Strategic Messaging That Combines Visuals and Text Shown to Reduce Stigma Toward Opioid Use Disorder Among Healthcare Professionals

A new study led by researchers at the Johns Hopkins Bloomberg School of Public Health suggests that using a combination of visual materials and written narratives to convey anti-stigma messages about opioid use disorder was associated with lower levels of stigma among health care professionals in the U.S.

The findings, published online on February 4 in JAMA Network Open.

For their analysis, the researchers evaluated the effectiveness of two message frames. One communicated the importance of using non-stigmatizing language—such as “person with substance use disorder” instead of “addict.” The second emphasized the effectiveness of FDA-approved medications, such as buprenorphine and methadone, to treat opioid use disorder. The researchers tested the effects of these messages communicated through visuals alone or visuals combined with a written narrative from the perspective of one of three different messengers: a patient with opioid use disorder, a clinician, and a health care administrator.

The researchers found that both message frames were associated with decreased feelings of wanting to be socially distant from people with opioid use disorder when communicated through a visual and a written narrative from a patient with opioid use disorder. This combination was also associated with a higher warmth rating towards people with opioid use disorder.

“The findings suggest that visuals alone may not be enough in a communication campaign aiming to reduce stigma toward people with opioid use disorder,” says Alene Kennedy-Hendricks, PhD, assistant professor in the Department of Health Policy and Management and deputy director of the Center for Mental Health and Addiction Policy at the Bloomberg School. “Featuring the voices of patients with opioid use disorder communicating about the importance of non-stigmatizing language and effective treatment may be a more effective strategy.”

Stigma is one of the most significant barriers to the overdose crisis in the U.S. Among healthcare providers, stigma is associated with less interest in working with patients with substance use disorder and treating patients with opioid use disorder with highly effective, FDA-approved medications. Stigma is also associated with lower support for policies and system-level changes to improve access to effective treatment and overdose prevention services.

The messages evaluated in the study were developed by experts in the Johns Hopkins Center for Mental Health and Addiction Policy in the Department of Health Policy and Management and the Johns Hopkins Center for Communication Programs at the Bloomberg School. Stigma researchers, clinicians, peer recovery specialists, community substance use treatment providers, and individuals with lived experiences participated in the strategic process to generate messages used in the campaign.

Using a web-based, national sample of U.S. health care professionals, the researchers analyzed survey responses from 1,842 study participants from November 13-30, 2020. Study participants were randomly selected into nine groups with approximately 200 participants in each group. Eight of the study groups were exposed to one of the two message frames through just a visual or a visual combined with a written narrative from the perspective of one of three messengers. The last group was not exposed to any message.

The researchers measured survey responses using 5-point Likert scales. The survey questions included perceptions of individual blame for opioid use disorder, view of opioid use disorder as a medical condition, desire for social distance from people with opioid use disorder, and feelings of warmth. The researchers also measured perceived acceptability of stigmatizing language in health care settings and attitudes about medication treatment for opioid use disorder.

The participants who were exposed to only visual messages did not have any lower levels of stigma relative to the control group. However, participants exposed to visual-only messages about non-stigmatizing language did report higher levels of recognition of the inappropriateness of stigmatizing language in health care settings.

Exposure to messages about the importance of using non-stigmatizing language and the value of medication treatment for opioid use disorder when communicated by a visual combined with a written narrative from the perspective of a health care administrator was also associated with a higher warmth rating toward people with opioid use disorder. Participants exposed to the visual combined with a written narrative from the perspective of a clinician did not have any difference in levels of stigma relative to the control group.

“The stigma campaign that rolled out at Johns Hopkins Health System, the key elements of which we evaluated in this study, is part of a broader effort to reduce overdose mortality in Baltimore,” says Kennedy-Hendricks. “Stigma reduction is an important component of this work. Creating stigma-free environments where people with opioid use disorder feel welcome also aligns with the broader goal of setting a standard of excellence in the health system.”

Read more about the findings, reducing stigma, and more information about the “Words Matter” pledge in the Johns Hopkins Health System.