Roughly 15 million rural residents struggle with drug and alcohol abuse, HIV, Hepatitis B and C, other sexually transmitted/infectious diseases, and mental disorders, and rural life has been characterized as having distinct features that create significant barriers to care for these stigmatizing illnesses.  We will study clinical practice domains that are the cornerstone of ethically sound treatment – the therapeutic alliance, confidentiality, informed consent, and treatment compliance.  Three specific aims are offered: (1) to use multi-source qualitative data to develop a new health care instrument and conceptual model with will identify barriers adversely affecting clinicians’ efforts to care for people with stigmatizing illnesses in various settings; (2) to use that quantitative instrument to survey multidisciplinary clinicians and thus to test 3 hypotheses and to test the fit of the initial model; and (3) to identify educational and informational resources that may improve care for stigmatizing illnesses.  Our hypotheses are: (1) clinicians will identify ethical and psychosocial issues that are barriers to optimal care that are greater when caring for more highly stigmatizing illnesses, particularly for those in rural areas; (2) clinicians will report distinct clinical care problem-seeking behaviors that are different when caring for more highly stigmatizing illnesses, particularly in rural areas; and (3) clinicians’ community, practice, professional, and personal characteristics will moderate the effects.


Our 5 year project has 2 phases: (1) a qualitative phase with experts, panels, interviews, and focus groups to identify assessment constructs, and indicators; and (2) a quantitative phase to survey multidisciplinary licensed clinicians about their views, experiences, behaviors, problems, and needs in caring for people with stigmatizing illnesses in rural and non-rural areas of Alaska and New Mexico.  Thus, the project will produce a new survey instrument, extensive qualitative and quantitative data, and a needs assessment, all concerning clinicians’ care of people with stigmatizing illnesses.  This is the initial step of a program that will later study patients and non-licensed caregivers to characterize barriers to optimal clinical care for often neglected disorders that represent immense human suffering and resource utilization in our country. Ultimately, our aim is to improve health care for people suffering from stigmatizing illnesses such as substance abuse, HIV and other sexually transmitted diseases, and mental disorders, especially individuals with such disorders who live in rural areas.


This project is funded by the National Institute on Drug Abuse through a grant awarded to the University of New Mexico Health Sciences Center (UNMHSC).  UNMHSC has contracted with Behavioral Health Research and Services to implement the Alaska portion of the grant.