Portrayals of alcohol use disorder treatment outcomes and their effects on stigma: Population-based, randomized survey experiment in rural Uganda.

Abstract

We assessed the extent to which portrayals of AUD treatment effectiveness influenced multiple domains of stigma. This cross-sectional, whole-population survey experiment was conducted with 1363 adults living in eight villages of southwestern Uganda in 2021-2022. Participants were randomly assigned to receive a vignette describing a typical man (control) or one of six vignette variants describing a man with untreated AUD, treated AUD, or other variations of treated or untreated AUD with differing outcomes. personal willingness to have the man marry into their family, belief that he is receiving divine punishment, and belief that he brings shame on his family. Participants also reported their perceptions about whether most people in their villages would hold those stigmatizing attitudes (i.e., perceived norms). We fitted multivariable Poisson regression models to estimate the effect of vignette assignment on personal beliefs and perceived norms. Participants reported more stigmatizing personal beliefs across all AUD vignettes compared to control. Average marginal effects (AME) of assignment on the excess probability of stigmatizing personal beliefs ranged from 0.57 (95 % Confidence Interval CI=0.43-0.71) to 0.74 (CI=0.58-0.90) for unwillingness to have the man marry into their family, 0.66 (CI=0.53-0.80) to 0.81 (CI=0.67-0.95) for believing the man brings shame upon his family, and 0.29 (CI=0.20-0.38) to 0.36 (CI=0.27-0.46) for believing the man is receiving divine punishment. AMEs of vignette assignment on perceived norms were similar. Stigma toward men with AUD in rural Uganda was high regardless of AUD treatment effectiveness. Culturally-tailored stigma reduction interventions are needed.