Overdose Measures Matter

Indicator Profile

Description of experiences of stigmatizing treatment in local healthcare and social service settings, as reported by program clients

Category: Stigma Reduction

Audience: Program Implementer

Data Type: Qualitative

Indicator Overview

Description:

This qualitative indicator collects the experiences of stigmatizing treatment in local healthcare and social service settings, as reported by program clients.

Stigma is a well-documented, complicated issue that can lead to a “continuous cycle of harm” for people who use drugs (PWUD).1

Rationale:

Stigma can have devastating effects on a person’s ability to access help and complete treatment. It can lead to a reduction of helpful programs and policies to aide PWUD.1

Understanding and reducing stigma can improve a client’s participation in programs. This indicator can be used to identify program participation barriers due to stigma and opportunities for program improvements.

This indicator is intended to be tailored to your unique needs and concerns. Consider if your organization would benefit from learning about experiences of stigmatizing treatment more broadly or within specific care and service settings. For example, you may want to:

  • Ask participants about experiences of stigmatizing treatment more broadly, across all local healthcare and social service settings
  • Ask participants about experiences of stigmatizing treatment within specific healthcare and service settings that your organization directly provides or is interested in learning more about

Related Indicators:

To gain a more comprehensive understanding of additional barriers program participants face, consider tracking the description of barriers to initiating or engaging in care and services.

To understand ways in which your organization may be trying to address stigma, consider tracking practices, programs and policies within or supported by your organization to address stigma towards PWUD. If your organization employs peer workers, you may also want to consider tracking efforts to support equitable treatment of peer workers employed by your organization.

Indicator Details

Definitions:

Stigma is a process where people with certain social identities are labeled, stereotyped and devalued, leading to discriminatory behavior and internalized shame.2 Stigma can prevent people from seeking treatment.

Examples of stigmatizing treatment can include:

  • feeling ignored by program staff or providers
  • being treated negatively because of their substance use
  • program staff or providers making critical or insulting comments because of their substance use
  • feeling unwelcome by program staff or providers
  • feeling that program staff and providers are dismissive of their concerns or treat them differently from others
  • program staff and providers using language that is hurtful

Ways to Examine the Data:

  1. Participant demographics (e.g., race, ethnicity, sex, gender, age group, priority population)

  2. Organizations or types of organizations repeatedly mentioned by clients as providing stigmatizing treatment

Consider:

  • Can I (someone) make the organization aware of the stigmatizing treatment?
  • Is education available or could it be provided?

  • Should this organization be avoided when making referrals?

Learn more about collecting demographic data. This type of data collection may require specialized training, skill and financial resources.

Data Sources:

  • People who use drugs, including those served by your program

Data Collection Methods:

  • Program intake survey
  • Point in time (PIT) Surveys
  • Focus groups
  • Interviews

Note: Collection of data may require additional funding and staff support

Application and Considerations

Suggested Use:

  • To identify potential problems or concerns with existing programming
  • To help identify opportunities for program improvement
  • To assess the effectiveness of current programming

Health Access Considerations:

You may want to consider:

  • How would you collect feedback from a diverse group of individuals for this indicator? Consider the different populations represented in your program or community and how engagement might vary across demographics.
  • How does stigma towards people who use drugs influence how people access and initiate care? For example, will clients re-engage following a negative experience?
  • How might other types of stigma and prejudice impact participants’ experiences when accessing or receiving care? For example, prejudice against people of different backgrounds and nationalities?
  • What type of stigma reduction training or policies are being adopted and implemented by health and social service organizations in your community? How are they being implemented? Do they appear to be effective?

Evaluation Considerations:

Limitations:

  • Potential for inaccuracies in self-reported data as participants may have difficulty recalling past events, may be hesitant or unwilling to disclose certain information or provide responses that are deemed socially acceptable but not accurate (i.e., social desirability bias.)
  • If you only collect data from a small group of people served by your program, you may encounter selection bias. Selection bias occurs when individuals or a group selected for a study are different from the broader population. This may mean that the data collected from this small group of people may not reflect the more general experiences of people in your community.

Policy Considerations and Resources:

Additional Resources

Examples:

  • Klusaritz, H., Bilger, A., Paterson, E., Summers, C., Barg, F. K., Cronholm, P. F., ... & Doubeni, C. A. (2023). Impact of stigma on clinician training for opioid use disorder care: a qualitative study in a primary care learning collaborative. The Annals of Family Medicine, 21(Suppl 2), S31-S38.
    https://www.annfammed.org/content/21/Suppl_2/S31.abstract

References:

  1. Judd, H., Yaugher, A.C., O’Shay, S. and Meier, C.L. (2023). Understanding stigma through the lived experiences of people with opioid use disorder. Drug and Alcohol Dependence, (249).
    https://www.sciencedirect.com/science/article/abs/pii/S0376871623011110
  2. Tsai, A. C., Kiang, M. V., Barnett, M. L., Beletsky, L., Keyes, K. M., McGinty, E. E., Smith, L.R., Strathdee, S.A., Wakeman, S.E., & Venkataramani, A. S. (2019). Stigma as a fundamental hindrance to the United States opioid overdose crisis response. PLOS Medicine, 16(11), 1-18.
    https://doi.org/10.1371/journal.pmed.1002969
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