Establishing Best Practices for Communicating and Opioid Misuse, Abuse, and Overdose in Appalachia

Background:  The Appalachian Region has some of the highest rates of opioid misuse and abuse and associated adverse outcomes, set against a backdrop of additional challenges related to depressed socio-economic conditions and limited access to healthcare.^1,2 There are no published studies or best practices for communicating about opioids in the region and many stakeholders report “throwing messages at the wall and hoping something sticks.” It is suspected that political, economic, social, and cultural factors influence prevention and treatment efforts in Appalachia, including how those living in the region conceptualize and receive health communication.^3-5

Program background: The Appalachian Regional Commission (ARC) and ORAU conducted research in 2015-2017 to explore how opioids are impacting parts of Appalachia differently than the rest of the nation, and to establish communication best practices. Research included 1) Social media scans to explore the demographics, channels, topics, and sentiments associated with conversations about opioids among individuals and organizations in the Region. 2) Twenty-seven expert interviews to learn regional differences in how opioids are impacting communities, lessons learned from previous communication campaigns, and unique geographic, economic, and socio-cultural factors that influence how messages and spokespersons are perceived. Interviews included experts from each state in the Appalachian Region and encompassed many opioid stakeholder groups.  3) Fifteen focus groups with members of the general public and individuals in recovery from five Appalachian communities. Groups assessed knowledge, attitudes, and beliefs about opioids and opinions about prevention and treatment message topics and tactics. 

Evaluation Methods and Results: ORAU researchers used Tracx^©social listening software to scan conversations about prescription opioid drugs and illicit opioids in the Appalachian Region and in two states outside the region. Information on audience demographics, channels, and sentiments was collected and compared. ORAU researchers also analyzed social media conversations to identify key themes and patterns within and across states. Interviews and focus groups were conducted, audio-recorded, and transcribed in the spring of 2017. Categorical content analysis was performed using qualitative analysis software NVivo10, from which key themes and patterns were identified.      

Conclusions:  Differences within the region were noted as it pertains to the primary communication channels used, community perceptions of the risks of prescription opioids, and stigma toward those who experience addiction and overdose. Similarities were observed in terms of the key messages needed to address the opioid crisis in the Region as well as preferences for message framing, design, and spokespeople.  

Implications for research and/or practice:  The large and diverse Appalachian Region, which is 42% rural and encompasses all of West Virginia and parts of 12 other states, is a unique population to consider when crafting and disseminating messages on opioid misuse, abuse, and overdose. Negative experiences with researchers, journalists, and government entities have created sensitivities to some messages and spokespersons. Successful communication initiatives in the Region should consider partnering with faith-based entities, respected local individuals, and community organizations that can appropriately frame opioid messages and speak to both the uplifting and tragic experiences shared by their communities. References: (1) Havens JR, 2008; (2) Keyes KM, 2014; (3) Behringer B, Friedell GH, 2006; (4)Balamurugan A. et al, 2007; (5)Moreland JJ et al, 2013