Knowledge translation of stigma and trust findings from an ... and Research... · harm reduction...
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Background Knowledge translation of stigma and trust findings from an evaluation of harm reduction services in British Columbia, Canada Heather Burgess, 1 Charlene Burmeister 2 , Katie Lacroix 2 , Hugh Lampkin 2 , Brian LeBlanc 2 , Cheri Newman 2 , Alissa M. Greer 1,2 , Erin Gibson 3 , Alex Scott 4 , and Jane A. Buxton 1,2 1. School of Population & Public Health, University of British Columbia, Vancouver BC .2. BC Centre for Disease Control, Vancouver BC, 3. Fraser Health Authority, 4. Vancouver Coastal Health Authority Methods • UBC Peter Wall Ins/tute • PEEP Research Team • Regional Harm Reduc/on Coordinators • CIE Working Group • VANDU volunteers • Jon Vincent Photography • Dr. Keith Ahamad, BCCfE Stigma, drug use, and healthcare Experiences of stigma and discrimination among people who use drugs (PWUD) have been documented as a barrier to accessing health and social services 1 Stigma from healthcare practitioners (HCPs) and service providers (SPs): • deters PWUDs from seeking health and social services • compromises quality of care, and • may result in suboptimal health outcomes The Peer Engagement and Evaluation Project (PEEP) • A participatory, qualitative evaluation of harm reduction services in British Columbia, the evaluation employed a team of peer research assistants (PRAs) • “Peer” refers to people who have lived experience with drug use, and whose experience informs their professional work • 13 focus groups were held across BC between July and September of 2015 • Qualitative analysis of focus group transcripts produced four themes, one being Stigma & Trust Discussion The Process: Developing the learning module Development of Narratives Development of Summary Slides The Product: A four part learning module Objectives Communicate PEEP stigma and trust findings to stakeholders Engage stakeholders in experiential learning Facilitate collaborative efforts to reduce stigma against PWUD Increase awareness of stigma and its inadvertent consequences Stakeholders: • People who use drugs • Health Care Practitioners • Service Providers • Peer Research Assistants • Public Health Leadership Peer engagement: Con-nual collabora-on with PRAs Development of Narra/ves Development of Narrated Photo Series Development of Summary Slides • Synthesis of qualitative data into narratives • Ongoing consultation with PRAs • Consultation with Provincial Harm Reduction Coordinators • Iterative revisions of narratives • Ethics approval • PRA recruitment of volunteers for photos • Photo shoot and editing • Recording of narration and audio editing • Consultation with PRAs, Harm Reduction Coordinators, and an addictions specialist • Synthesis of expert suggestions for facilitating access to services Next Steps • Stigma against PWUD results in discriminatory policies and service provision practices. It poses a barrier to PWUD accessing health, social and harm reduction services • Meaningful involvement of people with lived experience with illicit drug use is key to developing acceptable and effective services • Experiential learning educates service providers about caring for a population by allowing them to directly interact with that population; PWUD have identified experiential learning as necessary for reducing stigma and facilitating access to harm reduction • The PEEP Stigma & Trust Learning Module aims to provide a basis for collaborative engagement of PWUD, service providers, and public health leaders, with the objective of reducing systemic stigma and discrimination against PWUD • Knowledge exchange • Sharing learning module with stakeholders • Engaging participants in experiential learning • Evaluation of module • Development and implementation of evaluation tools 1. Neale J, Tompkins C, Sheard L. Barriers to accessing generic health and social care services: a qualitative study of injecting drug users. Health & Social Care in the Community [Internet]. 2007;16(2):147-154. Available from: http://onlinelibrary.wiley.com.ezproxy.library.ubc.ca/doi/10.1111/j.1365-2524.2007.00739.x/abstract 2. Amlani A, Burmeister C, Newman C, Gibson E, Lampkin H. On engagement – learning from our PEEPS. Lecture presented at: Harrison Regional Convergence; 2016 March 1; Harrison, CA. 3. Rossiter K, Kontos P, Colantonio A, Gilbert J, Gray J, Keightley M. Staging data: theatre as a tool for analysis and knowledge transfer in health research. Social Science & Medicine [Internet]. 2008 January;66(1). Available from: http://www.sciencedirect.com.ezproxy.library.ubc.ca/science/article/pii/S0277953607004157 “So people won’t go because they’re scared to be labeled, right?” – Male referring to hospital services, Northern Health Authority, BC 1. Narrated photo series • A slideshow of photos and a recording of a PRA narrating the photos depicts the experiences of PEEP participants • There are 12 photo series with a variety of professionals and settings 2. Facilitated Dialogue • Participants identify and discuss attitudes and behaviours from the photo series • Participants discuss motivations for, and the potential impacts of, these behaviours 3. Theatre of the Oppressed • Participants reenact the situation shown in the photo series, substituting constructive behaviours for problematic ones • Developed by Augusto Boal of Brazil, Theatre of the Oppressed has been used for both the collection and dissemination of data 3 4. Summary Slides • Show quotations from focus groups on which narratives are based • Suggest positive approaches that participants can consider using to reduce stigma in their workplaces and interactions Jon Vincent Photography Jon Vincent Photography Jon Vincent Photography S/gma & Trust Healthy rela/onships develop over /me Providers need experien/al training Breaches of confiden/ality Mistrust of methadone system Lack of symptom relief Subthemes of stigma and trust findings from PEEP Op/ons & Opportuni/es All service providers have the opportunity to: • Treat patients with dignity and respect • Consider the impact of their interactions on patient well-being Methadone Prescribers have an opportunity to: • Treat patients on a case-by-case basis • Consider the impact of discontinuing methadone treatment or revoking carry privileges on illicit drug use • Address factors contributing to imperfect treatment adherence, and support patients in accessing additional supports • Consider alternative agonist treatments Policy makers have an opportunity to: • Engage methadone providers and patients in incorporating current evidence into practice guidelines • Consider ways to increase access to pharmaceutical and non-pharmaceutical, evidence- based treatment Example summary slide Acknowledgments
Transcript of Knowledge translation of stigma and trust findings from an ... and Research... · harm reduction...
Background
Knowledge translation of stigma and trust findings from an evaluation of harm reduction services in British Columbia, Canada Heather Burgess,1 Charlene Burmeister2, Katie Lacroix2, Hugh Lampkin2, Brian LeBlanc2, Cheri Newman2, Alissa M. Greer1,2, Erin Gibson3, Alex Scott4, and Jane A. Buxton1,2 1. School of Population & Public Health, University of British Columbia, Vancouver BC .2. BC Centre for Disease Control, Vancouver BC, 3. Fraser Health Authority, 4. Vancouver Coastal Health Authority
Methods
• UBCPeterWallIns/tute• PEEPResearchTeam• RegionalHarmReduc/onCoordinators• CIEWorkingGroup
• VANDUvolunteers• JonVincentPhotography• Dr.KeithAhamad,BCCfE
Stigma, drug use, and healthcare Experiences of stigma and discrimination among people who use drugs (PWUD) have been documented as a barrier to accessing health and social services1
Stigma from healthcare practitioners (HCPs) and service providers (SPs):
• deters PWUDs from seeking health and social services
• compromises quality of care, and
• may result in suboptimal health outcomes
The Peer Engagement and Evaluation Project (PEEP) • A participatory, qualitative evaluation of harm reduction services in British
Columbia, the evaluation employed a team of peer research assistants (PRAs)
• “Peer” refers to people who have lived experience with drug use, and whose experience informs their professional work
• 13 focus groups were held across BC between July and September of 2015
• Qualitative analysis of focus group transcripts produced four themes, one being Stigma & Trust
Discussion
The Process: Developing the learning module
Development of Narratives
Development of Summary Slides
The Product: A four part learning module
Objectives
Communicate PEEP stigma and trust findings to stakeholders
Engage stakeholders in experiential learning
Facilitate collaborative efforts to reduce stigma against PWUD
Increase awareness of stigma and its inadvertent consequences
Stakeholders:
• People who use drugs
• Health Care Practitioners
• Service Providers
• Peer Research Assistants
• Public Health Leadership
Peerengagement:Con-nualcollabora-onwithPRAs
DevelopmentofNarra/ves
DevelopmentofNarratedPhotoSeries
DevelopmentofSummarySlides
• Synthesis of qualitative data into narratives
• Ongoing consultation with PRAs
• Consultation with Provincial Harm Reduction Coordinators
• Iterative revisions of narratives
• Ethics approval • PRA recruitment of
volunteers for photos
• Photo shoot and editing
• Recording of narration and audio editing
• Consultation with PRAs, Harm Reduction Coordinators, and an addictions specialist
• Synthesis of expert suggestions for facilitating access to services
Next Steps
• Stigma against PWUD results in discriminatory policies and service provision practices. It poses a barrier to PWUD accessing health, social and harm reduction services
• Meaningful involvement of people with lived experience with illicit drug use is key to developing acceptable and effective services
• Experiential learning educates service providers about caring for a population by allowing them to directly interact with that population; PWUD have identified experiential learning as necessary for reducing stigma and facilitating access to harm reduction
• The PEEP Stigma & Trust Learning Module aims to provide a basis for collaborative engagement of PWUD, service providers, and public health leaders, with the objective of reducing systemic stigma and discrimination against PWUD
• Knowledge exchange
• Sharing learning module with stakeholders
• Engaging participants in experiential learning
• Evaluation of module
• Development and implementation of evaluation tools
1. Neale J, Tompkins C, Sheard L. Barriers to accessing generic health and social care services: a qualitative study of injecting drug users. Health & Social Care in the Community [Internet]. 2007;16(2):147-154. Available from: http://onlinelibrary.wiley.com.ezproxy.library.ubc.ca/doi/10.1111/j.1365-2524.2007.00739.x/abstract 2. Amlani A, Burmeister C, Newman C, Gibson E, Lampkin H. On engagement – learning from our PEEPS. Lecture presented at: Harrison Regional Convergence; 2016 March 1; Harrison, CA. 3. Rossiter K, Kontos P, Colantonio A, Gilbert J, Gray J, Keightley M. Staging data: theatre as a tool for analysis and knowledge transfer in health research. Social Science & Medicine [Internet]. 2008 January;66(1). Available from: http://www.sciencedirect.com.ezproxy.library.ubc.ca/science/article/pii/S0277953607004157
“So people won’t go because they’re scared to be labeled, right?” – Male referring to hospital services, Northern Health Authority, BC
1. Narrated photo series • A slideshow of photos and a recording of a PRA narrating the photos depicts
the experiences of PEEP participants
• There are 12 photo series with a variety of professionals and settings
2. Facilitated Dialogue • Participants identify and discuss attitudes and behaviours from the photo
series
• Participants discuss motivations for, and the potential impacts of, these behaviours
3. Theatre of the Oppressed
• Participants reenact the situation shown in the photo series, substituting constructive behaviours for problematic ones
• Developed by Augusto Boal of Brazil, Theatre of the Oppressed has been used for both the collection and dissemination of data3
4. Summary Slides • Show quotations from focus groups on which narratives are based
• Suggest positive approaches that participants can consider using to reduce stigma in their workplaces and interactions
JonVincentPhotography JonVincentPhotography JonVincentPhotography
S/gma&Trust
Healthyrela/onshipsdevelopover
/me
Providersneed
experien/altraining
Breachesofconfiden/ality
Mistrustofmethadonesystem
Lackofsymptomrelief
Subthemes of stigma and trust findings from PEEP
Op/ons&Opportuni/esAll service providers have the opportunity to: • Treat patients with dignity and respect • Consider the impact of their interactions on patient well-being Methadone Prescribers have an opportunity to: • Treat patients on a case-by-case basis • Consider the impact of discontinuing methadone treatment or revoking carry privileges on
illicit drug use • Address factors contributing to imperfect treatment adherence, and support patients in
accessing additional supports • Consider alternative agonist treatments Policy makers have an opportunity to: • Engage methadone providers and patients in incorporating current evidence into practice
guidelines • Consider ways to increase access to pharmaceutical and non-pharmaceutical, evidence-
based treatment
Example summary slide
Acknowledgments
