Manejo do estigma de profissionais de serviços de saúde em relação às pessoas que usam drogas: desenvolvimento de uma intervenção

Abstract

Stigma towards people who use drugs is a phenomenon that negatively affects health outcomes. Although well-documented, it is worrisome that stigma has also become widely reported among health care professionals. Thus, the primary aim of this thesis was to design an intervention to manage the stigma of health service professionals towards people who use drugs. The designing process resulted in three studies: (1) first, a theoretical-conceptual narrative review presented the main definitions in the field of stigma and the negative consequences in the context of drug use and other health care. This studyhighlights how the adoption of moralizing perspectives drives people who use drugs away from treatments and points to the need for investments in evidence-based strategies; (2) second, a systematic literature review based on the PRISMA protocol identified and evaluated studies that carried out interventions to reduce stigma towards people who use drugs. Results revealed the diversity between studies and their methodological limitations without strong enough evidence to infer their effectiveness. This study emphasizes the necessity to test approaches different from those traditionally adopted; and (3) third, a comprehensive description of the intervention designing process that resulted in the “opening the black box” of the proposed active components and the protocol presentation based on the TIDieR guide. Experts’ preliminary evaluation showed that many of the proposed activities covered the active components in ahighly accurate and appropriate manner to the target population. We suggest that future research should investigate the effectiveness of the intervention protocol in health services. We hope this thesis can serve to strengthen public policies on drugs based on human rights and to improve the quality of care provided to people who use drugs in health services.