Research report: A qualitative study of client and healthcare provider perspectives on the role of stigma in self-directed discharge for people who inject drugs with injecting-related infections

The research, published in BMC Health Services Research, interviewed both patients and clinicians at a major tertiary hospital in Sydney to understand why self-directed discharge is so common in this group, and it found a striking gap between what patients and their doctors believe is going on. The study used semi-structured, one-on-one interviews with five patients who inject drugs and eight clinicians who routinely care for them. Patients were recruited through a review of admission records and referrals from clinicians, while clinician participants were identified through consultation with relevant service managers.

That analysis produced six themes, split evenly between interpersonal and structural stigma. The interpersonal themes concerned perceptions of drug seeking, pain management, and general care experiences. The structural themes were described as double standards, hospital culture, and access constrained by stigma.

Patients in the study mainly attributed their decisions to leave against medical advice to unmet medical and psychosocial needs that they linked directly to stigma. Incomplete treatment for injecting-related infections carries the risk of subsequent avoidable harms, which is what makes these departures a clinical concern rather than a mere inconvenience. The clinicians interviewed for the study told a different story.

They primarily felt that the desire to use drugs and external social factors drove patients to discharge themselves. The authors conclude that the findings support further stigma reduction education for clinicians and action at an institutional level on drug-related stigma. Such measures, they suggest, may improve patient experiences and potentially reduce rates of self-directed discharge.

The study is careful to frame this as a potential benefit rather than a demonstrated outcome, since a qualitative interview study of this size can characterise experiences and generate hypotheses but cannot on its own show that interventions will work. That caveat matters when weighing the results. With thirteen participants drawn from a single urban Australian hospital, the study offers depth rather than breadth, and its findings describe perspectives in one setting rather than prevalence across the health system.

The published version is also an early-release, peer-reviewed accepted manuscript that is subject to further edits before the final version of record appears. Nonetheless, the direction of the evidence is consistent with the study's stated background: stigma experienced in hospital increases the risk of self-directed discharge, incomplete treatment, and subsequent avoidable harms. What the research adds is a paired perspective.

By interviewing patients and clinicians about the same phenomenon and comparing their accounts, the study shows that the two groups locate the causes of self-directed discharge in different places: patients in the care they receive, clinicians in forces outside the hospital.

Subject of Research: The role of stigma in self-directed discharge among people who inject drugs with injecting-related infections

Article Title: A qualitative study of client and healthcare provider perspectives on the role of stigma in self-directed discharge for people who inject drugs with injecting-related infections

Article References: Acheson, L. S., Brener, L., Siefried, K. J., Steele, M., Zhou, C., Matthews, G. V., Ezard, N., & Clifford, B. (2026). A qualitative study of client and healthcare provider perspectives on the role of stigma in self-directed discharge for people who inject drugs with injecting-related infections. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15478-y

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15478-y

Keywords: stigma, self-directed discharge, people who inject drugs, injecting-related infections, qualitative research, hospital care, health services research, pain management, structural stigma, clinician education, Australia, qualitative