A scoping review of mass media interventions intended to reduce stigma towards people who use drugs

Background

People who use drugs face high levels of stigma, which exacerbates shame, prohibits disclosure, reduces access to health and social services, and likely influences policy. Mass media interventions provide a potential avenue to reduce stigma; however, there is a lack of consensus on appropriate content. We conducted a scoping review aiming to understand the characteristics and content of existing interventions, and how authors conceptualised and measured stigma. 

Methods

We systematically searched Medline, Embase, APA PsycINFO, CINAHL, ERIC, IBSS and Web of Science for: (i) people who use drugs, (ii) stigma, (iii) mass media. Title, abstract and full text screening were performed by two authors for 25% of the records. Further articles were identified through forward and backward citation searching. Data were charted in reference to intervention: (i) authors; (ii) subjects and intended recipients; (iii) characteristics; (iv) content; (v) conceptualisation and measurement of stigma. Findings were narratively synthesised, aided by descriptive statistics and simple qualitative content analyses.

Results

60 reports were included (from 14,256 records) pertaining to 44 interventions. People who use(d) drugs contributed to 25/44 interventions with variable levels of involvement (sometimes limited to people identifying as in recovery). 38/44 interventions were developed by teams with members from health backgrounds. 32/44 interventions were developed with the stated aim of reducing stigma specifically towards people with dependent, heavy, or injecting drug use; the other 12/44 did not specify a level of use. Intended recipients included the general public (19/44) and healthcare professionals (34/44). Interventions ranged from single pieces of media (e.g., a video or pamphlet) to multi-faceted print and digital interventions, including online training programmes. Interventions used various protest (chastising stigmatisers) and education (providing information) approaches; 21 included contact with people who use(d) drugs (few included individuals declaring active use). Many characterised dependence as a ‘disease’ and emphasised the possibility of recovery. Some campaigns characterised people who use drugs in pejorative terms, which may perpetuate negative stereotypes. Most reports did not clearly define stigma. Quantitative studies used >50 instruments related to stigma, assessing various phenomena.

Conclusions

Interventions used markedly different messaging approaches. Many emphasised disease models and the possibility of recovery, whilst there is unclear evidence that these framings reduce stigma. Whilst stigma is a complex construct, used to explain a range of phenomena, it was mostly under-theorised. Numerous instruments were used to measure different ‘domains of stigma’ (e.g., attitudes, blame, fear) mostly without recognition that these measures may not be correlated.