Strategies to Reduce Addiction Stigma Among Health Professionals

Effect of Exposure to Visual Campaigns and Narrative Vignettes on Addiction Stigma Among Health Professionals: A Randomized Experiment

The aim of this study was to evaluate the effects of exposure to stigma reduction message frames communicated by visual campaigns and narrative vignettes among a national sample of health professionals.

Study Overview

• Status: Completed
• Conditions: Opioid Use Disorder; Substance Use Disorders; Stigma, Social
• Intervention / Treatment: Behavioral: Words Matter - Visual Campaign; Behavioral: Words Matter - Visual Campaign & Narrative Vignette (Messenger: Person with Opioid Use Disorder) Experimental: Words Matter - Visual Campaign & Narrative Vignette (Messenger: Clinician); Behavioral: Words Matter - Visual Campaign & Narrative Vignette (Messenger: Clinician); Behavioral: Words Matter - Visual Campaign & Narrative Vignette (Messenger: Health System Administrator); Behavioral: Medication Treatment for Opioid Use Disorder Works - Visual Campaign; Behavioral: Medication Treatment for Opioid Use Disorder Works - Visual Campaign & Narrative Vignette (Messenger: Person with Opioid Use Disorder); Behavioral: Medication Treatment for Opioid Use Disorder Works - Visual Campaign & Narrative Vignette (Messenger: Clinician); Behavioral: Medication Treatment for Opioid Use Disorder Works - Visual Campaign & Narrative Vignette (Messenger: Health System Administrator)

Detailed Description

This randomized experiment evaluated the impact of exposure to message frames communicating the importance of non-stigmatizing language regarding addiction and the effectiveness of medication treatment for opioid use disorder delivered through a visual campaign alone or through a visual campaign in addition to a narrative vignette from the perspective of one of three messengers (a person with opioid use disorder, a clinician, or a health system leader) on attitudes toward people with opioid use disorder and medications for treating opioid use disorder among a national sample of health professionals.

• Study Type: Interventional
• Enrollment (Actual): 1842
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Maryland
    • Baltimore, Maryland, United States, 21205
      • Johns Hopkins Bloomberg School of Public Health

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• employed as health professional in the United States, including clinicians (e.g., physicians, nurses, physician assistants, pharmacists, and optometrists), technicians and technologists (e.g., laboratory technologist or technician, emergency medical technician, paramedic, licensed practical or licensed vocational nurse, medical records or health information technician, etc.), health aids and assistants (e.g., nursing aide, home health aide, medical assistant, pharmacy aide, phlebotomist, etc.)
• participant in existing web-based survey panel (IPSOS's KnowledgeNetworks panel and partner opt-in panel)

Exclusion Criteria:

• not employed in health profession
• not able to complete experiment and survey in English

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

9

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
No Intervention: No exposure control group; This group was not exposed to any message frame.
Experimental: Words Matter - Visual Campaign; Participants randomized to this arm were exposed to a visual campaign communicating the importance of use of non-stigmatizing language regarding substance use disorder and opioid use disorder in clinical settings.	Behavioral: Words Matter - Visual Campaign; Visual campaign emphasizing the importance of using non-stigmatizing language related to substance use and opioid use disorder in clinical settings.
Experimental: Words Matter - Visual Campaign & Narrative Vignette (Messenger: Person with Opioid Use Disorder); Participants randomized to this arm were exposed to a visual campaign communicating the importance of use of non-stigmatizing language regarding substance use disorder and opioid use disorder in clinical settings and a narrative vignette told from the perspective of a person with opioid use disorder.	Behavioral: Words Matter - Visual Campaign & Narrative Vignette (Messenger: Person with Opioid Use Disorder) Experimental: Words Matter - Visual Campaign & Narrative Vignette (Messenger: Clinician); Visual campaign emphasizing the importance of using non-stigmatizing language related to substance use and opioid use disorder in clinical settings combined with a narrative vignette told from the perspective of a person with opioid use disorder
Experimental: Words Matter - Visual Campaign & Narrative Vignette (Messenger: Clinician); Participants randomized to this arm were exposed to a visual campaign communicating the importance of use of non-stigmatizing language regarding substance use disorder and opioid use disorder in clinical settings and a narrative vignette told from the perspective of a clinician.	Behavioral: Words Matter - Visual Campaign & Narrative Vignette (Messenger: Clinician); Visual campaign emphasizing the importance of using non-stigmatizing language related to substance use and opioid use disorder in clinical settings combined with a narrative vignette told from the perspective of a clinician working with patients with opioid use disorder
Experimental: Words Matter - Visual Campaign & Narrative Vignette (Messenger: Health System Administrator); Participants randomized to this arm were exposed to a visual campaign communicating the importance of use of non-stigmatizing language regarding substance use disorder and opioid use disorder in clinical settings and a narrative vignette told from the perspective of a health system administrator/leader.	Behavioral: Words Matter - Visual Campaign & Narrative Vignette (Messenger: Health System Administrator); Visual campaign emphasizing the importance of using non-stigmatizing language related to substance use and opioid use disorder in clinical settings combined with a narrative vignette told from the perspective of a health system administrator/leader
Experimental: Medication Treatment Works - Visual Campaign; Participants randomized to this arm were exposed to a visual campaign communicating the effectiveness of medications for treating opioid use disorder in saving lives.	Behavioral: Medication Treatment for Opioid Use Disorder Works - Visual Campaign; Visual campaign emphasizing the effectiveness and value of medications to treat opioid use disorder in saving lives
Experimental: Medication Treatment Works - Visual Campaign & Narrative Vignette (Person with OUD); Participants randomized to this arm were exposed to a visual campaign communicating the effectiveness of medications for treating opioid use disorder in saving lives and a narrative vignette told from the perspective of a person with opioid use disorder.	Behavioral: Medication Treatment for Opioid Use Disorder Works - Visual Campaign & Narrative Vignette (Messenger: Person with Opioid Use Disorder); Visual campaign emphasizing the effectiveness and value of medications to treat opioid use disorder in saving lives combined with a narrative vignette told from the perspective of a person with opioid use disorder
Experimental: Medication Treatment Works - Visual Campaign & Narrative Vignette (Clinician); Participants randomized to this arm were exposed to a visual campaign communicating the effectiveness of medications for treating opioid use disorder in saving lives and a narrative vignette told from the perspective of a clinician.	Behavioral: Medication Treatment for Opioid Use Disorder Works - Visual Campaign & Narrative Vignette (Messenger: Clinician); Visual campaign emphasizing the effectiveness and value of medications to treat opioid use disorder in saving lives combined with a narrative vignette told from the perspective of a clinician who treats people with opioid use disorder
Experimental: Medication Treatment Works - Visual Campaign & Narrative Vignette (Health System Administrator); Participants randomized to this arm were exposed to a visual campaign communicating the effectiveness of medications for treating opioid use disorder in saving lives and a narrative vignette told from the perspective of a health system administrator/leader.	Behavioral: Medication Treatment for Opioid Use Disorder Works - Visual Campaign & Narrative Vignette (Messenger: Health System Administrator); Visual campaign emphasizing the effectiveness and value of medications to treat opioid use disorder in saving lives combined with a narrative vignette told from the perspective of a health system administrator/leader

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Rating of willingness to have person with opioid use disorder marry into their family	Item from the Social Distance Scale that measures one element of stigma (desire for social distance). Measured on 5-point Likert scale with 5 indicating greater unwillingness and 1 indicating greater willingness to have a person with opioid use disorder marry into the family. Measured via survey questionnaire.	Measured immediately post-exposure to message frame intervention
Rating of willingness to have person with opioid use disorder as a neighbor	Item from the Social Distance Scale that measures one element of stigma (desire for social distance). Measured on 5-point Likert scale with 5 indicating greater unwillingness and 1 indicating greater willingness to have a person with opioid use disorder as a neighbor. Measured via survey questionnaire.	Measured immediately post-exposure to message frame intervention
Rating of agreement that opioid use disorder is a medical condition	Rating of agreement with statement "Opioid use disorder is a chronic medical condition like diabetes mellitus" on 5-point Likert scale with 5 indicating strong disagreement and 1 indicating strong agreement. Measured via survey questionnaire.	Measured immediately post-exposure to message frame intervention
Rating of agreement that individuals with opioid use disorder are to blame	Rating of agreement with statement "Individuals with opioid use disorder only have themselves to blame for their problem" on 5-point Likert scale with 5 indicating strong disagreement and 1 indicating strong agreement. Measured via survey questionnaire.	Measured immediately post-exposure to message frame intervention
Rating of support for increasing government spending on opioid use disorder treatment	Rating of support for increasing government spending on treatment of opioid use disorder with 5 indicating strongly favoring and 1 indicating strongly opposing. Measured via survey questionnaire.	Measured immediately post-exposure to message frame intervention
Feeling thermometer measure of warmth toward people with opioid use disorder	Rating of warmth felt toward people with opioid use disorder with 0 indicating extremely cold and 100 indicating extremely warm. Measured via survey questionnaire.	Measured immediately post-exposure to message frame intervention

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Stigmatizing Language - Addict	Rating of agreement that term "addict" appropriate in a clinical care setting with 1 indicating strongly agree (that term is appropriate) and 5 indicating strongly disagree (that term is appropriate). Measured via survey questionnaire.	Measured immediately post-exposure to message frame intervention
Stigmatizing Language - Substance abuse	Rating of agreement that term "substance abuse" appropriate in a clinical care setting with 1 indicating strongly agree (that term is appropriate) and 5 indicating strongly disagree (that term is appropriate). Measured via survey questionnaire.	Measured immediately post-exposure to message frame intervention
Stigmatizing Language - dirty	Rating of agreement that term "'dirty' in reference to the result from a drug test" appropriate in a clinical care setting with 1 indicating strongly agree (that term is appropriate) and 5 indicating strongly disagree (that term is appropriate). Measured via survey questionnaire.	Measured immediately post-exposure to message frame intervention
Stigmatizing Language - clean	Rating of agreement that term "'clean' in reference to the result from a drug test" appropriate in a clinical care setting with 1 indicating strongly agree (that term is appropriate) and 5 indicating strongly disagree (that term is appropriate). Measured via survey questionnaire.	Measured immediately post-exposure to message frame intervention
Stigmatizing Language - addicted baby	Rating of agreement that term "addicted baby" appropriate in a clinical care setting with 1 indicating strongly agree (that term is appropriate) and 5 indicating strongly disagree (that term is appropriate). Measured via survey questionnaire.	Measured immediately post-exposure to message frame intervention
Stigmatizing Language - person with substance use disorder	Rating of agreement that term "person with substance use disorder" appropriate in a clinical care setting with 1 indicating strongly agree (that term is appropriate) and 5 indicating strongly disagree (that term is appropriate). Measured via survey questionnaire.	Measured immediately post-exposure to message frame intervention
Stigmatizing Language - substance use	Rating of agreement that term "substance use" appropriate in a clinical care setting with 1 indicating strongly agree (that term is appropriate) and 5 indicating strongly disagree (that term is appropriate). Measured via survey questionnaire.	Measured immediately post-exposure to message frame intervention
Stigmatizing Language - negative test result	Rating of agreement that term "negative test result" appropriate in a clinical care setting with 1 indicating strongly agree (that term is appropriate) and 5 indicating strongly disagree (that term is appropriate). Measured via survey questionnaire.	Measured immediately post-exposure to message frame intervention
Stigmatizing Language - positive test result	Rating of agreement that term "positive test result" appropriate in a clinical care setting with 1 indicating strongly agree (that term is appropriate) and 5 indicating strongly disagree (that term is appropriate). Measured via survey questionnaire.	Measured immediately post-exposure to message frame intervention
Stigmatizing Language - baby born with neonatal opioid withdrawal syndrome	Rating of agreement that term "baby born with neonatal opioid withdrawal syndrome" appropriate in a clinical care setting with 1 indicating strongly agree (that term is appropriate) and 5 indicating strongly disagree (that term is appropriate). Measured via survey questionnaire.	Measured immediately post-exposure to message frame intervention
Willingness to sign pledge committing to using non-stigmatizing language	Binary (yes/no) measure of whether participant is willing to sign a pledge committing to using non-stigmatizing language related to substance use disorder in clinical settings. Measured via survey questionnaire.	Measured immediately post-exposure to message frame intervention
Perception of opioid use disorder treatment effectiveness	Participant perception of whether there is a treatment for opioid use disorder that is effective for a long period of time (three close-ended response options: yes, there is a treatment; no, there isn't such a treatment; don't know). Measured via survey questionnaire.	Measured immediately post-exposure to message frame intervention
Rating of willingness to have person taking medication marry into their family	Rating of willingness to have person taking medication to treat opioid use disorder marry into family. Item from the Social Distance Scale that measures one element of stigma (desire for social distance). Measured on 5-point Likert scale with 5 indicating greater unwillingness and 1 indicating greater willingness to have a person taking medication to treat opioid use disorder marry into the family. Measured via survey questionnaire.	Measured immediately post-exposure to message frame intervention
Rating of willingness to have person taking medication marry as a neighbor	Rating of willingness to have person taking medication to treat opioid use disorder as a neighbor. Item from the Social Distance Scale that measures one element of stigma (desire for social distance). Measured on 5-point Likert scale with 5 indicating greater unwillingness and 1 indicating greater willingness to have a person taking medication to treat opioid use disorder as a neighbor. Measured via survey questionnaire.	Measured immediately post-exposure to message frame intervention
Rating of strength/weakness of person taking medication	Rating of strength/weakness of person taking medication to treat opioid use disorder on 5-point Likert scale with 5 indicating strong and 1 indicating weak. This is a semantic differential measure. Measured via survey questionnaire.	Measured immediately post-exposure to message frame intervention
Rating of agreement that recovery is possible	Rating of agreement with statement "Most people with opioid use disorder will, with medication treatment, get well and return to productive lives" on a 5-point Likert scale with 5 indicating strongly disagree and 1 indicating strongly agree. Measured via survey questionnaire.	Measured immediately post-exposure to message frame intervention
Feeling thermometer measure of warmth toward people taking medication	Rating of warmth felt toward people taking medication to treat opioid use disorder with 0 indicating extremely cold and 100 indicating extremely warm. Measured via survey questionnaire.	Measured immediately post-exposure to message frame intervention

Collaborators and Investigators

• Sponsor: Johns Hopkins Bloomberg School of Public Health
• Investigators: Principal Investigator: Alene Kennedy-Hendricks, PhD, Johns Hopkins Bloomberg School of Public Health

Publications and helpful links

General Publications

• Kennedy-Hendricks A, McGinty EE, Summers A, Krenn S, Fingerhood MI, Barry CL. Effect of Exposure to Visual Campaigns and Narrative Vignettes on Addiction Stigma Among Health Care Professionals: A Randomized Clinical Trial. JAMA Netw Open. 2022 Feb 1;5(2):e2146971. doi: 10.1001/jamanetworkopen.2021.46971.

Study record dates

Study Major Dates

• Study Start (Actual): November 13, 2020
• Primary Completion (Actual): November 30, 2020
• Study Completion (Actual): November 30, 2020

Study Registration Dates

• First Submitted: October 28, 2021
• First Submitted That Met QC Criteria: November 8, 2021
• First Posted (Actual): November 19, 2021

Study Record Updates

• Last Update Posted (Actual): November 19, 2021
• Last Update Submitted That Met QC Criteria: November 8, 2021
• Last Verified: November 1, 2021

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Mental Disorders; Chemically-Induced Disorders; Pathologic Processes; Narcotic-Related Disorders; Substance-Related Disorders; Disease; Opioid-Related Disorders; Physiological Effects of Drugs; Central Nervous System Depressants; Peripheral Nervous System Agents; Analgesics; Sensory System Agents; Narcotics; Analgesics, Opioid
• Other Study ID Numbers: IRB14743

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No