The effect of role play-based education on nursing students’ stigmatizing attitudes, empathy levels, and communication skills toward the care of individuals with substance use disorder
4 affiliations
- 1Department of Nursing, Faculty of Health Sciences, Hakkari University
- 2Department of Nursing, Faculty of Health Sciences, Gaziantep University
- 3Department of Health Care Services, Kırıkhan Vocational School, Hatay Mustafa Kemal University
- 4Logos Psychology Clinic
Abstract
Background: Stigmatizing attitudes toward individuals with substance use disorder (SUD) remain common among healthcare professionals and students and may negatively affect care quality, therapeutic relationships, and treatment access. Nursing students may demonstrate stigma, limited empathy, and insufficient communication skills in SUD care contexts. Active learning approaches such as role play have been suggested to improve affective and communication-related competencies; however, experimental studies simultaneously targeting stigma, empathy, and communication skills in SUD contexts remain limited.
Purpose: This study aimed to examine the effect of role play–based education on nursing students’ stigmatizing attitudes toward individuals with SUD, empathy levels, and communication skills.
Materials and methods: A quasi-experimental pretest–posttest control group design was conducted during the 2025–2026 academic year with 76 nursing students (experimental n = 38; control n = 38) at a faculty of health sciences in Türkiye. The experimental group received a structured four-session role play–based SUD education program, while the control group continued with the standard curriculum. Data were collected using the Toronto Empathy Questionnaire (TEQ), Communication Skills Inventory (CSI), and Attitudes Toward Mental Illness Scale—Substance Related Subscale (ATMI-SRS). Linear mixed models were used as the primary analysis, supported by ANCOVA and mixed ANOVA. The Bonferroni-adjusted significance level was set at α = 0.017.
Results: Significant time × group interactions were found for all outcomes. The experimental group showed greater reductions in stigmatizing attitudes than controls ( β = −5.61, p < 0.001), with a 57% reduction versus 15% in controls. Empathy increased significantly ( β = 11.92, p < 0.001), and communication skills improved significantly ( β = 20.06, p < 0.001). Effects were stronger among students with higher baseline stigma levels.
Conclusion: Role play–based education appears effective in reducing stigma and improving empathy and communication skills toward individuals with SUD among nursing students. Despite quasi-experimental design limitations, findings support integrating structured role play into nursing curricula. Further randomized controlled studies with larger samples and long-term follow-up are recommended.
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BibTeX
@article{bor2026effect,
title = {{The effect of role play-based education on nursing students’ stigmatizing attitudes, empathy levels, and communication skills toward the care of individuals with substance use disorder}},
author = {Neşe Ataman Bor and Soner Berşe and Sümeyye Akçoban and Ezel Avcı},
journal = {Frontiers in Public Health},
year = {2026},
month = oct,
doi = {10.3389/fpubh.2026.1941630},
url = {https://www.frontiersin.org/articles/10.3389/fpubh.2026.1941630/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - The effect of role play-based education on nursing students’ stigmatizing attitudes, empathy levels, and communication skills toward the care of individuals with substance use disorder
AU - Neşe Ataman Bor
AU - Soner Berşe
AU - Sümeyye Akçoban
AU - Ezel Avcı
PY - 2026
DA - 2026/10/19
JO - Frontiers in Public Health
DO - 10.3389/fpubh.2026.1941630
UR - https://www.frontiersin.org/articles/10.3389/fpubh.2026.1941630/full
AB - Background: Stigmatizing attitudes toward individuals with substance use disorder (SUD) remain common among healthcare professionals and students and may negatively affect care quality, therapeutic relationships, and treatment access. Nursing students may demonstrate stigma, limited empathy, and insufficient communication skills in SUD care contexts. Active learning approaches such as role play have been suggested to improve affective and communication-related competencies; however, experimental studies simultaneously targeting stigma, empathy, and communication skills in SUD contexts remain limited. Purpose: This study aimed to examine the effect of role play–based education on nursing students’ stigmatizing attitudes toward individuals with SUD, empathy levels, and communication skills. Materials and methods: A quasi-experimental pretest–posttest control group design was conducted during the 2025–2026 academic year with 76 nursing students (experimental n = 38; control n = 38) at a faculty of health sciences in Türkiye. The experimental group received a structured four-session role play–based SUD education program, while the control group continued with the standard curriculum. Data were collected using the Toronto Empathy Questionnaire (TEQ), Communication Skills Inventory (CSI), and Attitudes Toward Mental Illness Scale—Substance Related Subscale (ATMI-SRS). Linear mixed models were used as the primary analysis, supported by ANCOVA and mixed ANOVA. The Bonferroni-adjusted significance level was set at α = 0.017. Results: Significant time × group interactions were found for all outcomes. The experimental group showed greater reductions in stigmatizing attitudes than controls ( β = −5.61, p < 0.001), with a 57% reduction versus 15% in controls. Empathy increased significantly ( β = 11.92, p < 0.001), and communication skills improved significantly ( β = 20.06, p < 0.001). Effects were stronger among students with higher baseline stigma levels. Conclusion: Role play–based education appears effective in reducing stigma and improving empathy and communication skills toward individuals with SUD among nursing students. Despite quasi-experimental design limitations, findings support integrating structured role play into nursing curricula. Further randomized controlled studies with larger samples and long-term follow-up are recommended.
SN - 2296-2565
ER -