Social Norms Theory-Based Interventions Can Improve Health Care Workers Attitudes Toward Patients With HIV, People Who Inject Drugs

Online interventions based on the social norms theory can reduce the number of health care workers who express stigma toward people living with HIV (PLHIV) and people who inject drugs (PWID), according to the results of a recent study published in Drug and Alcohol Dependence. Social norms appear to be a powerful tool that can influence both attitude and behavior.¹

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“The effect of changes in perceptions of colleagues’ agreement was stronger than changes in personal attitudes,” the study authors wrote in the article. “These findings highlight the power of social norms in influencing individual behavior, even more significantly than personally held attitudes.”

Ultimately, investigators observed that changing personal attitude or changing perception about a colleagues’ attitude toward PLHIV or PWID were each independently associated with how a health care worker wanted to behave. PLHIV and PWID are faced with stigma by health care workers.

In a 2022 national sample, 37% of a PLHIV reported stigma or discrimination within the past year. In a 2021 national sample, approximately 80% of PWID reported an occurrence of stigma or discrimination.

Investigators recently conducted a study to evaluate the efficacy of an online intervention informed by social norm theory at reducing stigma and stigmatizing behavior toward PLHIV and PWID and improving the behavior intentions of health care workers.

Social norms theory suggests that a person’s behavior can be influenced by how they perceive a behavioral norm.

“Social norms interventions attempt to modify perceptions of what behavior is normative as a means of influencing actual behavior,” wrote Mark B. Johnson, PhD, who separately studied social norms theory.²

The current study recruited people aged 18 years and older who work in a health care setting in Australia to watch short videos informed by the social norms theory. The intervention would address why participants may think their colleagues have a negative view about this patient population; how misperceptions about colleague behaviors may influence their own professional behavior and quality of care; and ultimately challenges health care workers’ assumptions about their colleagues.¹

The videos challenged how a participant thought their colleague held more negative views toward PLHIV and PWID. In fact, the literature illuminated that colleagues’ views were actually more comparable to the participant’s own point of view, which highlights the influence of social norms on how people act.

The data also suggest an association between a health care worker seeing stigmatizing behavior and then behaving in a similar stigmatizing fashion. However, improving an individual’s perception of their colleague’s attitude toward PLHIV was associated with reduced stigma, and improving one’s personal attitude toward both patient populations made the person more likely to recognize and disagree with stigmatizing behavior.

The study contains some limitations, the first of which being that health care workers completed a survey, and only those who were signed up with a specific research panel could join. Most participants were female, behavioral intentions were only measured with a single tool, and no follow-up surveys were conducted.

Investigators said more research should be done to address the unintended consequences of these interventions, such as increased stigma, the pervasiveness of more subtle forms of stigma, and research that evaluates the systemic and structural factors that perpetuate stigmatization in the health care setting.

The study authors wrote, “there is an opportunity to build on online social norms-based interventions to continually challenge stigmatizing behaviors in healthcare and to raise health workers’ awareness of more subtle forms of stigma and discrimination in health settings.”

References

1. Broady T, Brener L, Horwitz R, Cama E, Treloar C. Reducing stigma towards people living with HIV and people who inject drugs using social norms theory: An online study with Australian health care workers. Drug and Alc Dep. 2023 Vol 249. doi: 10.1016/j.drugalcdep.2023.109953
2. Johnson M. Experimental Test of Social Norms Theory in a Real-World Drinking Environment. J Stud Alcohol Drugs. 2012 Sep; 73(5): 851–859. doi: 10.15288/jsad.2012.73.851.