Project Holistique: Developing and Pilot Testing an Online Stigma Reduction Education Program to Improve Access to Skin And Soft Tissue Infections Support and Treatment For People Who Inject Drugs

Abstract

Canada has a high prevalence of people who inject drugs (PWID), who often experience stigma when seeking care for skin and soft tissue infections (SSTI) from healthcare workers (HCWs). This health-related stigma impairs access to SSTI support and treatment, leading many PWID to self-treat or delay care, resulting in severe complications and even fatalities. An online stigma reduction education program for HCWs can address this issue by promoting compassionate, non-judgmental care and reducing biases. This dissertation aimed to develop and pilot test an online stigma reduction education program for HCWs working with PWID. A qualitative study was conducted to determine the program's content and format, including interviews with seven PWID and three focus groups with seven HCWs. PWID provided input on the education program's content, highlighting the importance of module topics through personal accounts of encountering judgment and discrimination in healthcare settings, which led to their reluctance to seek available services. HCWs provided input on the content and the format of the education program. Participants contributed to shaping the content and format, informing the development of an online stigma reduction education program hosted on a dedicated website, "Project Holistique”. A pilot study was conducted using a one-group, pre-test-post-test design with 16 HCWs who completed the self-paced program over three weeks. Pre- and post-program surveys assessed changes in attitudinal outcomes, and post-test data evaluated the program's feasibility, focusing on usability, content relevance, applicability, and complexity. Participants rated the program positively, with a median score of seven for usability and content relevance. The content's complexity was deemed appropriate. Analysis of pre- and post-intervention surveys showed significant improvements in attitudes towards PWID, with reductions in social distance and negative views. The findings support the feasibility and effectiveness of the online stigma reduction education program as a tool for reducing stigma among HCWs. This research provides a foundation for further program refinement, large-scale testing, and broader implementation of the developed program. The program aims to equip HCWs with the essential information and skills to treat PWID compassionately, without discrimination and stigma, thereby improving SSTI outcomes for PWID.