Medical provider stigma experienced by people who use drugs (MPS-PWUD): Development and validation of a scale among people who currently inject drugs in New York City. (1st April 2021)

• Record Type: Journal Article
• Authors: Fong, Chunki; Mateu-Gelabert, Pedro; Ciervo, Courtney; Eckhardt, Benjamin; Aponte-Melendez, Yesenia; Kapadia, Shashi; Marks, Kristen
• Is Part Of: Drug and alcohol dependence. Volume 221(2021)
• Publication Date: 2021-04-01
• Subjects: Stigma in medical settings -- People who use drugs -- Stigma scale; Drug abuse -- Periodicals; Alcoholism -- Periodicals; 616.86
• DOI: 10.1016/j.drugalcdep.2021.108589
• Languages: English
• ISSNs: 0376-8716

Abstract

Highlights: We present a validated Medical Provider Stigma Experienced by PWUD scale. We report high levels of drug use stigma in medical settings among PWID. High stigma levels are associated with less open communication with medical providers. PWID with a high level of enacted stigma were less likely to seek HCV treatment. The MPS-PWUD scale could help measure stigma experienced by PWUD in medical settings. Abstract: Background: Stigmatizing attitudes towards people who use drugs (PWUD) impact their access and retention in health care. Current measures of PWUD stigma in medical settings are limited. Therefore, we developed and validated the Medical Provider Stigma Experienced by PWUD (MPS-PWUD) scale. Methods: As part of an ongoing clinical trial, we recruited HCV RNA positive people who inject drugs in New York City. Based on 164 participants, principal component analysis (PCA) was conducted on fifteen stigma items answered on a 5-point Likert scale. We evaluated internal consistency using Cronbach's alpha coefficient and assessed construct validity by comparing stigma levels with willingness to communicate health concerns with medical providers and likelihood to seek HCV treatment. Results: PCA identified a 9-item scale with two components of stigmatization that explained 60.8 % of the total variance and overall high internal consistency (alpha = 0.90). The enacted stigma (alpha = 0.90) consisted of 6 scale items related to the medical providers' stigmatizing actions or perceptions. The internalized stigma component (alpha = 0.84) included 3 scale items related to PWUD's shame or drug use disclosure. As hypothesized, higher levels of either stigma were associated with less likelihood to openly communicate with medical providers (p < 0.005). Participants with a higher level of enacted stigma were less likely to seek HCV treatment (p = 0.011). Conclusions: The validated MPS-PWUD scale could help healthcare providers, harm reduction services and researchers measure stigma experienced by PWUD in medical settings in efforts to minimize the impact of stigma on limiting access to and retention of care for PWUD.