Effect of Web-Based Training in Prevention and Management of Substance Use Disorders (SUDs) on Structural Stigma among Healthcare Workers in Selected Facilities in Nairobi, Machakos and Makueni Counties, Kenya

Abstract

The rise of alcohol, tobacco and substance use in Kenya today necessitates a hands-on and cost-effective approach to reverse this trend. Studies show that primary healthcare workers are best placed to provide necessary screening and treatment of alcohol, tobacco and substance use disorders. Major obstacles to the effectiveness, uptake and patient adherence to these interventions are lack of knowledge about alcohol, tobacco and substance use and negative attitudes and stigma towards sufferers of substance use disorders held by health care workers. An innovative, evidence supported and cost effective solution is to provide Web-based training on substance use disorders and their treatment to primary health professionals. This study sought to evaluate the effect of a web-based training in SUD on health worker knowledge, attitudes, and levels of stigma towards people with alcohol, tobacco and substance use disorders. A prospective before and after design was used. Data was collected using the Opening Minds Scale for Healthcare workers and a KAP Survey, in 11 health facilities located in Nairobi, Machakos and Makueni Counties of Kenya. A total of 102 healthcare workers completed the pre-test, the training intervention and the post-test survey. Paired t-tests showed statistically significantly lowered levels of stigma after the training compared to before the training. The stigma scores reduced on average by2.91 (CI: 0.85 - 4.97, p=0.006), 3.04 (CI: 0.98 - 5.10, p=0.001) and 2.71 (CI: 0.62 - 4.81, p=0.011) for stigma towards people with alcohol, substance and tobacco use disorders, respectively.The reduction seen in the overall stigma levels was related to decrease in social distance and self-stigma and increased social responsibility among the respondents after web-based training. After web-based training, knowledge and skills surrounding substance use disorder screening and case management improved.The study found higher rates of substance use among healthcare workers compared to the general Kenyan population - placing them at moderate to high risk of developing substance use disorders. These findings indicate that web-based training has an overall positive effect on a stigma among healthcare workers. It is a promising approach for not only improving attitudes but also providing knowledge and skills to healthcare providers in a cost-effective manner. It is recommended that the training be rolled out countrywide to combat stigma against people with these disorders. More research should be done on the dimensions of stigma to understand how to target them specifically.