patient with opioid use disorder enhanced campaign effectiveness
Participants exposed to the words matter or medication treatment work visual campaigns alone did not have significant reductions in stigmatizing attitudes and beliefs relative to the control group. However, those exposed to the combined words matter visual campaign and opioid use disorder patient vignette reported significantly lower levels of unwillingness to have a person with opioid use disorder marry into the family (see figure below) and higher levels of warmth toward people with opioid use disorder relative to those in the control.
Similarly, exposure to the medication treatment works visual campaign paired with the opioid use disorder patient vignette was associated with reduced social distance from people with opioid use disorder, including both lower levels of unwillingness to have a person with opioid use disorder marry into the family (see figure below) and to have a person with opioid use disorder as a neighbor, along with higher warmth rating compared to controls.
Notably, adding the opioid use disorder patient vignette to the visual campaigns for both message themes produced significantly greater reductions in stigma compared to the visual campaigns alone. Additionally, combining the visual campaigns with a healthcare administrator vignette resulted in higher warmth ratings toward individuals with opioid use disorder compared to controls. However, adding clinician vignettes to the visual campaigns provided no additional benefit for either type of message theme.
Exposure to the words matter campaign combined with vignettes reduced endorsement of stigmatizing language
Compared to the control group, the words matter visual campaign combined with patient vignette group was less likely to endorse several stigmatizing opioid use disorder-related terms, such as “addict,” “substance abuse,” “dirty,” and “clean,” as being appropriate for use in clinical settings. Similarly, those assigned to the words matter visual campaign combined with either the clinician vignette or healthcare administrator vignette also had lower levels of endorsed stigmatizing terminology. The combination of the words matter visual campaign and narrative vignettes resulted in greater awareness of stigmatizing language compared to the visual campaign alone. However, relative to the no exposure control group, none of the conditions increased willingness to sign a pledge committing to the use non-stigmatizing language in clinical settings.
Narratives emphasizing medication effectiveness had limited impact on attitudes specifically toward those taking medications
Exposure to the medication treatment works visual campaign paired with either the opioid use disorder patient vignette or the healthcare administrator vignette, but not the clinician vignette, was associated with significantly higher feelings of warmth toward individuals receiving medication to treat opioid use disorder. However, unlike the increases in positive attitudes it produced toward those with opioid use disorder more generally (see Figures above), the medication treatment works message frames did not shift other stigma-related outcomes, such as social distance from people receiving medication to treat opioid use disorder, compared to the control group. Descriptively, the control group (measuring attitudes in the absence of any intervention) had more positive attitudes toward those taking medication than toward those with opioid use disorder more generally (e.g., 71 vs. 41% regarding unwillingness for someone to marry into family and 45 vs. 21% for unwillingness to have someone as a neighbor).
This randomized clinical trial tested the effectiveness of different message themes and sources for reducing stigma toward individuals with opioid use disorder among a large, national sample of US healthcare professionals. The study assessed the effects of 2 message themes (words matter and medication treatment works) delivered through visual campaigns alone or in combination with text-based narrative vignettes from 3 perspectives: patients with opioid use disorder, clinicians, or healthcare administrators.
Findings suggest that standalone visual campaigns have limited impact on reducing healthcare provider stigma directed at individuals with opioid use disorder. However, combining visual campaigns with first-person narratives, especially for those from patients with lived experiences of opioid use disorder and recovery, was more effective in reducing stigmatizing attitudes. This finding aligns with prior research based on the narrative engagement framework, which highlights that health communication messages addressing substance use are more engaging and effective when delivered through first-person narratives. Prior research has also shown that first-person accounts of substance use disorder recovery are prevalent on social media platforms (e.g., TikTok), where individuals share their lived experience and offer encouragement to others. However, little is known about the reach of these messages on social media platforms with hundreds of millions of users and their potential impact on reducing stigma among broader audiences.
While combining visual elements with narrative vignettes in stigma-reduction messaging effectively increased recognition of stigmatizing opioid use disorder-related terminology (e.g., “addict”) as inappropriate in clinical settings, it did not lead to immediate changes in behavioral intentions. For instance, none of the experimental exposures significantly increased participants’ willingness to sign a pledge committing to the use of non-stigmatizing language over the control condition. Similarly, the medication treatment works message framing had limited impact on reducing stigmatizing beliefs and attitudes toward those taking medications, such as social distance toward individuals receiving medication for opioid use disorder or support for policies to improve access to medications for opioid use disorder. That said, the more positive attitudes toward those taking medications for opioid use disorder versus those with opioid use disorder more generally, supports prior research showing the portraying a substance use disorder as treatable helps to reduce stigma. It is possible that there was simply not as much room to improve on these comparatively more positive attitudes toward those taking medications with a stigma reduction campaign.
These findings underscore that while combining visual campaigns with narrative vignettes to encourage the use of non-stigmatizing language or highlight the effectiveness of medication can address some dimensions of stigma, more comprehensive strategies are necessary – particularly those that focus on changing healthcare providers’ behaviors, not just their knowledge and attitudes. Scaling effective stigma-reduction communication campaigns across diverse clinical settings could foster greater willingness among healthcare providers to treat individuals with opioid use disorder, including through the use of empirically-supported medications. This, in turn, could reduce barriers to care and improve treatment quality for those affected by opioid use disorder.
This randomized study tested various messaging strategies on the reduction of stigmatizing attitudes toward individuals with opioid use disorder among healthcare professionals. Findings indicate that standalone visual campaigns had limited impact on reducing healthcare provider stigma. However, when visual campaigns were paired with first-person narratives – particularly those from patients with lived experiences of opioid use disorder and recovery – messaging was more effective in reducing stigmatizing attitudes. Yet, narratives focused on the effectiveness of opioid use disorder medications had limited impact. These results highlight that while combining visual campaigns with narrative vignettes show promise in reducing healthcare professional stigma, more comprehensive strategies are needed to combat the persistent stigma toward individuals with opioid use disorder within the medical field.
Kennedy-Hendricks, A., McGinty, E. E., Summers, A., Krenn, S., Fingerhood, M. I., & Barry, C. L. (2022). Effect of exposure to visual campaigns and narrative vignettes on addiction stigma among health care professionals: A randomized clinical trial. JAMA Network Open, 5(2). doi: 10.1001/jamanetworkopen.2021.46971.
l
National drug overdose mortality rates have surged to over 100,000 annually in recent years, with opioids implicated in about 3 out of every 4 of these deaths. While FDA-approved medications for opioid use disorder, such as methadone and buprenorphine, are available, stigma remains a significant barrier to their adoption. Many individuals with opioid use disorder are hesitant to seek out treatment due to fears of discrimination, and stigma perpetuated by healthcare professionals further contributes to suboptimal care (e.g., less interest in prescribing opioid use disorder medications).
Research has shown that the language used to describe substance-related conditions shapes beliefs and attitudes about their causes and potential solutions. Exposure to stigmatizing terminology (e.g., “substance abuser”) is associated with greater support for punitive responses to opioid use disorder, rather than treatment-focused approaches. Yet, the use of stigmatizing language remains common in clinical settings. Efforts to reduce the use of stigmatizing language and enhance healthcare providers’ understanding of the effectiveness and utilization of opioid use disorder medications are critically needed. Educational initiatives and health communication campaigns implemented in clinical settings may help to achieve this goal.
Healthcare professionals are frequently exposed to messaging from various sources, including patients, colleagues (i.e., other clinicians), and healthcare administrators. However, the extent to which the source of a message influences its impact on reducing clinicians’ stigma toward individuals with opioid use disorder remains unclear.
Identifying which messengers are most effective could inform efforts to design stigma reduction campaigns. For example, healthcare professionals may relate more to messages from other healthcare professionals, as perceived similarity with narrative characters is linked to higher engagement. Conversely, messages delivered by patients with opioid use disorder may elicit greater empathy in healthcare professionals. This study tested different stigma-reduction message frames – focused on either the use of non-stigmatizing language in clinical settings or the effectiveness of opioid use disorder medications – and various message sources (a patient with opioid use disorder, healthcare provider, healthcare administrator) for reducing stigmatizing attitudes toward individuals with opioid use disorder among healthcare providers.
This randomized clinical trial included a national sample of 1842 US healthcare professionals recruited through online survey panels. The sample was 47 years old, on average, and predominantly female (72%) and non-Hispanic White (73%), with nurses (27%) and physicians (25%) representing the largest healthcare professional subgroups.
Participants were randomly assigned to 1 of 8 exposure groups or a no exposure control group (9 possible conditions in total; see table below), with approximately 200 participants in each group. Each experimental group was exposed to 1 of 2 possible message themes:
1) Words matter – emphasized the importance of using non-stigmatizing language, or
2) Medication treatment works – highlighted the effectiveness of FDA-approved medications for opioid use disorder treatment
Each experimental group was exposed to a visual messaging campaign alone or a visual messaging campaign combined with a narrative vignette delivered from the perspective of either a patient with opioid use disorder, clinician, or healthcare administrator. Thus, each participant in an experimental group was exposed to 1 of 4 conditions (visual campaign only, visual + patient vignette, visual + clinician vignette, or visual + administrator vignette) for one of two message themes (words matter or medication treatment works). See figure below for more details.
Primary outcomes were assessed via an online survey administered immediately after participants were exposed to the stigma-reduction messages and measured stigma toward people with opioid use disorder, such as preferences for social distance from people with opioid use disorder (e.g., “Willingness to have a person with opioid use disorder marry into your family”), blame attributions (e.g., “Individuals with opioid use disorder have only themselves to blame for their problem”), and support for government spending on opioid use disorder (e.g., “Favor for increasing government spending on treatment for opioid use disorder”). Control group participants answered the same questions but without any exposure to stigma-reduction messaging prior to the assessment. Participants responded to these items using a 5-point Likert scale to indicate their level of agreement or disagreement with each statement. Participants also rated the level of warmth they felt toward people with opioid use disorder on a 0-100 scale. Participants assigned to 1 of the 4 words matter message theme groups were also presented with items asking them to evaluate the level of appropriateness for using various opioid use disorder-related terms in clinical settings. Terms included stigmatizing language (e.g., “addict”) and recommended alternatives (e.g., “person with substance use disorder”). They were also asked if they would be willing to sign a pledge committing to the use non-stigmatizing language. Participants in the 4 medication treatment works message theme groups answered questions related to their perceptions of opioid use disorder medication treatment (e.g., effectiveness, social distance from people using opioid use disorder medication). For the analysis, the researchers compared stigma levels between the experimental groups and the no-exposure control group to determine which messaging strategies were more or less effective in reducing stigma.
Adding a personal narrative from a patient with opioid use disorder enhanced campaign effectiveness
Participants exposed to the words matter or medication treatment work visual campaigns alone did not have significant reductions in stigmatizing attitudes and beliefs relative to the control group. However, those exposed to the combined words matter visual campaign and opioid use disorder patient vignette reported significantly lower levels of unwillingness to have a person with opioid use disorder marry into the family (see figure below) and higher levels of warmth toward people with opioid use disorder relative to those in the control.
Similarly, exposure to the medication treatment works visual campaign paired with the opioid use disorder patient vignette was associated with reduced social distance from people with opioid use disorder, including both lower levels of unwillingness to have a person with opioid use disorder marry into the family (see figure below) and to have a person with opioid use disorder as a neighbor, along with higher warmth rating compared to controls.
Notably, adding the opioid use disorder patient vignette to the visual campaigns for both message themes produced significantly greater reductions in stigma compared to the visual campaigns alone. Additionally, combining the visual campaigns with a healthcare administrator vignette resulted in higher warmth ratings toward individuals with opioid use disorder compared to controls. However, adding clinician vignettes to the visual campaigns provided no additional benefit for either type of message theme.
Exposure to the words matter campaign combined with vignettes reduced endorsement of stigmatizing language
Compared to the control group, the words matter visual campaign combined with patient vignette group was less likely to endorse several stigmatizing opioid use disorder-related terms, such as “addict,” “substance abuse,” “dirty,” and “clean,” as being appropriate for use in clinical settings. Similarly, those assigned to the words matter visual campaign combined with either the clinician vignette or healthcare administrator vignette also had lower levels of endorsed stigmatizing terminology. The combination of the words matter visual campaign and narrative vignettes resulted in greater awareness of stigmatizing language compared to the visual campaign alone. However, relative to the no exposure control group, none of the conditions increased willingness to sign a pledge committing to the use non-stigmatizing language in clinical settings.
Narratives emphasizing medication effectiveness had limited impact on attitudes specifically toward those taking medications
Exposure to the medication treatment works visual campaign paired with either the opioid use disorder patient vignette or the healthcare administrator vignette, but not the clinician vignette, was associated with significantly higher feelings of warmth toward individuals receiving medication to treat opioid use disorder. However, unlike the increases in positive attitudes it produced toward those with opioid use disorder more generally (see Figures above), the medication treatment works message frames did not shift other stigma-related outcomes, such as social distance from people receiving medication to treat opioid use disorder, compared to the control group. Descriptively, the control group (measuring attitudes in the absence of any intervention) had more positive attitudes toward those taking medication than toward those with opioid use disorder more generally (e.g., 71 vs. 41% regarding unwillingness for someone to marry into family and 45 vs. 21% for unwillingness to have someone as a neighbor).
This randomized clinical trial tested the effectiveness of different message themes and sources for reducing stigma toward individuals with opioid use disorder among a large, national sample of US healthcare professionals. The study assessed the effects of 2 message themes (words matter and medication treatment works) delivered through visual campaigns alone or in combination with text-based narrative vignettes from 3 perspectives: patients with opioid use disorder, clinicians, or healthcare administrators.
Findings suggest that standalone visual campaigns have limited impact on reducing healthcare provider stigma directed at individuals with opioid use disorder. However, combining visual campaigns with first-person narratives, especially for those from patients with lived experiences of opioid use disorder and recovery, was more effective in reducing stigmatizing attitudes. This finding aligns with prior research based on the narrative engagement framework, which highlights that health communication messages addressing substance use are more engaging and effective when delivered through first-person narratives. Prior research has also shown that first-person accounts of substance use disorder recovery are prevalent on social media platforms (e.g., TikTok), where individuals share their lived experience and offer encouragement to others. However, little is known about the reach of these messages on social media platforms with hundreds of millions of users and their potential impact on reducing stigma among broader audiences.
While combining visual elements with narrative vignettes in stigma-reduction messaging effectively increased recognition of stigmatizing opioid use disorder-related terminology (e.g., “addict”) as inappropriate in clinical settings, it did not lead to immediate changes in behavioral intentions. For instance, none of the experimental exposures significantly increased participants’ willingness to sign a pledge committing to the use of non-stigmatizing language over the control condition. Similarly, the medication treatment works message framing had limited impact on reducing stigmatizing beliefs and attitudes toward those taking medications, such as social distance toward individuals receiving medication for opioid use disorder or support for policies to improve access to medications for opioid use disorder. That said, the more positive attitudes toward those taking medications for opioid use disorder versus those with opioid use disorder more generally, supports prior research showing the portraying a substance use disorder as treatable helps to reduce stigma. It is possible that there was simply not as much room to improve on these comparatively more positive attitudes toward those taking medications with a stigma reduction campaign.
These findings underscore that while combining visual campaigns with narrative vignettes to encourage the use of non-stigmatizing language or highlight the effectiveness of medication can address some dimensions of stigma, more comprehensive strategies are necessary – particularly those that focus on changing healthcare providers’ behaviors, not just their knowledge and attitudes. Scaling effective stigma-reduction communication campaigns across diverse clinical settings could foster greater willingness among healthcare providers to treat individuals with opioid use disorder, including through the use of empirically-supported medications. This, in turn, could reduce barriers to care and improve treatment quality for those affected by opioid use disorder.
This randomized study tested various messaging strategies on the reduction of stigmatizing attitudes toward individuals with opioid use disorder among healthcare professionals. Findings indicate that standalone visual campaigns had limited impact on reducing healthcare provider stigma. However, when visual campaigns were paired with first-person narratives – particularly those from patients with lived experiences of opioid use disorder and recovery – messaging was more effective in reducing stigmatizing attitudes. Yet, narratives focused on the effectiveness of opioid use disorder medications had limited impact. These results highlight that while combining visual campaigns with narrative vignettes show promise in reducing healthcare professional stigma, more comprehensive strategies are needed to combat the persistent stigma toward individuals with opioid use disorder within the medical field.
Kennedy-Hendricks, A., McGinty, E. E., Summers, A., Krenn, S., Fingerhood, M. I., & Barry, C. L. (2022). Effect of exposure to visual campaigns and narrative vignettes on addiction stigma among health care professionals: A randomized clinical trial. JAMA Network Open, 5(2). doi: 10.1001/jamanetworkopen.2021.46971.
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