Before Meeting the Prescriber: Novel Validated Survey Assessing Staff Stigma towards SUD

Introduction:

Previous work has demonstrated that there is great stigma towards persons with substance use disorders in both medical and non-medical settings, and this stigma has negative impact on access to treatment and provision of medical care. There is also demonstrated stigma towards medications for opioid use disorder, particularly the opioid agonist therapies methadone and buprenorphine, in both healthcare and non-healthcare settings (including criminal justice and social services).

Current validated surveys in the field, such as the Drug Use and Drug Users’ Problems Perception Survey, use outdated and stigmatizing language rather than currently accepted person-first language. There is a need for an updated validated measure of stigma towards people with substance use disorders and medications for opioid use disorder as more anti-stigma education is implemented in medical and non-medical service settings.

Methods:

First, a draft survey instrument was developed based on literature review of surveys assessing stigma towards substance use disorders, mental illness, and HIV. Several questions were adapted from previously validated items in the Prejudicial Evaluation Scale and General Social Survey. The draft instrument was distributed to a group of content and methods experts with revisions made to improve face and content validity. The revised instrument included questions assessing deservingness towards persons with drug addiction (6 items), stigma towards persons with drug addiction as measured by social distance measures (4 items), attitudes towards disease of opioid addiction (3 items), comfort providing services to people on medications for opioid use disorder (6 items), and attitudes and stigma towards opioid agonist medications (4 items). The survey was distributed to non-prescriber healthcare staff across inpatient and outpatient settings at Johns Hopkins. Recruitment occurred by email over a six month period and surveys were completed anonymously online. Factor analysis (iterated principal factoring with varimax rotation) was utilized for item reduction and identification of subscales. Cronbach’s alpha was then computed to assess internal consistency.

Results:

The survey was distributed to approximately 1450 healthcare staff, with 301 total responses for an approximate response rate of 21%. The median length of time to complete the survey was 5.5 minutes. One item had a positive response rate greater than 94% and was discarded due to low variability. Based on the results of factor analysis, we further discarded items with an item-factor loading < 0.4. The results also suggested the 6 items assessing deservingness towards persons with drug addiction did not perform well as they were designed (low item-factor loadings and low Cronbach’s alpha). Thus, this section is not included in the final set of the instrument. The final set of the instrument has 18 items. Cronbach’s alpha for scales ranged from 0.69-0.85.

Conclusions:

This novel survey demonstrates a concise and valid instrument using updated, person-centered language to assess stigma and attitudes of non-prescriber healthcare staff towards people with substance use disorders and towards medications used to treat opioid use disorder. This survey can be utilized in both healthcare and non-healthcare settings that serve patients with substance use disorders to evaluate stigma and impact of anti-stigma efforts.

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