Module 6: Opioid Use Education – Topic E Challenge and eliminate stereotypes and harmful attitudes based in gender, sexual orientation, ability, race, culture, income, immigration, age, and stigma in health professions in education materials about opioid use.

Learning Objectives

By the end of this topic, the student should be able to:

• Describe the phenomenon of stereotyping, implicit bias and negative attitudes among health and social service providers and the public regarding opioid use and opioid use disorders (OUD).
• Discuss the impact of stereotyping and bias on people receiving services related to opioid use and OUD.
• List strategies for challenging explicit and implicit stereotypes.
• Describe methods for eliminating stereotypes and biases in educational materials about opioid use.

Key Concepts

• Health and social service providers hold the same level of harmful attitudes as the general public do about opioids and the people who use them.
• Implicit bias and negative stereotyping are complex phenomena.
• Negative stereotypes, biases, and stigma based in a variety of human characteristics have significantly negative influences on the quality of health care and the likelihood that an individual will seek care.
• Some strategies have been shown to increase awareness of harmful attitudes and change those attitudes.
• Educational materials regarding opioid use and opioid use disorder (OUD) can be used to correct misinformation and reduce stigma.
• Persons from diverse groups in society can experience pain, may need to use opioids, and may experience OUD. They may suffer stereotyping or be the target of biases, stigma, or harmful attitudes because of their personal characteristics or because of opioid use alone.
• Stigma, stereotyping, and implicit/explicit biases have a significantly negative impact on access to and the quality of health care, health-seeking behaviours, and health care outcomes.
• Health and social service providers can influence clients’ experience of health care and the health care environment by increasing their self-awareness, creating safe health care environments, and ensuring that educational materials related to opioids and OUD are medically accurate, avoid slang and negative language, and promote evidence-based information.

Health and Social Service Providers Attitudes and Biases

People seeking health care report experiencing stereotyping, negative attitudes, and biases by staff and clinicians. Those using opioids, especially those who are seen as being dependent, can be unfairly characterized as:

• criminals,
• poor employees,
• lacking morality and exhibiting willfully malicious behaviour, and
• to blame for the pain or dependence they are experiencing.

Psychological mechanisms and the characteristics of the relationship between client and provider can lead to unintentional, unconscious, and unrecognized biases in decisions about treating pain.

The Impact of Stereotyping and Harmful Attitudes

• In studies of racial biases in education, stereotyping has been shown to impair intellectual function and influence school performance.
• Stereotype threat theory has shown that stereotyping has a negative effect on interpersonal interactions and can lead to avoidance, impaired communication, and poor adherence for the person who perceives they fit a negative stereotype.

Stereotypes or biases held by health and social service providers can negatively affect the diagnosis, treatment, and quality of care. For example, there may be increased errors and reduced client safety.

Perceived stereotypes or negative attitudes can undermine health-seeking behaviour for those who feel stigmatized.

Strategies for Increasing Awareness of and Changing Harmful Attitudes

Health and social service providers should create safe and non-threatening care environments that promote consistent and standardized approaches to care and service exemplified by:

• friendliness,
• warmth,
• compassion, and
• courtesy.

Efforts by health and social service providers to reduce or overcome biases should be encouraged.

• Education on the harmful effects of stereotyping, stigma, and biases should be provided for health and social service providers and the public.
• Efforts should be made to promote the presence of diverse role models in printed materials, hiring practices, and mission statements.
• There should be processes in place to address the anxiety and fear of those persons who may feel or expect to feel stigmatized, racialized, and discriminated against.

Health and social service providers can address written and educational materials related to opioid use or opioid use disorder by:

• correcting misinformation
• using medically correct terminology and accurate definitions, and avoiding slang
• describing best practices and using an evidence-based approach when discussing risks
• promoting evidence-based education regarding the science of addiction
• Removing stigmatizing or harmful language; for example, the terms substance abuse and substance abuser are no longer used because of the negative connection with physical abuse, emotional abuse, and sexual abuse

Systemic racism and addiction: How are they connected?

“I had always felt an underlying tone of dismissal when accessing the healthcare system. I felt belittled, degraded, and misunderstood enough times to almost convince me that I was not ‘good enough’ to access it. As a result, because I felt this treatment was racially motivated, I was unable to find a practitioner whom I could trust for medical help.”

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Questions

Implicit biases among health and social service providers are the result of which of the following?

a. Lived experience

b. Personal characteristics

c. Client characteristics

d. All of the above

Correct! Implicit biases are a complex phenomenon experienced by all people.e

Incorrect. The correct answer is d. Implicit biases are a complex phenomenon experienced by all people.

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True or false: Only members of certain groups in society experience negative bias.

a. True

b. False

Correct! Many people face stereotypes and negative biases depending on the context of their experience.

Incorrect. The correct answer is b. Many people face stereotypes and negative biases depending on the context of their experience.

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Stereotyping and negative biases in health care can have which of the following impacts?

a. Poor adherence

b. Lower quality care

c. Higher risks of errors

d. All of the above

Correct! Stereotyping and negative biases have been shown to have a broad, significant, negative impact on health care provision.

Incorrect. The correct answer is d. Stereotyping and negative biases have been shown to have a broad, significant, negative impact on health care provision.

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Which of the following is a recommended strategy for challenging and eliminating stereotypes and harmful attitudes in educational materials regarding opioid use and OUD?

a. Using street language and slang in brochures

b. Describing the type of people who might be using opioids

c. Correcting misinformation about opioid use

d. Describing risk factors for opioid use

Correct! Correcting misinformation is an important function of educational materials. There are no typical opioid users, and the risk for opioid use is individual and usually associated with pain. Using slang can perpetuate stereotypes.

Incorrect. The correct answer is c. Correcting misinformation is an important function of educational materials. There are no typical opioid users, and the risk for opioid use is individual and usually associated with pain. Using slang can perpetuate stereotypes.

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References